Stereotactic body radiotherapy for inoperable stage I non-small cell lung cancer.

Stereotactic Body Radiotherapy (SBRT) is one kind of emerging advanced radiotherapy that uses a high dose of radiation delivered to a precise target. The results of treatment by SBRT in inoperable stage I non-small cell lung cancer (NSCLC) are very impressive from both retrospective and prospective studies. The local control is up to 85% and the result suggests improved overall survival with little toxicity compared to the conventional fractionation technique. With its excellent result and safety record, SBRT should be considered as an optional treatment for inoperable stage I NSCLC.

Prevalence incidence and management of anemia in cancer patients treated in the radiation oncology division, Siriraj Hospital.

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 radiation oncology division, 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 < 12 g/dl for both genders. Results: It was found that the prevalence of anemia within 30 days before starting radiotherapy was 54.4% and the incidence of anemia during radiotherapy was 34.3%. The frequency of anemia, defined as the number of patients in the study in whom Hb <12.0 g/dL were found at least once either at enrollment or during the survey, was 66%. Previous chemotherapy was the main predicting factor for anemia before radiotherapy. Concurrent chemo-radiotherapy patients developed a higher incidence of anemia during the survey than patients with radiotherapy alone. The incidence of anemia was highest in gynecologic malignancy patients. Only 25/112 (22.3%) of anemic patients at initial evaluation received treatment for anemia. Most of the patients were treated with a blood transfusion and none was treated with erythropoietin. Our mean trigger hemoglobin level for treatment of anemia was 9.3 g/dl. Conclusion: Anemia is common in the patients who are treated with radiotherapy in our institute with the prevalence of anemia before starting radiotherapy as high as 54.4% especially in patients previously treated with chemotharapy. One-thirds of patients developed anemia during radiotherapy, with a higher incidence in gynecologic malignancy patients and patients who receive combined chemo-radiotherapy. The total frequency of anemia in patients treated in the Division of Radiation Oncology, Siriraj Hospital was as high as 66% before and during radiotherapy.

Results of cervical cancer patients treated according to clinical practice guideline in Siriraj Hospital.

Patients with cervical cancer stage Ib-IVa treated with curative intent at Siriraj Hospital between January and December 2002 were included in the study. There were 362 patients with an age range of 26-86 years old. We found that 65.3% of the patients were treaded according to Siriraj Hospital’s clinical practice guideline (CPG) and 34.7% were not treated according to the CPG. Early results of the treatment showed that 70.4% of the patients treated according to the CPG had complete response at 3 months. After further follow up and salvage treatments, five more patients treated according to CPG accomplished complete responses. The overall results of CPG treatment were comparable to the result of cervical cancer treatment in the literature.