Preliminary result of using intensity modulated radiation therapy (IMRT) as a primary treatment for prostate cancer at Siriraj Hospital in Thailand: toxicity and biochemical outcomes.

Objective: This study is a retrospective study of the outcome and the incidence of the toxicity of using intensity-modulated radiation therapy (IMRT) as the primary treatment for prostate cancer at Siriraj Hospital. Methods: Hospital records and radiotherapy medical records of prostate cancer patients treated with IMRT as the primary treatment between July 2004 and May 2009 at Siriraj Hospital were all reviewed. Seventy-five prostate cancer patients were included in the study. Patient’s biochemical failure was established at the time of prostatic specific antigen progression above the post-treatment nadir value +2 ng/ml according to the Phoenix definition. Acute and Late toxicity were assessed and scored according to the Radiotherapy Oncology Group grading system. Results: The median follow up time was 25 months (range 3 – 63 months). The two years overall survival (OS) and freedom from biochemical failure rate (FFBF) were 93.7 and 95.8%, respectively. Five patients (6.6%) developed prostatic specific antigen failure according to the Phoenix definition. The incidences of grade  2 of acute and late gastrointestinal toxicity were 12% and 2.7%, respectively. The incidences of grade  2 of acute and late genito-urinary toxicity were 61.3% and 41.3%, respectively. Conclusion: This preliminary result of using IMRT as the primary treatment for prostate cancer provides good outcomes. The FFBF and OS are comparable with other studies. The incidences of acute and late gastrointestinal toxicity are acceptable, but the incidences of acute and late genito-urinary toxicity are higher than other studies.

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.

Effect of Amifostine to prevent radiotherapy-induced acute and late toxicity in head and neck cancer patients who had normal or mild impaired salivary gland function.

BACKGROUND: Amifostine has a potential role for salivary gland protection in head and neck cancer patients who had radiotherapy. MATERIAL AND METHOD: Sixty-seven head and neck cancer patients were randomized to receive radiotherapy or radiotherapy plus Amifostine. The efficacy of the treatment was determined by a questionnaire evaluating dryness of mouth and the oral comfort, the RTOG/EORTC acute/late radiation morbidity scoring criteria, collection of the whole saliva and the 99mTc-pertecnetate scintigraphy of the salivary glands. RESULTS: Amifostine significantly reduced the mean questionnaire scores from 6.49 to 3.73, the incidence of grade > or = 2 mucositis from 75% to 36% and acute xerostomia from 82% to 39%. The salivary gland function returned to normal at a rate of 36.3% in the Amifostine group versus 9.1% in the control group. CONCLUSION: Amifostine is effective in reducing the incidence and severity of acute mucositis, acute and late xerostomia in head and neck cancer patients.

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.

Deadly soft tissue sarcoma: Curable using a multidisciplinary approach.

We present the role of multidisciplinary approach to treat our patient with a soft tissue sarcoma at her thigh successfully. A 56-year-old female complained of a progressive enlarging soft tissue mass on her thigh before the diagnosis of malignant fibrous histiocytoma was confirmed by appropriate approach. With final diagnosis and staging of the disease, the appropriate treatment was decided from all members of Siriraj Musculoskeletal Tumor Board to save not only patient's life but also preserve her extremity and function.

Concurrent radiation therapy and irinotecan in stage IIIB cervical cancer.

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.

A young woman with rectal bleeding.

Rectal cancer is a common malignancy in Thailand. A case of 39-year-old female with rectal bleeding caused by adenocarcinoma of rectum is reported here. Successful treatment was achieved by preoperative chemoradiation therapy and low anterior resection. She is now symptom free and has good sphincter control. The history, physical examination, investigations, diagnosis and treatment are discussed.

Definitive radiotherapy for early glottic carcinoma: Outcome and prognostic factors.

This study was performed to analyse the outcome of definitive radiation therapy (RT) for early stage (T1,T2) squamous cell carcinoma of the glottis and define the prognostic factors influencing the local control by this method of treatment. Sixty-two newly-diagnosed patients treated at Division of Radiation Oncology, Department of Radiology, Siriraj Faculty of Medicine from January 1987 to December 1995 were retrospectively reviewed with the median follow-up period 35 months. The complete response rate (CR) from this study was 91.9 percent (57/62) with 14 patients developing locoregional recurrence later. The two-year and five-year local control were 72.8 and 67.8 percent respectively. Among the factors analysed for local control (stage, anterior commissure involvement, initial field size and histologic grade), only grade showed statistically significant impact by univariate analysis. The overall survival at two-year and five-year were 91.6 and 86.2 percent, respectively. RT can be definitive treatment in this group of patients but salvage surgery should be provided in some cases.