A pilot comparison study of setup verification between two-dimensional kilo-voltage (2DkV) matchand kilo-voltage cone-beam computed tomography (kV-CBCT) match for nasopharyngeal cancer patients.

Objective: Setup verification is the critical part to make sure of the accuracy for Intensity-modulated radiotherapy in nasopharyngeal cancer patients. This pilot study was designed to answer whether and how much the kV-CBCT in addition to 2DkV is more accurate than 2DkV alone in terms of verification parameters. Methods: Images acquisition: Offline images were displayed in the matched position between reference images. 2D and 3D matches: The bony matches were done by using the location of the tumor in the nasopharyngeal and upper neck regions. The distances displaced from the isocenter were recorded in x-y-z directions. Analysis: The distance of the isocenter shift in each direction (X, Y, Z) were presented as point estimations. The alignment between the two methods was assessed with Pearson’s and Spearman’s correlation. The 3 mm difference within 90% is considered as an acceptable range of non-inferiority of 2DkV, compared with CBCT. Results: 11 nasopharyngeal cancer patients were included into this study. The correlation between 2DkV and kV-CBCT were 0.46, 0.11 and 0.16 for Superior-inferior (SI), Anterior-posterior (AP) and Left-right (LR) directions, respectively. The central value for the kV-CBCT; SI, AP and LR directional shift were 0.07, 0.06 and 0.03 cm, respectively, whereas the central value for 2DkV; SI, AP and LR directional shift were 0.05, 0.07 and 0.04 cm. For the difference shift < 3 mm, the results > 90% were within acceptable value: 100% and 96.96% for SI and LR directions whereas the AP direction was 87.87%. Conclusion: Compared with kV-CBCT by using our criteria, 2DkV images are accurate enough for treatment verification in nasopharyngeal cancer patients.

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.

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.

Hyperthermia in combination with radiation therapy for treatment of advanced inoperable breast cancer.

Twelve breast cancer patients with locally advanced inoperable lesions were studied. Six cases had received chemotherapy, 6 had not. Most of the tumors were ulcerative lesions with an average size of 11.5 cm. The patients were treated with 43 degrees C hyperthermia once or twice a week together with radiation at a dose of 20-70 Gy. Six of them were also treated with concurrent chemotherapy. Two cases responded completely (17%) and 10 cases responded partially (83%). The result indicates that the combination of hyperthermia and radiation, with or without chemotherapy, might be a good treatment option for locally advanced inoperable breast cancer, especially for patients who have had failure or contraindication to chemotherapy. It is an effective treatment for palliation of local symptoms, showing a tendency to achieve local control of large, ulcerative advanced breast lesions especially when such treatment is followed by salvage surgery.

Evaluation of clinical significance of a new tumour marker, cyfra21-1, in diagnosios of squamous cell cervical cancer: A preliminary study.

The purpose of this study was to evaluate the significance of Cyfra21-1 as a new tumour marker in the diagnosis of squamous cell cervical cancer. Cyfra21-1 enzyme immunoassay was used for the determination of Cyfra21-1 levels in sera of 120 cervical cancer patients and 17 normal control cases. According to the International Federation of Gynaecology and Obstetrics (FIGO) stage, these cervical cancer patients were staged at CIN or CIS, stage I, stage II and stage III (19,17,42 and 42 cases, respec-tively). The 17 normal controls comprised five healthy women and 12 patients with benign gynaecological diseases and tumours that had presented negative results from Papanicolauo smears. We found that the normal value of serum Cyfra21-1 level was 0.99 + 0.28 ng/ml (mean+ 2SE). Serum Cyfra21-1 levels of the cervical cancer patients increased depending on the severity of the disease. Moreover, the Serum Cyfra12-1 levels of only the patients with FIGO stage III were significantly higher than those of the normal controls, and the patients in CIN or CIS and stage I (p=0.0055). The serum Cyfra21-1 levels of the normal controls the patients in CIN or CIS, stage I, and stage II differed insignificantly from one another. This test showed a sensitivity of 65 per cent and specificity of 82 per cent. The ROC curve was used to determine the cut-off value (1.3 ng/ml) of the increased levels. A prospective study should be further performed to evaluate the usefulness of this marker as a non-invasive modality for diagnosis and monitoring cervical cancer in the future.