Search

PURPOSEConcurrent chemoradiotherapy followed by adjuvant chemotherapy (CRT-AC) and induction chemotherapy followed by concurrent chemoradiotherapy (IC-CRT) are among the best treatments in nasopharyngeal carcinoma (NPC). This study aimed to develop a model for deciding the sequence of chemotherapy in NPC.METHODSData were separated into two cohorts. The CRT-AC cohort had 295 patients, while the IC-CRT cohort had 112. The predictors were standard factors with BMI and neutrophil-lymphocyte ratio (NLR) to predict overall survival (OS). A flexible parametric survival model was used.RESULTSA total of 132 (44.7%) and 72 patients (64.3%) died in the CRT-AC and IC-CRT cohorts, respectively. The predictors in the final models were age, sex, T, N, NLR, and BMI. The models of OS for CRT-AC and IC-CRT had concordance indices of 0.689 and 0.712, respectively, with good calibration curves. When changing the burden of disease along with NLR and BMI, we found that CRT-AC was not significantly different OS from IC-CRT when low NLR (

Human papillomavirus (HPV) infection detected in oropharyngeal squamous cell carcinoma (OPSCC) is associated with a better survival outcome from previous literature. However, Thailand and several Asian countries have a low prevalence of HPV-associated OPSCC and, therefore, have a low positive rate of immunostaining with p16. Tumor microenvironments (TME), including tumor-infiltrating CD8+ lymphocytes (CD8+ TIL) and programmed death ligand 1 (PD-L1), are proposed as significant prognostic indicators in addition to p16. Objectives: Explore the expression p16, CD8+ TIL, and PD-L1 and its value as prognostic indicators for overall survival (OS) in patients with OPSCC. Materials and Methods: Data from patients with OPSCC diagnosed from 2012 to 2018 were recovered from medical records and national registry. All available glass slides and slides of immunohistochemistry (IHC) of p16, CD8, and PD-L1 were reviewed. The TME was classified into four types according to the expression pattern of PD-L1 and CD8+TIL. Overall survival (OS) was assessed using the Kaplan–Meier method and Cox regression model analysis. Results: In 160 OPSCC patients, p16 was positive in 27 (16.88%). The density of CD8+ TIL was higher in the p16+ and PD-L1+ groups (p = 0.005, 0.039); however, there was no association between p16 and the status of PD-L1. P16 and CD8+ TIL were significant prognostic factors for better OS (p = 0.007, 0.001), but not PD-L1 status (p = 0.317). Among the four types of TME, carcinoma showed mainly type IV TME (PD-L1−/TIL+), while OPSCCs with type I TME (PD-L1+/TIL+) had the best survival outcome. Conclusions: The positivity of p16 and the density of CD8+ TIL were associated with better OS in OPSCC, while the status of PD-L1 was not significantly related to OS. OPSCC with type I TME (PD-L1+/TIL+) showed the best prognosis of all types of TME.

Objective: The current standard of care for locally advanced rectal cancer is associated with multimodality therapy. Neoadjuvant chemoradiation significantly decreased the locoregional recurrence rate and improved survival. However, distant metastasis develops rather than local recurrence, which becomes the leading cause of death. This study aimed to evaluate the oncological outcomes of total neoadjuvant therapy (TNT) in locally advanced rectal cancer. Materials and Methods: This retrospective study recruited 18 patients diagnosed with locally advanced rectal adenocarcinoma (cT3-4 or cN1-2), treated with consolidation TNT. The primary endpoint was pathological complete response (pCR). The secondary endpoint included postoperative outcomes, local recurrences, and distant metastases. Results: The pathologic complete response was observed in 27.8% of consolidation therapy cases. Downstaging of the T-category was achieved in 10 (55.6%) patients, and downstaging of the N-category was achieved in 14 (77.8%) patients. Only one patient who achieved pCR developed distant metastasis, whereas all patients with pathological stage III developed distant metastasis. Conclusions: TNT is a promising approach for patients with locally advanced rectal cancer. This strategy improved complete pathologic response rates in TNT, and pCR was found to be associated with fewer local recurrences and greater disease-free survival.

Objective: Setup verification is the critical part to make sure of the accuracy for Intensity-modulated radiotherapy in nasopharyngeal cancer patients. This pilot study was designed to answer whether and how much the kV-CBCT in addition to 2DkV is more accurate than 2DkV alone in terms of verification parameters. Methods: Images acquisition: Offline images were displayed in the matched position between reference images. 2D and 3D matches: The bony matches were done by using the location of the tumor in the nasopharyngeal and upper neck regions. The distances displaced from the isocenter were recorded in x-y-z directions. Analysis: The distance of the isocenter shift in each direction (X, Y, Z) were presented as point estimations. The alignment between the two methods was assessed with Pearson’s and Spearman’s correlation. The 3 mm difference within 90% is considered as an acceptable range of non-inferiority of 2DkV, compared with CBCT. Results: 11 nasopharyngeal cancer patients were included into this study. The correlation between 2DkV and kV-CBCT were 0.46, 0.11 and 0.16 for Superior-inferior (SI), Anterior-posterior (AP) and Left-right (LR) directions, respectively. The central value for the kV-CBCT; SI, AP and LR directional shift were 0.07, 0.06 and 0.03 cm, respectively, whereas the central value for 2DkV; SI, AP and LR directional shift were 0.05, 0.07 and 0.04 cm. For the difference shift < 3 mm, the results > 90% were within acceptable value: 100% and 96.96% for SI and LR directions whereas the AP direction was 87.87%. Conclusion: Compared with kV-CBCT by using our criteria, 2DkV images are accurate enough for treatment verification in nasopharyngeal cancer patients.

No Abstract

Objective: Malnutrition is the most common problem in head and neck cancer (HNC) patients receiving concurrent chemoradiotherapy. The radiation toxicities cause decreased food intake, with resultant severe weight loss and malnutrition. This study sought to determine whether an active nutrition improvement counseling program before and during concurrent chemoradiotherapy for HNC patients could increase the treatment completion rate without the interruptions caused by the side effects of chemoradiotherapy. Methods: The findings of a prospective study of the effects of an active nutrition improvement program before and during concurrent chemoradiotherapy (study, n = 32) was compared with those of a retrospective chart review of HNC patients who had received definite or postoperative concurrent chemoradiotherapy (control, n = 80). The correlations between nutritional status and the number of treatment completions, number of tube feeding insertions during treatment, RTOG toxicity, nutritional status, and quality of life were obtained. Results: There was no statistically significant difference between the concurrent chemoradiotherapy completion rates of both groups (p = 0.121; 95% CI, 0.226-1.188). The major cause of delayed or discontinued chemotherapy was oral mucositis. No significant differences were found in the tube feeding insertion rates and RTOG toxicities of both groups. However, the data showed a clinically significant difference in the concurrent chemoradiotherapy completion rate for the study group (56%), more than 15 percentage points higher than the control group’s rate (40%). Conclusion: An active nutrition improvement program before and during concurrent chemoradiotherapy is clinically beneficial for HNC patients, providing a higher treatment completion rate than otherwise.

Background. Traditionally, rectal cancer surgery is recommended 6 to 8 weeks after completing neoadjuvant chemoradiation. Extending the waiting time may increase the tumor response rate. However, the perioperative complication rate may increase. The purpose of this study was to determine the association between extending the waiting time of surgery after neoadjuvant chemoradiation and perioperative outcomes. Methods. Sixty patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by radical resection at Siriraj hospital between June 2012 and January 2015 were retrospectively analyzed. Demographic data and perioperative outcomes were compared between the two groups. Results. The two groups were comparable in term of demographic parameters. The mean time interval from neoadjuvant chemoradiation to surgery was 6.4 weeks in Group A and 11.7 weeks in Group B. The perioperative outcomes were not significantly different between Groups A and B. Pathologic examination showed a significantly higher rate of circumferential margin positivity in Group A than in Group B (30% versus 9.3%, resp.; P=0.04). Conclusions. Extending the waiting to >8 weeks from neoadjuvant chemoradiation to surgery did not increase perioperative complications, whereas the rate of circumferential margin positivity decreased.

Objective: This study was designed to find the prevalence of anemia in cancer patients before radiotherapy and the incidence of anemia during radiotherapy treatment. The study also planned to identify factors that affect the incidence and prevalence of anemia and the management of anemia in the Division of Radiation Oncology, Siriraj Hospital. Methods: This study is designed prospectively to collect hemoglobin level and factors that might cause anemia in patients whom were treated with radiotherapy at Siriraj Hospital during April - June 2006. The eligible criteria were patients age >18 years old, had a pathology confirmed to be malignancy, and had never been treated with radiotherapy before. Patients were excluded if they were not treated with radiotherapy, had skin/central nervous system or hematologic malignancies. In this trial, anemia was defined as Hb level