[show abstract][hide abstract] ABSTRACT: To assess and compare the impact on skin reactions and cosmesis between hypofractionated whole breast and conventional irradiation for early breast cancer.
Seventy-three patients with operable breast cancer (pT1-3pN0-1M0) who underwent breast-conserving surgery were assigned for irradiation to either conventional arm (50 Gy in 25 fractions) with a sequential electron boost of 15-16 Gy over five weeks or hypofractionated arm (43.2 Gy in 16 fractions) with a concomitant electron boost of 0.6 Gy over three weeks.
At 3-week follow-up, skin toxicities in the hypofractionated arm were significantly worse than that seen in the conventional arm, while at 6-week follow-up, the percentages of skin toxicities in the conventional arm were higher After a median follow-up of six months, there was no significant difference in skin toxicities between the two treatment groups. In addition, there were no significant differences in the mean scores of cosmetic outcome for patients between two regimens.
This hypofractionated radiotherapy regimen of 43.2 Gy in 16 fractions with a concomitant electron boost showed good results in terms of normal tissue effects and cosmesis. A long-term follow-up is needed to confirm these favorable results.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2012; 95(2):229-40.
[show abstract][hide abstract] ABSTRACT: To compare simultaneous integrated boost and sequential boost after conventional irradiation in breast-conserving therapy in aspect of late effects and cosmetic results.
Between August 2006 and June 2007, 60 breasts were treated in this prospective nonrandomized study, designed to compare simultaneous integrated boost (additional 10 Gy/25F) and sequential boost (15 Gy/5F) to the tumor bed in terms of late effects and cosmetic results at 7-month and 3-year follow-up. Pearson Chi-square test was used, with an a-value of 0.05.
Hyper/hypopigmentation and induration/fibrosis were commonly seen at 7-months follow-up (p = 0.84 and 0.83, respectively). The cosmetic results were good or excellent.
Although the present study included a small number of patients and short follow-up time, the preliminary results were comparable between the study groups.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 04/2009; 92(3):390-7.
[show abstract][hide abstract] ABSTRACT: The authors present the result of a dosimetric comparison of inverse-planed intensity modulated, forward-planned intensity modulated, and conventional tangential technique in breast conserving radiotherapy.
The breasts (Right side: Left side = 1:1), heart, and lungs of 28 patients were contoured on all the computed tomography (CT)-slice. Three different treatment plans were created: (1) inverse IMRT (iIMRT), (2) forward IMRT (fIMRT), and (3) conventional tangential technique (CVT). The total prescribed dose for all plans was 50 Gy/25 fractions. All treatment plans were normalized at 95% of the prescribed dose covered the entire PTV and used inhomogeneity corrections.
For the entire group, the mean breast volume was 517 cc. The V105% for iIMRT, fIMRT and conventional plans was 1.12%, 2.36% and 16.81%, which iIMRT better than fIMRT and CVT (p < 0.001) and fIMRT better than CVT (p < 0.05). The Dmax for the iIMRT plan received 105.03%, which was significantly less than those from the fIMRT(106.6%, p < 0.001) and the conventional (110.68%, p < 0.001) plan. The PTV coverage (V95-105%) for the iIMRT, fIMRTand conventional was 96%, 91% and 87%, which iIMRT better than fIMRT and CVT (p < 0.05) and fIMRT better than CVT (p < 0.05). The PTV CI for the iIMRT technique was 0.704, which was significantly more conformity than those from the fIMRT (0.639, p < 0.001) and the conventional (0.539, p < 0.001) techniques. The PTV CI of fIMRT is significantly better than CVT (p < 0.005). Mean ipsilateral lung dose was 642.7 cGy, 747.6 cGy and 882.25 cGy for iIMRT fIMRT and CVT respectively (p < 0.05) The V20Gy reduced from 14.87% for conventional plan to 12.82% for the fIMRT plan, while 0.88% was obtained for the iIMRT plan (P<0.05). The heart V30 Gy value was 3.124%, 4.65%, and 5.84% for iIMRT, fIMRT and conventional plans, respectively (p < 0.05). The mean dose of contralateral breast was 55.86 cGy, 60.33 cGy, 68.57 cGy for iIMRT, fIMRT and conventional plans, respectively (p < 0.05 both). The mean contralateral lung dose was 57.8 cGy, 43.87 cGy, and 32.28 cGy for iIMRT, fIMRT and conventional plans, respectively (p < 0.005 both).
The iIMRT technique provides significantly improved PTV Dmax, PTV V105%, PTV V110%, target volume coverage, dose homogeneity and dose conformity throughout the target volume of breast and reduced doses to all critical structures, compared to the fIMRT and conventional techniques. In view of fIMRT technique, it significantly improved the dose distribution and reduced dose to OARs compared to conventional technique, although not better than iIMRT technique.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 11/2008; 91(10):1571-82.
[show abstract][hide abstract] ABSTRACT: Three dimensional conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT) have been implemented at Department of Therapeutic Radiation and Oncology, King Chulalongkorn Memorial Hospital (KCMH) since July 2005. This is the first study in Thailand to evaluate the pattern of care and utilization of 3D CRT and IMRT for treatment in each individual cancer.
Between July 2005 and July 2007, 925 newly diagnosed cancer patients underwent IMRT or 3D CRT at KCMH. The authors retrospectively reviewed the experience and utilization of 3D CRT and IMRT for each disease site and region.
There were 471 males and 454 females. There were 332 patients (35.9%) treated with IMRT. Among the 332 IMRT patients, there were 100, 32 and 27 nasopharyngeal, lung and prostate cancers, respectively. On the contrary, 593 patients (64.1%) were treated with 3D CRT. Among these, breast, cervix and lung cancers were the most common diseases. Except for head and neck as well as genitourinary cancer 3D CRT was still the main technique used in more than 60% of the patients at KCMH.
3D CRT and IMRT have been successfully implemented at KCMH for 2 years. Three dimensional conformal radiation therapy was still the main technique used in more than 60% of the patients at KCMH. Prospective studies evaluating tumor control and treatment sequelae are expected.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 03/2008; 91(2):215-24.
[show abstract][hide abstract] ABSTRACT: This is the first report in Thailand to evaluate the efficacy of using intensity-modulated radiotherapy (IMRT) in the primary treatment of head-and-neck cancer.
From July 2005 to March 2006, eighteen patients with head and neck cancer were treated with IMRT, fourteen of which were nasopharyngeal cancer. The median age at diagnosis was 52 years (range 23-58 years). The treatment plan composed of two sequential plans for PTV-low risk (50Gy in 25 fractions) and PTV-high risk (20Gy in 10 fractions). Chemotherapy was given to 13 patients with locoregionally advanced disease (stage T3/T4 and N2/3) using cisplatin (n = 3) or carboplatin (n = 10) every 3 weeks during the course of radiation therapy.
The median overall treatment time was 49 days (range, 43-57 days), and 77.8 percent of the patients completed 35 fractions within 50 days. The clinical complete response and partial response rates at 3 months after complete radiation were 71.4% and 28.6%, respectively. However at the median follow-up of 5.6 months, the complete response rate increased to 89%. Treatment break during RT range from 3 to 7 days, was observed in three patients. All of them received concurrent chemoradiation. No distant metastasis was noted.
The authors' experience of using concurrent chemotherapy with IMRT for a cohort of patients with head and neck carcinoma showed a very high rate response rate at early follow-up. Long-term clinical outcome is expected.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 01/2007; 89(12):2068-76.
[show abstract][hide abstract] ABSTRACT: Intracavitary brachytherapy plays an important role in the treatment of cervical carcinoma. Previous results have shown controversy between the effect of dose rate on tumor control and the occurrence of complications. We performed a prospective randomized clinical trial to compare the clinical outcomes between low-dose-rate (LDR) and high-dose-rate (HDR) intracavitary brachytherapy for treatment of invasive uterine cervical carcinoma.
A total of 237 patients with previously untreated invasive carcinoma of the uterine cervix treated at King Chulalongkorn Memorial Hospital were randomized between June 1995 and December 2001. Excluding ineligible, incomplete treatment, and incomplete data patients, 109 and 112 patients were in the LDR and HDR groups, respectively. All patients were treated with external beam radiotherapy and LDR or HDR intracavitary brachytherapy using the Chulalongkorn treatment schedule.
The median follow-up for the LDR and HDR groups was 40.2 and 37.2 months, respectively. The actuarial 3-year overall and relapse-free survival rate for all patients was 69.6% and 70%, respectively. The 3-year overall survival rate in the LDR and HDR groups was 70.9% and 68.4% (p = 0.75) and the 3-year pelvic control rate was 89.1% and 86.4% (p = 0.51), respectively. The 3-year relapse-free survival rate in both groups was 69.9% (p = 0.35). Most recurrences were distant metastases, especially in Stage IIB and IIIB patients. Grade 3 and 4 complications were found in 2.8% and 7.1% of the LDR and HDR groups (p = 0.23).
Comparable outcomes were demonstrated between LDR and HDR intracavitary brachytherapy. Concerning patient convenience, the lower number of medical personnel needed, and decreased radiation to health care workers, HDR intracavitary brachytherapy is an alternative to conventional LDR brachytherapy. The high number of distant failure suggests that other modalities such as systemic concurrent or adjuvant chemotherapy might lower this high recurrence, especially in Stage IIB and IIIB.
International Journal of Radiation OncologyBiologyPhysics 09/2004; 59(5):1424-31. · 4.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: A retrospective study was performed on 69 patients with intracranial germ cell tumors who were treated at the Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital from 1990 to 2000. Median age was 15 years. Forty-two cases (60.87%) had histologically confirmed germinoma or nongerminomatous germ cell tumors. Germinoma was the predominate histology followed by mixed germ cell tumors. Pineal and suprasellar regions were the two leading sites, hydrocephalus (85.5%) and diplopia (57.97%) were the two most common clinical presentations. Only 13 cases had the result of cerebrospinal fluid (CSF) cytology or magnetic resonance imagine (MRI) of the spine before initial treatment. Serum tumor markers, Alpha fetoprotein and beta-human chorionic gonadotropin, were available in 66.67 per cent. Total or partial tumor removal were feasible in 24 cases. Whole brain irradiation was given in almost all cases with the median dose of 3,600 cGy. The median total tumor dose was 5,400 cGy. Whole spine radiation was utilized in 17 cases. The mean follow-up time was 41 months. The five-year disease free survival was 73.59 per cent. Overall 3 and 5 year survival rates were 86.45 per cent and 81.64 per cent, respectively.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 08/2003; 86(7):603-11.
[show abstract][hide abstract] ABSTRACT: A retrospective review was performed on 576 patients who have been diagnosed breast cancer and referred to Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between January 1995-September 2001. There were three hundred ninety nine cases of invasive breast cancer that available for estrogen (ER) and/or progesterone (PR) receptor status. The mean and median age in our study were 49.6 year and 49.0 year respectively. About 60.9 per cent of the patients were pre and peri-menopause and 37.8 per cent were post-menopause. Most of the histological cell type were invasive ductal carcinoma which comprised of 92.7 per cent. Histologic grading were nearly equal for moderately and poorly differentiated grade: 43.66 per cent and 40.66 per cent. The results of our study showed 53.4 per cent of 399 patients had ER positive and 42.1 per cent of 380 patients had PR positive. The proportion of ER+PR+, ER+PR-, ER-PR+, and ER-PR- were 36.31 per cent, 15.53 per cent, 5.79 per cent and 42.37 per cent respectively. Older age and post-menopause women had higher ER+. While patients with increase tumor size, poorly differentiated grading, increase positivity of axillary lymph nodes and higher stage have more chance of ER negative and PR negative.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 07/2002; 85 Suppl 1:S193-202.
[show abstract][hide abstract] ABSTRACT: A retrospective study was performed on 131 patients with stage 1B cervical carcinoma who were referred and treated with external beam radiation and intracavitary brachytherapy at the Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between February 1985 and February 2000. Primary outcomes were overall survival rate, progression free survival rate, recurrence, and treatment-related complications. The treatment results from different sources of intracavitary radiation therapy were secondary endpoints. The number of patients treated with Ra-226, Cs-137, and Ir-192 intracavitary irradiation were 12, 84, and 35 patients respectively. The median follow-up times were 69, 59, and 21 months for Ra-226, Cs-137, and Ir-192, respectively. Actuarial 5-year overall survival rate was 89 per cent. The 5-year progression free survival rate was 80 per cent. Actuarial 5-year survival and progression free survival rate were comparable among different sources of intracavitary brachytherapy (p = 0.553 and p=0.793, respectively). The overall recurrent rate was 16.8 per cent. Of the recurrence; 40.9 per cent was locoregional, 54.6 per cent was distant failure, and 4.5 per cent was combined locoregional and distant failure. The overall complication rate was 25.95 per cent. The severe complication rates (Grade III-V) from treatment occurred in the urinary bladder (0.76%) and in the small bowel (0.76%.) These results suggest that radiation therapy alone is an effective treatment for stage 1B cervical carcinoma. Additionally, all types of intracavitary brachytherapy provide comparable clinical results.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 07/2001; 84 Suppl 1:S216-27.