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Tatsuya Ohno,
Dang Huy Quoc Thinh,
Shingo Kato,
C R Beena Devi,
Ngo Thanh Tung, Kullathorn Thephamongkhol,
Miriam Joy C Calaguas,
Juying Zhou,
Yaowalak Chansilpa,
Nana Supriana,
Dyah Erawati,
Parvin Akhter Banu,
Cho Chul Koo,
Kunihiko Kobayashi,
Takashi Nakano,
Hirohiko Tsujii
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ABSTRACT: The purpose of this study was to evaluate the efficacy and toxicity of radiotherapy concurrently with weekly cisplatin, followed by adjuvant chemotherapy, for the treatment of N2-3 nasopharyngeal cancer (NPC) in Asian countries, especially regions of South and Southeast Asian countries where NPC is endemic. Between 2005 and 2009, 121 patients with NPC (T1-4 N2-3 M0) were registered from Vietnam, Malaysia, Indonesia, Thailand, The Philippines, China and Bangladesh. Patients were treated with 2D radiotherapy concurrently with weekly cisplatin (30 mg/m (2)), followed by adjuvant chemotherapy, consisting of cisplatin (80 mg/m(2) on Day 1) and fluorouracil (800 mg/m(2) on Days 1-5) for 3 cycles. Of the 121 patients, 56 patients (46%) required interruption of RT. The reasons for interruption of RT were acute non-hematological toxicities such as mucositis, pain and dermatitis in 35 patients, hematological toxicities in 11 patients, machine break-down in 3 patients, poor general condition in 2 patients, and others in 8 patients. Of the patients, 93% completed at least 4 cycles of weekly cisplatin during radiotherapy, and 82% completed at least 2 cycles of adjuvant chemotherapy. With a median follow-up time of 46 months for the surviving 77 patients, the 3-year locoregional control, distant metastasis-free survival and overall survival rates were 89%, 74% and 66%, respectively. No treatment-related deaths occurred. Grade 3-4 toxicities of mucositis, nausea/vomiting and leukopenia were observed in 34%, 4% and 4% of the patients, respectively. In conclusion, further improvement in survival and locoregional control is necessary, although our regimen showed acceptable toxicities.
Journal of Radiation Research 11/2012; · 1.68 Impact Factor
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ABSTRACT: 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.
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.
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).
IMRT and radiation dose limitation to the inner ear appeared to decrease SNHL.
Radiation Oncology 02/2011; 6:19. · 2.32 Impact Factor
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Shingo Kato,
Tatsuya Ohno, Kullathorn Thephamongkhol,
Yaowalak Chansilpa,
Yang Yuxing,
C R Beena Devi,
Anita Z Bustam,
Miriam J C Calaguas,
Rey H de los Reyes,
Chul-Koo Cho,
To Anh Dung,
Nana Supriana,
Hideyuki Mizuno,
Takashi Nakano,
Hirohiko Tsujii
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ABSTRACT: To evaluate the toxicity and efficacy of concurrent chemoradiotherapy using weekly cisplatin for patients with locally advanced cervical cancer in East and Southeast Asia, a multi-institutional Phase II clinical study was conducted among eight Asian countries.
Between April 2003 and March 2006, 120 patients (60 with bulky Stage IIB and 60 with Stage IIIB) with previously untreated squamous cell carcinoma of the cervix were enrolled in the present study. Radiotherapy consisted of pelvic external beam radiotherapy (total dose, 50 Gy) and either high-dose-rate or low-dose-rate intracavitary brachytherapy according to institutional practice. The planned Point A dose was 24-28 Gy in four fractions for high-dose-rate-intracavitary brachytherapy and 40-45 Gy in one to two fractions for low-dose-rate-intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m(2)) were administered during the radiotherapy course.
All patients were eligible for the study. The median follow-up was 27.3 months. Of the 120 patients, 100 (83%) received four or five cycles of chemotherapy. Acute Grade 3 leukopenia was observed in 21% of the patients, and Grade 3 gastrointestinal toxicity was observed in 6%. No patient failed to complete the radiotherapy course because of toxicity. The 2-year local control and overall survival rate for all patients was 87.1% and 79.6%, respectively. The 2-year major late rectal and bladder complication rate was 2.5% and 0%, respectively.
The results have suggested that concurrent chemoradiotherapy using weekly cisplatin is feasible and effective for patients with locally advanced cervical cancer in East and Southeast Asia.
International journal of radiation oncology, biology, physics 10/2009; 77(3):751-7. · 4.59 Impact Factor
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ABSTRACT: To review the literature regarding the role of adjuvant radiotherapy (RT) in women with stage I endometrial cancer in terms of survival and pelvic control.
A systematic search of MEDLINE, EMBASE and the Cochrane Library databases was conducted for studies evaluating RT (1966 to October 2005).
Five randomized trials were identified that evaluated adjuvant external beam radiotherapy (EBRT) and/or intracavitary radiotherapy (ICRT) including one in which women had undergone complete surgical staging. No survival differences were identified; however, none of the studies were powered enough to show a survival benefit. In three studies reporting subgroup analyses, intermediate-risk subgroups (stages IA and IB, grade 3 or stage IC) who received RT had fewer pelvic recurrences compared to women not receiving RT. Unfortunately, none of the studies reported ultimate pelvic control as an outcome.
RT is not recommended in low-risk patients (stages IA, IB, grades 1 and 2). It is reasonable to consider EBRT for intermediate-risk subgroup patients (stage IC, grades 1 and 2, or stages IA, IB, grade 3), regardless of surgical staging, to reduce the risk of pelvic recurrence. EBRT is recommended for high-risk patients (stage IC, grade 3). The benefits of EBRT need to be weighed against the toxicity of treatment. Patients should be informed of the benefits and risks of EBRT. Additional analysis including ultimate pelvic control in subgroups would be helpful. More clinical trials are warranted to further define the role of EBRT in subgroups of patients and to clarify the role of ICRT.
Gynecologic Oncology 09/2006; 102(2):361-8. · 3.89 Impact Factor
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Bertrand Baujat,
Hélène Audry,
Jean Bourhis,
Anthony T C Chan,
Haluk Onat,
Daniel T T Chua,
Dora L W Kwong,
Muhyi Al-Sarraf,
Kwan-Hwa Chi,
Masato Hareyama,
Sing F Leung, Kullathorn Thephamongkhol,
Jean-Pierre Pignon
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ABSTRACT: To study the effect of adding chemotherapy to radiotherapy (RT) on overall survival and event-free survival for patients with nasopharyngeal carcinoma.
This meta-analysis used updated individual patient data from randomized trials comparing chemotherapy plus RT with RT alone in locally advanced nasopharyngeal carcinoma. The log-rank test, stratified by trial, was used for comparisons, and the hazard ratios of death and failure were calculated.
Eight trials with 1753 patients were included. One trial with a 2 x 2 design was counted twice in the analysis. The analysis included 11 comparisons using the data from 1975 patients. The median follow-up was 6 years. The pooled hazard ratio of death was 0.82 (95% confidence interval, 0.71-0.94; p = 0.006), corresponding to an absolute survival benefit of 6% at 5 years from the addition of chemotherapy (from 56% to 62%). The pooled hazard ratio of tumor failure or death was 0.76 (95% confidence interval, 0.67-0.86; p < 0.0001), corresponding to an absolute event-free survival benefit of 10% at 5 years from the addition of chemotherapy (from 42% to 52%). A significant interaction was observed between the timing of chemotherapy and overall survival (p = 0.005), explaining the heterogeneity observed in the treatment effect (p = 0.03), with the highest benefit resulting from concomitant chemotherapy.
Chemotherapy led to a small, but significant, benefit for overall survival and event-free survival. This benefit was essentially observed when chemotherapy was administered concomitantly with RT.
International Journal of Radiation OncologyBiologyPhysics 02/2006; 64(1):47-56. · 4.11 Impact Factor
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ABSTRACT: Radioactive iodine remnant ablation destroys residual thyroid tissue after surgical resection of papillary or follicular thyroid cancer. We systematically reviewed 1543 English references to determine whether remnant ablation decreases the risk of thyroid cancer-related death or recurrence after bilateral thyroidectomy for papillary or follicular thyroid cancer. In 13 cohort studies in which the analysis of thyroid cancer-related outcomes was statistically adjusted to a variable degree for prognostic factors or cointerventions, rates of recurrences of thyroid cancer-related outcomes were significantly decreased in the following: one of seven studies examining thyroid cancer-related mortality, three of six studies examining any tumor recurrence, three of three studies examining locoregional recurrence, and two of three studies examining distant metastases. Thyroid hormone suppressive therapy was not adjusted for in the majority of these analyses. In 18 cohort studies not adjusted for prognostic factors or interventions, the benefit of radioactive iodine ablation in decreasing the thyroid cancer-related mortality and any recurrence at 10 yr was inconsistent among centers. However, pooled analyses were suggestive of a statistically significant treatment effect of ablation for the following 10-yr outcomes: locoregional recurrence (relative risk of 0.31, 95% confidence interval, 0.2, 0.49) and distant metastases (absolute decrease in risk 3%, 95% confidence interval, risk decreases 1-4%). In conclusion, radioactive iodine ablation may be beneficial in decreasing recurrence of well-differentiated thyroid cancer; however, results are inconsistent among centers for some outcomes, and the incremental benefit of remnant ablation in low-risk patients treated with bilateral thyroidectomy and thyroid hormone suppressive therapy is unclear.
Journal of Clinical Endocrinology & Metabolism 09/2004; 89(8):3668-76. · 6.50 Impact Factor
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ABSTRACT: The present study was to evaluate the efficacy and toxicity of concurrent radiation therapy and irinotecan in patients with stage IIIB cervical cancer. Fifteen patients with no prior radiation therapy and chemotherapy were enrolled in the study. These patients received 50 Gy of external radiation to whole the pelvis, 50 Gy with an additional dose of 6-10 Gy to the parametrium and 1 or 2 sessions of intracavitary Cesium-137. Weekly intravenous infusion of 40 mg/m2 irinotecan was given for 5 cycles during the course of radiation therapy. Of 14 evaluable patients, 4 (28.6%) achieved complete response and 7 (50.0%) achieved partial response. Treatment-related toxicity included grade 1 & 2 anemia, grade 1 & 2 leucopenia, grade 1 & 2 neutropenia and 7.1 per cent grade 3 diarrhea. No grade 4 toxicity or treatment-related death occurred in the present study. CONCLUSION: Irinotecan is a promising new cytotoxic agent in treatment concurrently with radiation therapy in newly diagnosed locally advanced cervical cancer. This modality of treatment appeared to be effective with acceptable toxicity.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 06/2003; 86(5):430-5.
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ABSTRACT: Since 1997, our institute has used neoadjuvant chemotherapy for intraocular retinoblastoma. However, some of the patients showed signs of recurrence months to years later. We therefore attempted to determine the prognostic factors of treatment outcomes and survival in our patients.
We reviewed 90 patients treated from 1997 to 2006. The following information was recorded: demographic and ophthalmological data, clinical classification, histopathological data, and treatment methods and outcomes.
Enucleation was avoided in two of 57 eyes in the unilateral group. Sixteen of 54 eyes in the bilateral group were salvaged by systemic chemotherapy with local treatment. There was no difference in histopathological findings between the two groups. Nine of 57 patients in the unilateral group demonstrated poor outcomes, compared with four of 27 in the bilateral group. Significant poor prognostic factors for survival were optic nerve head invasion, orbital involvement, abnormal results on bone marrow aspiration, lumbar puncture, bone scan, and group E or F classification.
The 15% mortality rate in our patients is slightly higher than that reported in developed countries. Delayed diagnosis and treatment is the main cause of avoidable deaths. Improving education of both clinicians and parents would increase survival rates in this potentially fatal disease.
Japanese Journal of Ophthalmology 53(1):35-9. · 0.92 Impact Factor
