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To investigate the vaginal 11-point and volumetric dose-toxicity relationships in definitive cervical cancer radiotherapy.A retrospective cohort study of patients with cervical cancer with a complete response of at least 12 months was performed. Additional per vaginal examinations and patient-scoring questionnaires on the date of patient enrolment were assessed for vaginal strictures. Retrospective dosimetric analysis of vaginal 11-point and volumetric doses was performed with descriptive and probit analyses to investigate dose-toxicity relationships.Ninety-seven patients were included in the study, with a 20-month median follow-up. The incidence rate of grade 3 vaginal strictures was 22.7%. A comparison between patients with grade 1-3 vaginal strictures revealed significant differences in age, stage, initial tumour size, and vaginal involvement. PIBS + 2, PIBS, PIBS-2, D + 5, and D2cc were all significantly different among grade 1-3 vaginal strictures and showed significant probit coefficients. The lateral dose points were significantly higher in grade 2 strictures, but negative probit coefficients failed to establish causal inferences. Post-estimation analyses yielded effective doses (ED) for 15% and 20% probability of grade 3 vaginal strictures (ED15 and ED20) for PIBS + 2 at 57.4 and 111 GyThis study showed a significant relationship between age, tumour size, and lower-third vaginal involvement with the incidence of vaginal toxicity. The goal of a cumulative radiotherapy dose of ≤ 55 Gy

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 and Purpose: To report the workflow and dose accumulation for bladder preservation for a bladder cancer patient, using magnetic-resonance-guided radiation therapy (MRgRT) and the simultaneous integrated boost (SIB) technique at mid-bladder volume.Materials and Methods: A muscle-invasive bladder cancer patient was treated with MRgRT. The patient was treated with the SIB technique at mid-bladder volume, with 45 Gy to the whole bladder (CTV WB) and 55 Gy to the tumor bed (CTV boost) in 20 fractions. Daily re-optimization with an adapt-to-position (ATP) strategy was utilized for dose adjustment to encompass the bladder within anisotropic planning target volume (PTV WB and PTV boost). Results: The mean daily treatment time was 55 minutes (range, 35–73). The actual whole-bladder and tumor-bed-boost doses were 45.74 ± 5.91 and 54.1 ± 4.62 Gy, respectively. PTV WB encompassing CTV WB was 95.69% ± 5.36%. PTV boost encompassing CTV boost was 97.52% ± 6.05%. The actual rectal and bowel doses were below the reference plan doses.Conclusions: The use of MRgRT with the SIB and ATP strategy proved feasible for bladder cancer treatment. Mid-bladder volume allowed treatment with the SIB technique under MR monitoring.

OBJECTIVES: To demonstrate the usefulness of perfusion computed tomography (PCT) in the detection of local recurrent/residual (LR) tumor in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. MATERIALS AND METHOD: Over three years (from June 2010 to May 2013), 138 post-radiotherapy NPC patients were recruited for this prospective study. Patients were informed and consent was obtained for PCT of the nasopharynx additional to the routine contrast-enhanced CT scan of the nasopharynx. Two years follow-up after perfusion CT was performed, patients were divided into LR and non-LR groups. The perfusion CT parameters of the nasopharynx included, blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS). These parameters were analyzed and compared between the two groups. RESULTS: There are significantly higher PCT parameters including: BF, BV, PS and significantly lower MTT (p 0.75) between two reviewers. CONCLUSIONS: PCT is a useful method to identify local recurrent/residual tumor after radiotherapy in patients with NPC. Keywords: perfNusion CT, nasopharyngeal carcinoma, local recurrence, prospective study DOI: 10.31524/bkkmedj.2019.02.004

Background: Non-squamous cell carcinoma of the head and neck (HNnSCCA) is a rare tumor. Surgery is the standard treatment for resectable non-metastatic patients. Post-operative radiation (RT) is indicated for high-risk patients. No data from the randomized controlled trial utilizing post-operative concurrent chemoradiation (CCRT) is available. This study was aimed to determine the benefit of post-operative CCRT in the patients with resectable non-metastatic HNnSCCA. Methods: We retrospectively reviewed data of 139 patients with HNnSCCA (excluding nasopharyngeal, neuroendocrine, and skin cancers) who underwent surgery and post-operative radiation (RT) at Siriraj Hospital from 2009–2015. Results: Ninety-nine of the 139 patients had RT alone and 40 had CCRT. More patients receiving CCRT had ≥ one high-risk feature (80% CCRT vs. 57.6% RT; p=0.018). Five-year disease-free survival (DFS) and overall survival (OS) did not differ between the groups (58.6% CCRT vs. 68.2% RT; p=0.35 and 81.7% CCRT vs. 81.0% RT; p=0.35, respectively). Interestingly, post-operative CCRT was independently associated with significantly superior DFS (hazard ratio, HR 0.29; 95% confidence interval, CI 0.10 to 0.86; p=0.02) and OS (HR 0.08; 95% CI 0.01 to 0.43; p=0.003) according to multivariable analyses. Conclusion: Post-operative CCRT was associated with better survival in high-risk patients with resectable non-metastatic HNnSCCA comparing with post-operative RT alone. Post-operative CCRT might be considered as a treatment option for these patients.

BACKGROUND Locally advanced rectal cancer is treated using neoadjuvant chemoradiation (nCRT), followed by total mesorectal excision (TME). Tumor regression and pathological post-treatment stage are prognostic for oncological outcomes. There is a significant correlation between markers representing cancer-related inflammation, including high neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte (MLR) and unfavorable oncological outcomes. However, the predictive role of these markers on the effect of chemoradiation is unknown. AIM To evaluate the predictive roles of NLR, MLR, and PLR in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiation. METHODS Patients (n = 111) with locally advanced rectal cancer who underwent nCRT followed by TME at the Minimally Invasive Surgery Unit, Siriraj Hospital between 2012 and 2018 were retrospectively analyzed. The associations between post-treatment pathological stages, neoadjuvant rectal (NAR) score and the pretreatment ratios of markers of inflammation (NLR, MLR, and PLR) were analyzed. RESULTS Clinical stages determined using computed tomography, magnetic resonance imaging, or both were T4 (n = 16), T3 (n = 94), and T2 (n = 1). The NAR scores were categorized as high (score > 16) in 23.4%, intermediate (score 8-16) in 41.4%, and low (score < 8) in 35.2%. The mean values of the NLR, PLR, and MLR correlated with pathological tumor staging (ypT) and the NAR score. The values of NLR, PLR and MLR were higher in patients with advanced pathological stage and high NAR scores, but not statistically significant. CONCLUSION In patients with locally advanced rectal cancer, pretreatment NLR, MLR and PLR are higher in those with advanced pathological stage but the differences are not significantly different.

Introduction/Background Endometrial carcinoma (EC) is the most common gynaecologic malignancy in developed countries. Approximately eighty percent of cases are endometrioid type which usually presents in early stage and suitable for surgical staging. However, pelvic lymph node (PLN) evaluation mostly depends on surgeon preference. The objective of this study is to explore the associated factors and create the predictive model for PLN in endometrioid EC patients. Methodology Medical record of 293 patients with endometrioid EC, who received surgical staging in single University Hospital during 2009–2016, were reviewed. The relationship between PLN metastasis and these data: demographic factors, biochemical markers, preoperative and intraoperative tumor characteristics were analysed by using a logistic regression model. Consequently, a score was created in order to predict the probability of pelvic lymph node metastasis. The internal validation by bootstrapping 400 times was performed. Results From multivariate analysis, associated factors were grade of tumor, platelet count, deep myometrial invasion (deep MI: more than half of myometrial invasion) and size of tumor. Platelet count and size of tumor were re-calculated. Thrombocytosis (platelet count more than or equal to 380,000) and large tumor (tumor size more than or equal to 6 centimetres) were statistically significant for cut-off point. The generated score was: (2 × grade 2) + (4 × grade3) + (4 × deep MI) + (2 × large tumor) + (3 × thrombocytosis). The area under curve (AUC) for this score was 0.824. There were 88.9% sensitivity, 57.5% specificity, 40.5% positive predictive value and 94.1% negative predictive value, using score 4 as a cut-off point. The internal validation by bootstrapping 400 times revealed AuROC from 0.820 to 0.807 (optimism 0.013). Conclusion Grade of tumor, platelet count, deep MI and size of tumor, were associated with PLN metastasis in endometrioid EC. The generated score yield a promising result to predict PLN metastasis. Disclosure Nothing to disclose.

Purpose Titanium ring cap applicator (VariSource) was applied in treating cervical cancer patients by using image-guided brachytherapy (IGBT). However, its sizes appeared to be relatively large for most of our patients. Thus, we have developed a specific applicator “Siriraj Ring Cap,” which is slightly smaller and more suitable for our patients. This study was to evaluate effectiveness of this equipment. Methods and Materials Locally advanced cervical cancer patients were treated with external beam radiation therapy with or without concomitant chemotherapy. Siriraj Ring Cap was applied in all of the patients for at least one fraction. Dosimetric analysis was performed in each fraction of IGBT. Clinical outcomes of these patients were evaluated. Results Twenty-nine patients with 117 dosimetric planning were evaluated between January and December of 2014. Siriraj Ring Cap was fit to all patients in this study. By using this applicator, radiation doses to the targets ( D 90 high-risk clinical target volume and D 90 intermediate-risk clinical target volume) were higher in each fraction. There were no statistically differences of radiation doses to the bladder, rectum, sigmoid colon, and small bowel. Within 2-year followup, 3 patients (10.3%) developed locoregional recurrence. Two-year disease-free survival and overall survival were 75.9% and 89.7%, respectively. According to RTOG/EORTC complication criteria, Grade 1, 2, and 3 gastrointestinal complications were developed in 2 (6.9%), 4 (13.8%), and 1 (3.4%) patients, respectively. For genitourinary complications, 3 patients (10.3%) and 1 patient (3.4%) had Grades 1 and 2, respectively. Conclusions Siriraj Ring Cap is feasible for IGBT in cervical cancer patients with narrow vagina. Dosimetry and clinical outcomes were satisfactory by using our specific applicator.

To determine the proportion of women with undiagnosed cervical carcinoma before simple hysterectomy and its causes and to compare the oncologic outcomes of women diagnosed and treated with standard therapy to those undergoing inadvertent simple hysterectomy with subsequent treatment.Medical records were reviewed for patients with cervical carcinoma who underwent hysterectomy between 1 January 2004 and 31 December 2014. Demographic data, chemotherapeutic agents, and response rates were analyzed using descriptive statistics. The categorical variables were compared using chi-square or Fisher's exact test. The continuous data were compared using the independent t-test and Mann-Whitney test, as appropriate. The Kaplan-Meier method was used to evaluate the survival outcomes.Of the 526 patients with cervical carcinoma who underwent hysterectomy, 57 patients (10.8%) were diagnosed with cervical carcinoma after simple hysterectomy. After excluding 121 patients with invasion of3 mm and without lymphovascular space invasion (LVSI), 353 patients were preoperatively diagnosed with cervical carcinoma stage IA1 with LVSI to IIA and underwent proper surgical treatment. Fifty-two patients were encountered for inadvertent hysterectomy. Forty-four of 52 patients in the inadvertent hysterectomy group consented to subsequent treatment, with 43 patients receiving concurrent chemoradiotherapy and one undergoing additional surgery. The median time before subsequent treatment initiation was 1.6 months [0.5-9.2 months]. The 5-year DFS rates of the standard surgical treatment group and inadvertent hysterectomy group were 88.4% vs. 93.2%, respectively (P = 0.147). The 5-year OS rates of the standard surgical treatment group and the inadvertent hysterectomy group were 98.9% vs. 100%, respectively (P = 0.767).Women with cervical carcinoma who had small tumors and underwent inadvertent simple hysterectomy with appropriate consequent management had oncologic outcomes comparable to those in the standard surgical treatment group.

Background Concurrent chemoradiotherapy (CRT) is the standard treatment for head and neck (HN) cancer patients. Most patients experience malnutrition and weight loss during treatment because of mucositis and difficulty in swallowing. Prevention of malnutrition may allow more patients to complete their treatment. The present study aimed to examine whether prophylactic gastrostomy tube (PGT) could reduce treatment interruption, prevent malnutrition and maintain quality of life, especially in Thai patients who generally do not accept feeding tubes. Methods A prospective study was performed on HN cancer patients undergoing CRT at a tertiary hospital in Thailand (n = 95). Before starting CRT, all patients received nutritional assessment and were counselled about the risks and benefits of PGT. According to patient discretion, they chose to have a PGT (experimental group) or only nutritional counselling with a therapeutic feeding tube if required (control group). During CRT, weight, degree of mucositis, delayed chemotherapy and/or radiotherapy, and nutritional status were recorded. Quality of life (Functional Assessment of Cancer Therapy – Head and Neck Scale; FACT-H&N) was compared between two groups. Results There was no significant difference in the rates of delayed treatment. Mean weight loss was 3.1 and 4.8 kg in the experimental and control groups, respectively (P = 0.04). A higher proportion of patients in the control group experienced ≥10% weight loss (24% versus 4%; P = 0.03). In terms of quality of life, no significant difference in FACT-H&N score was found. Conclusions The results of the present study suggest that PGT provided similar quality of life without a reduction in treatment interruption. However, patients with PGT had significantly less weight loss (P = 0.04) during CRT.

Objective: To compare a modified single-isocenter technique between (1) 6 MV and 6FFF and (2) fixed collimator angles and adjusted collimator angles for three intracranial lesions by using VMAT-SRS. Materials and methods: Twenty patterns of three intracranial lesions varying in size and location were generated. The VMAT plans using Eclipse version 13.6 were initially generated according to the University of Alabama, Birmingham’s (UAB’s) guidelines. Planning parameters including 6 MV, 6FFF, and collimator angles were further modified. All plans were normalized to achieve a 99% dose coverage with 20 and 24 Gy to 5 mm and 10 mm lesions, respectively. Dosimetric parameters, including CIRTOG, CIPaddick, GI, HI, mean dose to the normal brain, and V5Gy and V12Gy, were analyzed using Wilcoxon or paired t-test. Results: The 6 MV plans with adjusted collimator angle provided better CIRTOG (1.217 vs. 1.266, p = 0.007) and CIPaddick (8.30 vs. 8.13, p = 0.007), while the 6FFF plans were not statistically different. For both energies, the adjusted collimator angles were less than V5Gy (p < 0.01), V12Gy (p < 0.01) and GI (p < 0.001) compared to the fixed collimator angles of UAB protocol, while the HI index was similar. The plans with 6FFF offered superior plan quality than 6 MV for target coverage (CIRTOG 1.222 vs. 1.266, p = 0.005 and CIPaddick 0.832 vs. 0.813, p = 0.002), dose fall off (GI 7.246 vs. 8.264, p < 0.001) and normal brain sparing (V12Gy 3.802 vs. 4.224, p < 0.001 and V5Gy 22.092 vs. 24.966, p < 0.001). Conclusion: The optimization of collimator angles show an improvement in dose fall-off and normal brain sparing relative to the fixed collimator angles. Plans with 6 FFF provide a better plan quality than 6 MV.

The purpose of the study is to compare the efficacy of benzydamine HCl with sodium bicarbonate in the prevention of concurrent chemoradiation-induced oral mucositis in head and neck cancer patients. Sixty locally advanced head and neck cancer patients treated with high-dose radiotherapy concurrently with platinum-based chemotherapy were randomly assigned to receive either benzydamine HCl or sodium bicarbonate from the first day of treatment to 2 weeks after the completion of treatment. The total score for mucositis, based on the Oral Mucositis Assessment Scale (OMAS), was used for the assessment, conducted weekly during the treatment period and at the fourth week of the follow-up. Pain score, all prescribed medications, and tube feeding needs were also recorded and compared. The median of total OMAS score was statistically significant lower in patients who received benzydamine HCl during concurrent chemo-radiotherapy (CCRT) than in those who received sodium bicarbonate, (p value

BACKGROUND To study the incidence of non-endometrioid carcinoma of endometrium and compare the clinical characteristics and treatment outcomes with endometrioid carcinoma patients. MATERIALS AND METHODS This study included 236 patients with endometrial carcinoma at Siriraj Hospital whom were diagnosed and treated from 2003 through 2006. The clinical characteristics, pathological features, treatment and clinical outcomes were collected from the medical records. The 5-year survival was calculated according to 2009 FIGO staging. RESULTS Non-endometrioid carcinoma of endometrium accounted for 10.2% of all endometrial carcinomas (24/236 patients). The 5 -year survival rate was significantly lower in the non-endometrioid group compared to the endometrioid group (77.3% vs 96%, p

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.

Purpose Conventional therapy for cervical node squamous cell carcinoma metastases from an unknown primary can cause considerable toxicity owing to the volume of tissues to be irradiated. In the present study, hypothesizing that using intensity-modulated radiotherapy (IMRT) would provide effective treatment with minimal toxicity, we reviewed the outcomes and patterns of failure for head-and-neck unknown primary cancer at a single tertiary cancer center. Methods and Materials We retrospectively reviewed the records of 52 patients who had undergone IMRT for an unknown primary at M.D. Anderson Cancer Center between 1998 and 2005. The patient and treatment characteristics were extracted and the survival rates calculated using the Kaplan-Meier method. Results Of the 52 patients, 5 presented with Stage N1, 11 with Stage N2a, 23 with Stage N2b, 6 with Stage N2c, 4 with Stage N3, and 3 with Stage Nx disease. A total of 26 patients had undergone neck dissection, 13 before and 13 after IMRT; 14 patients had undergone excisional biopsy and presented for IMRT without evidence of disease. Finally, 14 patients had received systemic chemotherapy. All patients underwent IMRT to targets on both sides of the neck and pharyngeal axis. The median follow-up time for the surviving patients was 3.7 years. The 5-year actuarial rate of primary mucosal tumor control and regional control was 98% and 94%, respectively. Only 3 patients developed distant metastasis with locoregional control. The 5-year actuarial disease-free and overall survival rate was 88% and 89%, respectively. The most severe toxicity was Grade 3 dysphagia/esophageal stricture, experienced by 2 patients. Conclusion The results of our study have shown that IMRT can produce excellent outcomes for patients who present with cervical node squamous cell carcinoma metastases from an unknown head-and-neck primary tumor. Severe late complications were uncommon.

Cervical cancer is the most common female cancer in the developing countries. Treatments of bulky stage IB cervical cancer have been challenged as the local control is relatively poor compared to smaller stage I disease, whether treated by radical surgery or irradiation. The treatment options are definitive concurrent chemoradiation therapy or radical surgery with or without neoadjuvant or adjuvant therapy. The treatment decision is based on the patients' status and preferences, tumor characteristics, and experiences of clinician. This study will review and compare the treatment modalities and rationales of a combination of treatment including surgery, radiation therapy, and chemotherapy for bulky stage IB cervical carcinoma.

BACKGROUND. Squamous cell carcinoma (SCC) of the eyelid is a rare malignancy with metastatic potential. In the current study, the outcomes of patients with SCC of the eyelid were evaluated after definitive and postoperative radiation therapy. METHODS. The medical records of all patients treated with radiotherapy for SCC of the eyelid at 1 institution between 1950 and 2005 were reviewed. Patient records were analyzed for clinical characteristics, pathologic features, radiation techniques, and outcomes. Survival rates were calculated using the Kaplan-Meier method; factors affecting survival were assessed using the log-rank test. RESULTS. During the study period, 39 patients with 42 eyelid SCCs were treated with radiotherapy. Thirty-two tumors were treated with primary radiotherapy and 10 were treated with postoperative radiotherapy after wide local excision. Surviving patients were followed for a median of 76 months. The 5-year disease-specific and overall survival rates for all patients were 86% and 71%, respectively. At 5 years, local, regional, and distant disease control rates for all tumors were 88%, 95%, and 97%, respectively. There were no significant differences in the 5-year local, regional, and distant control rates between tumors treated with definitive and those treated with postoperative radiotherapy. There were no grade 3 or 4 complications. CONCLUSIONS. Primary radiotherapy for SCC of the eyelid provides excellent locoregional control with reasonable complication rates and should be considered an alternative to surgery in selected patients. Cancer 2008. © 2007 American Cancer Society.

e17582 Background: Surgery is the mainstay of treatment for resectable non-metastatic NSCCA of head and neck. Postoperative radiation (RT) is delivered to patients (pt) with high risk for recurrence. Unlike the squamous cell counterpart where survival advantage from adding chemotherapy (CMT) as a radio-sensitizer is evident, the benefit of CCRT is uncertain in NSCCA pt. We hypothesized that CCRT would improve disease free survival (DFS), comparing to RT alone. Methods: NSCCA of head and neck pt who underwent curative surgery and RT at Siriraj hospital from 2006 to 2015 were included in this retrospective study. Patients with residual tumor after surgery or neuroendocrine histology were excluded. The primary outcome was DFS. The secondary outcome was overall survival (OS). Results: We included 139 pt, 99 (71.2%) had RT while 40 (28.8%) had CCRT. Baseline characteristics, including age, gender, primary site, histology and radiation dose were similar between 2 groups. Salivary gland was the most common primary site (67.6%). The most common histology was adenoid cystic carcinoma (35.3%), followed by mucoepidermoid carcinoma (25.9%). Patients who received RT alone had earlier stage (Stage I 29.3%, Stage IVa 14.1%), compared to CCRT group (Stage I 7.7%, Stage IVa 38.5%), p = 0.003. High risk features (positive margin, extranodal extension or ≥ 2 cervical lymph nodes metastasis) were found in 42% and 62% of pt with RT and CCRT, respectively (p = 0.03). In CCRT group, 92% of pt received cisplatin every 3 weeks during RT period. With the median follow-up time of 54.9 months, 3-year DFS was 79.4% and 79.5% in RT and CCRT groups, respectively (p = 0.22). There was no significant difference in 3-year OS between RT and CCRT groups (89.2% vs 89.9%, p = 0.76). Among pt with high-risk features (n = 67, 48.2%), 3-year DFS and OS were not significantly different between treatment groups. However, among pt without high-risk features, 3-year DFS in RT group was significantly higher than CCRT group (84.8% vs 79.0%, p = 0.04). Conclusions: This study demonstrates no survival benefit from adding concurrent CMT to RT following curative surgery in NSCCA of head and neck. Moreover, addition of CMT may be detrimental in pt without high-risk features.

Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brachytherapy has been used instead of low-dose-rate brachytherapy. Image-guided brachytherapy enables sufficient coverage of tumour and reduction of dose to the organs at risk, thus increasing the therapeutic ratio of treatment. Local control rates with three-dimensional brachytherapy appear better than with conventional techniques (about 90–100% and 70–90%, respectively).

Background: To evaluate treatment outcomes of patients with stage I-III endometrial cancer treated with postoperative radiation. Materials and Methods: A retrospective review of 166 endometrial cancer patients, undergoing surgery and postoperative radiotherapy at Siriraj Hospital from 2005-2008 was performed. Pathology was reviewed. Results of treatment were reported with 5-year loco-regional recurrence free survival (LRRFS), 5-year overall survival (OS), patterns of failure and toxicity, and according to stage and risk groups. Results: Median follow up time was 62.8 months. Pathological changes were found in 36.3% of the patients after central reviews, leading to 19% changes in risk groups. Most of the patients (83.7%) received pelvic radiation (PRT) and vaginal brachytherapy (VBT). Five-year LRRFS and OS of all patients were 94.9% and 85.5%, respectively. There was no recurrence or death in low and low-intermediate risk groups. For the high-intermediate risk group, 5-year LRRFS and OS were 96.2% and 90.8%, respectively, and for the high risk group 90.5% and 71%. Late grade 3 and 5 gastrointestinal toxicity was found in 3% and 1.2% of patients, respectively. All of them received PRT 5,000 cGy in 25 fractions. Conclusions: Low and intermediate risk patients had good results with surgery and adjuvant radiation therapy. For high risk patients, postoperative radiation therapy alone appeared to be inadequate as the most common pattern of failure was distant metastasis.

Purpose: The goal of this study was to explore the perspectives and practice of radiation oncologists who treat breast cancer patients who have had breast reconstruction. Methods: In 2010, an original electronic survey was sent to all physician members of the American Society of Radiation Oncology, National Cancer Research Institute-Breast Cancer Studies Group in the United Kingdom, Thai Society of Therapeutic Radiology and Oncology, Swiss Society of Radiation Oncology, and Turkish Radiation Oncology Society. We identified factors associated with radiation oncologists who treat breast cancer patients with reconstruction performed prior to radiation and obtained information regarding radiation management of the breast reconstruction. Results: 358 radiation oncologists responded, and 60% of the physicians were from the United States. While 64% of participants agree or strongly agree that breast image affects a woman’s quality of life during radiation, 57% feel that reconstruction challenges their ability to deliver effective breast radiation. Compared with other countries, treatment within the United States was associated with a high reconstruction rate (>/= 50% of mastectomy patients) prior to radiation (p < 0.05). Delayed-immediate reconstruction with a temporary tissue expander was more common in the United States than in other countries (52% vs. 23%, p = 0.01). Among physicians who treat patients with tissue expanders, the majority (60%) prefer a moderately inflated implant with 150-250 cc of fluid rather than a completely deflated (13%) or inflated expander (28%) during radiation. Among radiation oncologists who treat reconstructions, 49% never use bolus and 40% never boost a breast reconstruction. United States physicians were more likely than physicians from other countries to boost or bolus the reconstruction irrespective of the type of reconstruction seen in their clinic patients (p < 0.01). Conclusions: Great variation in practice is evident from our study of radiation treatment for breast cancer patients with reconstruction. Further research on the impact and delivery of radiation to a reconstructed breast may validate some of the observed practices, highlight the variability in treatment practice, and help create a treatment consensus.

Purpose The goal of this study was to explore the perspectives and practice of radiation oncologists who treat breast cancer patients who have had breast reconstruction. Methods In 2010, an original electronic survey was sent to all physician members of the American Society of Radiation Oncology, National Cancer Research Institute-Breast Cancer Studies Group in the United Kingdom, Thai Society of Therapeutic Radiology and Oncology, Swiss Society of Radiation Oncology, and Turkish Radiation Oncology Society. We identified factors associated with radiation oncologists who treat breast cancer patients with reconstruction performed prior to radiation and obtained information regarding radiation management of the breast reconstruction. Results 358 radiation oncologists responded, and 60% of the physicians were from the United States. While 64% of participants agree or strongly agree that breast image affects a woman’s quality of life during radiation, 57% feel that reconstruction challenges their ability to deliver effective breast radiation. Compared with other countries, treatment within the United States was associated with a high reconstruction rate (>/= 50% of mastectomy patients) prior to radiation (p Conclusions Great variation in practice is evident from our study of radiation treatment for breast cancer patients with reconstruction. Further research on the impact and delivery of radiation to a reconstructed breast may validate some of the observed practices, highlight the variability in treatment practice, and help create a treatment consensus.

Advanced imaging approaches (computed tomography, CT; magnetic resonance imaging, MRI; 18F-fluorodeoxyglucose positron emission tomography, FDG PET) have increased roles in cervical cancer staging and management. The recent FIGO (International Federation of Gynecology and Obstetrics) recommendations encouraged applications to assess the clinical extension of tumors rather than relying on clinical examinations and traditional non-cross sectional investigations. MRI appears to be better than CT for primary tumors and adjacent soft tissue involvement in the pelvis. FDG-PET/CT has increased in usage with a particular benefit for whole body evaluation of tumor metabolic activity. The potential benefits of advanced imaging are assisting selection of treatment based upon actual disease extent, to adequately treat a tumor with minimal normal tissue complications, and to predict the treatment outcomes. Furthermore, sophisticated external radiation treatment and brachytherapy absolutely require advanced imaging for target localization and radiation dose calculation.

Background Sensorineural hearing loss (SNHL) is one of the major long term side effects from radiation therapy (RT) in nasopharyngeal cancer (NPC) patients. This study aims to review the incidences of SNHL when treating with different radiation techniques. The additional objective is to determine the relationship of the SNHL with the radiation doses delivered to the inner ear. Methods A retrospective cohort study of 134 individual ears from 68 NPC patients, treated with conventional RT and IMRT in combination with chemotherapy from 2004-2008 was performed. Dosimetric data of the cochlea were analyzed. Significant SNHL was defined as > 15 dB increase in bone conduction threshold at 4 kHz and PTA (pure tone average of 0.5, 1, 2 kHz). Relative risk (RR) was used to determine the associated factors with the hearing threshold changes at 4 kHz and PTA. Results Median audiological follow up time was 14 months. The incidence of high frequency (4 kHz) SNHL was 44% for the whole group (48.75% in the conventional RT, 37% with IMRT). Internal auditory canal mean dose of > 50 Gy had shown a trend to increase the risk of high frequency SNHL (RR 2.02 with 95% CI 1.01-4.03, p = 0.047). Conclusion IMRT and radiation dose limitation to the inner ear appeared to decrease SNHL.

This study was performed to determine the reliability and replicability of IMD analysis using the Factor VIII immunohistochemical method. The following purpose was determining the relationship between IMD and clinical outcome in individual cervical cancer patient treated with radical radiotherapy. Twenty nine patients with stage IIIB cervical cancer were enrolled. Phase one was performed by using two pieces of tissue biopsy from different locations in the tumor from each patient. The IMD value was counted by the two pathologists after counterstaining by Factor VIII immunohistochemical method. No interobserver disagreement between the two pathologists was found (correlation coefficient = 0.92, 95% CI 0.82-0.96 for the first piece of tissue and 0.85, 95% CI 0.67-0.93 for the second piece). There was no variability in the IMD between the 2 pieces of tissue specimens from different locations of the tumor Phase two followed to evaluate the relationship between IMD and clinical outcome in individual cervical cancer patients. Because of the small sample size, different patients' characteristics, different treatment protocol and short term follow up, there is no statistically significant conclusion.