• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.3897-3901
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• 2016

Background: Breast cancer is by far the most frequent cancer of women (23% of all cancers), ranking second overall when both sexes are considered together. Since there has been change in clinico-pathological factors and treatment profiles for breast cancer patients over the years, the present study to evaluate the change trends in India. Materials and Methods: A detailed analysis was carried out with respect to age, menopausal status, family history, disease stage, surgery performed, histopathology, hormone receptor status, and use of chemotherapy or hormonal therapy. Change in various clinico-pathological factors and treatments of breast cancer cases was recorded and analysed. Results: Mean age at presentation was found to be earlier in 2005-2006 compared with 1997-98 (p value: 0.046). More premenopausal women were diagnosed with breast cancer in 2005-2006 when this was compared with initial years of assessment (p value ${\leq}0.001$). When change in the receptor status was evaluated, we observed that there was a decrease in cases of ER and PR receptor positivity which was significant (p value: 0.007). Over the period of time, more f patients were not offered surgery initially in view of advanced disease when the two time periods were compared (p value: ${\leq}0.001$). There was a significant increase in patients who were initially offered neo-adjuvant chemotherapy in view of advanced disease at presentation (p value: ${\leq}0.001$). There was increasing number of patients who received palliative treatment for symptoms in 2005-2006 when compared to patients treated in 1997-98((p value: ${\leq}0.001$). Conclusions: Changes in mean age at presentation, premenopausal status, and stage at presentation have occurred over the years. More aggressive patterns of disease have become more common with early age at presentation and aggressive biological behaviour with receptor negative tumours.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.5989-5993
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• 2013

Background: Radiation therapy is the mainstay of treatment for nasopharyngeal carcinoma. Importance of tumor coverage and challenges posed by its unique and critical location are well evident. Therefore we aimed to evaluate our radiation treatment plan through dose volume histograms (DVHs) to find planning target volume (PTV) dose coverage and factors affecting it. Materials and Methods: This retrospective study covered 45 histologically proven nasopharyngeal cancer patients who were treated with definitive 3D-CRT and chemotherapy between Feb 2006 to March 2013 at the Department of Oncology, Section Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan. DVH was evaluated to find numbers of shrinking field (phases), PTV volume in different phases and its coverage by the 95% isodose lines, along with influencing factors. Results: There were 36 males (80%) and 9 females (20%) in the age range of 12-84 years. Stage IVA (46.7%) was the most common stage followed by stage III (31.1). Eighty six point six-percent received induction, 95.5% received concurrent and 22.2% received adjuvant chemotherapy. The prescribed median radiation dose was 70Gy to primary, 60Gy to clinically positive neck nodes and 50Gy to clinically negative neck regions. Mean dose to spinal cord was 44.2Gy and to optic chiasma was 52Gy. Thirty seven point eight-percent patients completed their treatment in three phases while 62.2% required four to five phases. Mean volume for PTV3 was $247.8cm^3$ (50-644.3), PTV4 $173.8cm^3$ (26.5-345.1) and PTV5 $119.6cm^3$ (18.9-246.1) and PTV volume coverage by 95% isodose lines were 74.4%, 85.7% and 100% respectively. Advanced T stage, intracranial extension and tumor volume > $200cm^3$ were found to be important factors associated with decreased PTV coverage by 95% isodose line. Conclusions: 3D CRT results in adequate PTV dose coverage by 95% isodose line. However advanced T stage, intracranial extension and large target volume require more advanced techniques like IMRT for appropriate PTV coverage.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4567-4570
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• 2013

Background: Nasopharyngeal carcinoma (NPC) is the commonest radiocurable cancer in Malaysia. This study aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated in University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with NPC referred for treatment to the Oncology unit at UMMC from 2004-2008 were retrospectively analyzed. Treatment outcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), locoregional control (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survival analysis and differences in survival according to AJCC stage was compared using the log-rank test. Results: A total of 176 patients with newly diagnosed NPC were treated in UMMC during this period. Late presentation was common, with 33.5% presenting with T3-4 disease, 84.7% with N1-3 disease and 75.6% with AJCC stage 3-4 disease. Radical RT was given to 162 patients with 22.7% having RT alone and 69.3% having CCRT. The stipulated OTT was 7 weeks and 72.2% managed to complete their RT within this time period. Neoadjuvant chemotherapy was given to 14.8% while adjuvant chemotherapy was administered to 16.5%. The 5 years OS was 51.6% with a median follow up of 58 months. The 5 years OS according to stage were 81.8% for stage I, 77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were 54.4%, 48.4% and 70.6%, respectively. RT related late effects were documented in 80.2%. The commonest was xerostomia (66.7%). Other documented late effects were hearing deficit (17.3%), visual deficit (3.1%), neck stiffness (3.1%), dysphagia (3.4%), cranial nerve palsy (2.5%), pneumonitis (0.6%) and hypothyroidism (1.2%). Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especially those utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.627-635
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• 2011

Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap (4 cases), extended LD flap with STSG (3 cases), thoracoabdominal flap (4 cases) and thoracoepigastric flap (3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients' oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

• Journal of Life Science
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• v.33 no.11
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• pp.876-886
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• 2023

In some cases of head and neck cancers (HNC), surgical interventions may result in the loss of organs and/or changes to their functions, thereby significantly affecting the patient's quality of life. As a result, the surgical treatment of HNC patients is often limited to specific cases, and alternative treatment modalities, such as chemotherapy, are considered. However, serious adverse effects caused by chemotherapy, such as severe nausea and vomiting, necessitate the need for the development of adjunctive methods to minimize patient suffering. Chuanxiong, Ligusticum chuanxiong (L. chuanxiong), is a natural herb used in Eastern medicine to treat cerebrovascular disorders and headaches. This study aimed to predict the effect and potential of L. chuanxiong as an auxiliary anticancer drug through network-based pharmacology and molecular docking analysis. The study results showed that 40 out of 41 genes of L. chuanxiong shared common targets of HNC and their proteins could be used to target HNC cells to prevent cancer progression. The results of the functional enrichment analysis confirmed that L. chuanxiong is associated with the neuroactive-ligand metabolism and neurotransmitter pathways, indicating its potential medicinal value as an adjuvant in HNC treatment. Lastly, our findings demonstrated that the active ingredient of L. chuanxiong, (Z)-Ligustilide, has the ATP binding site of heat shock protein 90, a protein known to promote the activation of cancer cells. These results suggest that L. chuanxiong is a promising candidate for developing auxiliary anticancer drugs, and further research could potentially lead to the discovery of newer and safer anti-cancer agents.

• Journal of Gastric Cancer
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• v.20 no.2
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• pp.202-211
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• 2020

Purpose: This study was to investigate the prognostic significance of the preoperative fibrinogen and systemic inflammation response index (F-SIRI) in a Chinese cohort of resectable gastric cancer. Materials and Methods: Baseline characteristics, preoperative fibrinogen levels and peripheral neutrophil, monocyte, and lymphocyte counts were retrospectively reviewed in 240 patients who underwent radical gastrectomy. The optimal cut-off values for fibrinogen and SIRI were defined as 4.0 g/L and 1.2. Then patients with hyperfibrinogenemia (≥4.0 g/L) and high SIRI (≥1.2) were assigned with an F-SIRI of 2 (both of these hematological abnormalities), 1 (one of these abnormalities), and 0 (neither abnormality), respectively. The prognostic value was examined by univariate and multivariate survival analysis. Results: Preoperative F-SIRI was significantly correlated with tumor size, fibrinogen level, and adjuvant chemotherapy. Whereas there was no significant difference in age, gender, tumor location or other characteristics between groups. In addition, high preoperative F-SIRI was significantly associated with worse disease-free survival (DFS) (hazard ratio [HR], 2.299; 95% confidence interval [CI], 1.482-3.566; P<0.001) and overall survival (OS) (HR, 2.461; 95% CI, 1.584-3.824; P<0.001) by univariate survival analysis. Moreover, it remained an independent predictor for impaired DFS (HR, 2.023; 95% CI, 1.273-3.215; P=0.003) and OS (HR, 2.341; 95% CI, 1.480-3.705; P<0.001) in multivariate Cox regression analysis. Conclusions: Preoperative F-SIRI could serve as a significantly prognostic marker for long-term survival in Chinese patients who underwent radical gastrectomy.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4735-4739
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• 2016

Background: Intrahepatic cholangiocarcinoma (IHCCA) is an aggressive tumor for which surgical resection is a mainstay of treatment. However, recurrence after resection is common associated with a poor prognosis. Studies regarding recurrence of mass-forming IHCCA are rare; therefore, we investigated the pattern with our dataset. Methods: We retrospectively reviewed the medical and pathological records of 50 mass-forming IHCCA patients who underwent hepatic resection between January 2004 and December 2009 in order to determine the patterns of recurrence and prognosis. All demographic and operative parameters were analyzed for their effects on recurrence-free survival. Results: The median recurrence-free survival time was 188 days (95%CI: 149-299). The respective 1-, 2-, and 3-year recurrence-free survival rates were 16.2% (95%CI: 6.6-29.4), 5.4% (95%CI: 1.0-15.8) and 2.7% (95%CI: 0.2-12.0). There was an equal distribution of recurrence at solitary and multiple sites. Univariate analysis revealed no factors related to recurrence-free survival.Conclusion: The overall survival and recurrence-free survival after surgery for mass-forming IHCCA were found to be very poor. Almost all recurrences were detected within 2 years after surgery. Adjuvant chemotherapy after surgery may add benefit in the affected patients.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4577-4581
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• 2016

Objective: The aim of this study was to assess thyroid function in breast cancer patients exposed to therapeutic external beam radiation. The focus was on possible progressive changes and any relationships between the incidence of primary hypothyroidism, the time required to become hypothyroid, and factors such as chemotherapy, hormonotherapy and immunotherapy. Materials and Methods: Seventy females undergoing 3D conformal and IMRT radiation therapy for breast cancers were enrolled in a non-randomized prospective study. The patients was divided into two groups: those after mastectomy or breast conserving surgery (BCS) were irradiated to a scar of the chest wall/breast and the ipsilateral supraclavicular and the axillary areas (supraclavicular radiotherapy group - SC-RT group - 32 patients) and the control group receiving adjuvant chest wall/breast RT only (BCT group - 38 patients).The total doses were 50.0 to 70 Gy in 5 to 7 weeks. The median follow-up term was 24 months (range, 1-40 months). Thyroid function was evaluated by measuring thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. The minimum, maximum and mean thyroid gland doses for 20 Gy (V20) were calculated for all patients. Results: Statistically significant results were obtained for the SC-RT group. Two yearsa fter the end of RT the chance of an event was increased in 6% of the population (p=0.009) in the SC-RT group. In the BCT group no significance was noted. No statistically significant differences were found for V20, chemio-, immunotherapy and hormonotherapy or Ki67 values (p=0.12). No significant results were obtained for development of hypothyroidism and clinical factors (age, thyroid volume, treatment modalities). Conclusion: Radiotherapy is associated with a higher incidence of thyroid toxicity in breast cancer patients. Routine thyroid function monitoring should be recommended in such cases.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.1
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• pp.36-40
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• 2014

Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.318-321
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• 2002

The esophageal lymphoma is a very rare feature among gastrointestinal lymphoma, and there was no surgical report in Korea. A 62-year-old male patient with submucosal tumor detected on routine esophagoscopy had resection of tumor including the esophageal mucosa, which was confirmed as esophageal lymphoma. As the severe leakage was detected on esophagogram on post-op 7th day, esophagectomy and esophagogastrostomy was followed. Though adjuvant chemotherapy was not performed, there were no evidence of recurrence for 1 year follow up. We experienced a patient with esophageal lymphoma and reported with brief review of literature