Clinical Audit in Radiation Oncology: Results from One Academic Centre in Delhi, India

Kaur, Jaspreet,Mohanti, Bidhu Kalyan,Muzumder, Sandeep Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.5

The objective was to analyze the radiotherapy (RT) practice at the cancer centre of a tertiary academic medical institution in Delhi. This audit from an Indian public institution covered patient care processes related to cancer diagnosis, integration of RT with other anti-cancer modalities, waiting time, overall treatment time, and compliance with RT. Over a period of one year, all consecutively registered patients in radiotherapy were analyzed for the audit cycle. Analysis of 1,030 patients showed median age of 49.6 years, with presentation as stage I and II in 14.2%, stage III and IV in 71.2% and unknown stage in 14.6%. A total of 974 (95%) were advised for RT appointment; 669 (68.6%) for curative intent and 31.4% for palliation. Mean times for diagnostic workup and from registration at cancer centre to radiotherapy referral were 33 and 31 days respectively. Median waiting time to start of RT course was 41 days. Overall RT compliance was 75% and overall duration for a curative RT course ranged from 50 days to 61 days. Non-completion and interruption of RT course were observed in 12% and 13% respectively. Radiotherapy machine burden in a public cancer hospital in India increases the waiting time and 25% of advised patients do not comply with the prescribed treatment. Infrastructure, machine and manpower constraints lead to more patients being treated on cobalt (74%) and by two-dimensional (78%) techniques.

Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Phua, Chee Ee,Tan, Boon Seang,Tan, Ai Lian,Eng, Kae Yann,Ng, Bong Seng,Malik, Rozita Abdul,Ishak, Wan Zamaniah Wan Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.7

Purpose: To study the overall treatment time (OTT) and acute toxicity of intensity-modulated radiotherapy (IMRT) treatment for nasopharyngeal carcinoma (NPC). Methods: This retrospective study covered all NPC patients who underwent radical IMRT treatment at the Penang General Hospital from June 2011 to February 2012. Patients of any age and stage of disease with histologically proven diagnosis were included. Information was collected on patient demographics, clinical stage, treatment received, including any neoadjuvant and/or concurrent chemotherapy, acute toxity and completion of IMRT within the OTT. Results: A total of 26 NPC patients were treated with IMRT during the study period; 88.5% had stage III/IV disease. 45.2% received neo-adjuvant chemotherapy while 50.0% were given concurrent chemo-irradiation. All patients completed the treatment and 92.3% within the 7 weeks OTT. Xerostomia was present in all patients with 92.3% having grade 2. Severe grade III/IV acute toxicity occurred in 73.1% of patients, the commonest of which was oral mucositis (57.6%). This was followed by dysphagia which occurred in 53.8%, skin reactions in 42.3% and weight loss in 19.2%. However, haematological toxicity was mild with only one patient having leucopaenia. Conclusion: IMRT treatment for NPC is feasible in our center. More importantly, it can be delivered within the 7 weeks OTT in the majority of patients. Severe grade 3/4 toxicity is very common (73.1%) and thus maximal nutritional and analgesic support is required throughout the treatment.

직장암의 수술 후 방사선치료의 성적 - 예후 인자와 전체 치료기간이 미치는 영향에 관한 고찰 -

김주영,이명학,이규찬,Kim Joo-Young,Lee Myung-Hag,Lee Kyu-Chan 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.3

목적 : 국소적으로 진행된 직장암의 방사선치료에 있어 전통적인 치료방법으로 알려져 있는 근치적 수술 및 보조 방사선 및 항암치료의 성적을 알아보고 이에 영향을 미치는 예후 인자를 알아보기 위함이다. 대상 및 방법 : 1989년 7월 부터 1993년 12월 까지 항문상방 15 cm 이내에 존재하는 직장암으로 진단받고 근치적 수술을 받은 71명의 환자를 대상으로 후향적 분석을 시행하였다. 방사선치료는 6 MeV 선형가속기를 사용하여 주5회씩 5040 cGy 까지 조사되였고 수술후 21일에서 94일 사이에 시작되었고 5-FU와 ACNU chemotherapy가 4주 간격으로 시행되었다. 결과 : 전체환자의 5년 생존율과 5년 무병생존율은 각각 58.8$\%$및 57$\%$였다. 대상환자들의 2년 국소제어율은 76.6$\%$였다. 생존기간 및 무병생존기간의 중앙값은 각각 30개월 및 27개월이었다. 단변량 및 다변량분석시 무병생존율에 의미있게 예후인자로 작용했던 요인은 국소림프절로의 전이여부, 4개 이상의 임파선 전이, 6주이상의 수술과 방사선치료 시작 사이의 간격 및 7일 이상 지속되는 방사선치료 도중의 휴식기간 등이었다. 결론 : 국소적으로 진행된 직장암의 경우 근치적 수술 및 방사선치료 및 5-FU/ACNU를 기본으로 한 항암제를 시행하였을 때 B3 이상의 병기에서는 아직도 생존율이 저조하며 bowel wall penetration이 있거나 국소 림프절전이가 있을 때는 국소제어율도 환자의 절반 정도에서 밖에 얻을 수 없을 뿐만이 아니라 림프절전이가 없는 경우라도 원격전이율이 치료실패의 많은 부분을 차지함을 알 수 있었다. 이는 좀더 효과적인 항암치료제의 선택과 투여 방법이 방사선치료와 병행될 필요가 있음을 시사하며 수술 후 보조적인 방사선치료를 시행함에 있어서 방사선치료가 시작되는 기간이 지연될 때, 또 방사선치료가 7일 이상 중단될 때 치료결과에 영향을 줄 수 있음을 보여준다. 직장선암의 경우 수술과 방사선치료시작까지의 기간이 필요이상으로 연장되거나 치료중 휴식기간이 생겨 전체치료기간이 길어지지 않게 하여야 할 것이다. Purpose : To evaluate the results of the treatment of locally advanced but resectable rectal cancers and to analyze prognostic factors. especially with the emphasis on the treatment time factor. Materials and Methods : There were 71 patients with rectal cancer who had been treated by curative surgical procedure and postoperative radiotherapy from August 1989 to December 1993. The minimum follow up period was 24 months and the median follow-up was 35 months Radiation therapy had been given by 6 MV linear accelerator by parallel opposing or four-box portals. Whole pelvis was treated up to 5040 cGy in most cases. Systemic chemotherapy had been given in 94$\%$ of the patients, mostly with 5-FU/ACNU regimen. Assessment for the overall and disease-free survival rates were done by life-table method and prognostic factors by Log-Rank tests. Results : Five-year overall survival, disease-free survival were 58.8$\%$ and 57$\%$, respectively. Two-year local control rate was 76.6$\%$. Stage according to Modified Astler-Coller (MAC) system, over 4 positive lymph nodes, over 6weeks interval between definitive surgery and adjuvant radiotherapy and over 7 days of interruption during radiotherapy period were statistically significant, or borderline significant prognostic factors. Conclusion : The treatment results of patients with rectal cancers are comparable to those of other large institutes. The treatment results for the patients with bowel wall penetration and/or positive regional lymph nodes were still discouraging for their high local recurrence rate for the patients with MAC 'c' stage diseases and high distant metastases rate even for the patients with node-negative diseases. Maybe more effective regimen of chemotherapy would be needed with proper route and schedule. To maximize postoperative adjuvant treatment. radiotherapy should be started at least within 6 weeks after surgery and preferably as soon as wound healing is completed. Interruption of treatment during radiotherapy course affects disease-free survival badly, especially if exceeds 7 days. So, the total treatment period trout definitive surgery to the completion of radiotherapy should be kept as minimal as possiable.

Plenary Session lI : Serum Insulin-like Growth Factor-1 Levels and Prognosis of Early Hepatocellular Carcinoma; A Prospective Cohort Study

( Eun Ju Cho ),( Jeong Ju Yoo ),( Won Mook Choi ),( Min Jong Lee ),( Yuri Cho ),( Dong Hyeon Lee ),( Yun Bin Lee ),( Su Jong Yu ),( Jeong Min Lee ),( Kyung Suk Suh ),( Yoon Jun Kim ),( Jung Hwan Yoon 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

reflects hepatic synthetic function and plays an important role in the development and progression of various cancers. In this study, we investigated whether pretreatment serum IGF-1 levels predict time-to-recurrence (TTR) and overall survival (OS) in patients with early-stage hepatocellular carcinoma (HCC) after curative treatment. Methods: Consecutive HCC patients who had undergone surgical resection, radiofrequency ablation, or percutaneous ethanol injection as curative treatments of early HCC were included from two prospective cohorts and the training set (n=101) and the validation set (n=91) were established. Serum samples were collected before treatment and the levels of IGF-1 and IGF-binding protein-3 (IGFBP-3) were analyzed with regard to their associations with recurrence and survival. Results: In the training set, patients with low IGF-1 levels showed significantly shorter TTR (median, 14.4 months; 95% confidence interval [CI], 10.2-18.6) than patients with high IGF-1 levels (median, 50.2 months; 95% CI, 36.8-64.8; P<0.001) during a median follow-up period of 52.4 months. In the multivariate analysis, low levels of IGF-1 was an independent predictor of recurrence (hazard ratio [HR], 2.76; 95% CI, 1.66-4.62; P<0.001). Furthermore, together with high serum alpha-fetoprotein and multiple tumors, low levels of IGF-1 was significantly associated with poorer OS (HR, 8.08; 95% CI, 1.97-33.05; P=0.004). Applied to the independent validation set, low serum IGF-1 levels maintained its prognostic value for shorter TTR and OS. Conclusions: Low baseline IGF-1 levels independently correlated with shorter TTR and poorer survival in patients with early-stage HCC after curative treatment.

Surgery-first approach reduces the overall treatment time without damaging long-term stability in the skeletal class III correction: a preliminary study

박영욱,권광준,강예진,장인산 대한악안면성형재건외과학회 2021 Maxillofacial Plastic Reconstructive Surgery Vol.43 No.-

Background: Compared to the conventional approach, including preoperative orthodontic preparation, the socalled surgery-first approach (SFA) seems to reduce the overall treatment time in the correction of skeletal class IIIdentofacial deformity. However, there have been controversies about postoperative skeletal stability with SFA. Therefore, we investigated the long-term stability and the overall treatment time after maxillomandibular surgeryfor skeletal class III correction with or without preoperative orthodontic preparation. Methods: This retrospective study included eight patients who underwent maxillomandibular surgery for class IIIcorrection with the SFA (SFA group) and 20 patients who underwent the conventional approach (CA group). Acomparative study of the change in the maxillary and mandibular position on preoperative (T1), 1-day (T2), 6-month(T3), and 2-year (T4) postoperative lateral cephalograms. We calculated the overall treatment time for each group. Results: At the presurgical stage (T1), there was no bias in the skeletal features between the two groups. In the surgicalchange from T1 to T2, the mandible (point B) of the CA group was significantly moved superiorly. Short-term changesfrom T2 to T3 revealed that the mandible moved forward in both groups, whereas the maxillary position showed nosignificant changes. Long-term changes from T3 to T4 demonstrated that none of the measured parameters showedany significant differences. Finally, the average of overall treatment time was 15.1 months in the SFA group and 26.0months in the CA group. Conclusions: These findings suggest that SFA in bimaxillary orthognathic surgery for skeletal class III correction leadsto predictable long-term skeletal stability, similar to surgery with CA. Furthermore, SFA reduced the overall treatmenttime compared to CA