• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8667-8671
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• 2014

Background: Survival rates after resection of advanced gastric cancer are extremely poor. An increasing number of patients with gastric carcinomas (GC) are therefore being treated with preoperative chemotherapy. We evaluated 36 month survival rate of GC patients that were treated by adding a neoadjuvant chemoradiotherapy before gastrostomy.Materials and Methods: Patients with stage II or III gastric adenocarcinomas were enrolled. The patients divided into two groups: (A) Neoadjuvant group that received concurrent chemoradiation before surgery (4500cGy of radiation at 180cGy per day plus chemotherapy with cisplatin and 5-fluorouracil, in the first and the end four days of radiotherapy). Resection was attempted 5 to 6 weeks after end of chemoradiotherapy. (B) Adjuvant group that received concurrent chemo-radiation after surgical resection. Results: Two (16.7%) patients out of 12 patients treated with neoadjuvant chemo-radiotherapy and 5 (38.5%) out of 13 in the surgery group survived after 36 months. These rates were not significantly different with per protocol and intention-to-treat analysis. The median survival time of patients in group A and B were 13.4 and 21.6 months, respectively, again not significantly different. Survival was significantly greater in patients with well differentiated adenocarcinoma in group B than in group A (p<0.004). Conclusions: According to this study we suggest surgery then chemoradiotherapy for patients with well differentiated gastric adenocarcinoma rather than other approaches. Additional studies with greater sample size and accurate matching relying on cancer molecular behavior are recommended.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6059-6064
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• 2014

Background: Colorectal cancer is the second most frequent cancer in Malaysia. Nevertheless, there is little information on treatment and outcomes nationally. We aimed to determine the demographic, clinical and treatment characteristics of colorectal cancer patients treated at the University Malaya Medical Centre (UMMC) as part of a larger project on survival and quality of life outcomes. Materials and Methods: Medical records of 1,212 patients undergoing treatment in UMMC between January 2001 and December 2010 were reviewed. A retrospective-prospective cohort study design was used. Research tools included the National Cancer Patient Registration form. Statistical analysis included means, standard deviations (SD), proportions, chi square, t-test/ANOVA. P-value significance was set at 0.05. Results: The male: female ratio was 1.2:1. The mean age was 62.1 (SD12.4) years. Patients were predominantly Chinese (67%), then Malays (18%), Indians (13%) and others (2%). Malays were younger than Chinese and Indians (mean age 57 versus 62 versus 62 years, p<0.001). More females (56%) had colon cancers compared to males (44%) (p=0.022). Malays (57%) had more rectal cancer compared to Chinese (45%) and Indians (49%) (p=0.004). Dukes' stage data weres available in 67%, with Dukes' C and D accounting for 64%. Stage was not affected by age, gender, ethnicity or tumor site. Treatment modalities included surgery alone (40%), surgery and chemo/radiotherapy 32%, chemo and radiotherapy (8%) and others (20%). Conclusions: Significant ethnic differences in age and site distribution, if verified in population-based settings, would support implementation of preventive measures targeting those with the greatest need, at the right age.

• Radiation Oncology Journal
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• v.27 no.2
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• pp.71-77
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• 2009

Purpose: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and Methods: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of $\geq$45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). Results: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. Conclusion: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.100-106
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• 2001

Purpose : We performed a retrospective analysis to compare short term results of induction chemotherapy-radiotherapy versus concurrent chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma. Materials and Methods : From Oct. 1989 to May 1998, 62 patients with locally advanced nasopharyngeal carcinoma were treated with induction chemotherapy followed by radiotherapy (induction group) or concurrent chemo-radiotherapy (concurrent group). Induction chemotherapy was done for 50 patients, and concurrent chemotherapy for 12 patients. Age, sex, performance status, and pathologic types were evenly distributed between two groups. Stage distribution showed $32\%$ with IIB, $32\%$ with III, and $38\%$ with IV in induction group, and $50\%,\;33.3\%,\;and\;16.7\%$ in concurrent group, respectively. Chemotherapy regimen was CF (cisplatin and 5-FU) in both groups, and drug delivery method also same. Cisplatin $100\;mg/m^2$ was intravenously infused on day 1, and 5-FU $1,000\;mg/m^2$ on day $2\~6$. This was repeated at 3 weeks interval. At the end of radiotherapy, total cycles of chemotherapy were $1\~3$ (median 2) in both groups. Conventionally fractionated radiotherapy with daily fraction size $1.8\~2.0\;Gy$ and 5 fractions/week was done. Total dose was $69.4\~86\;Gy$(median 73.4 Gy) for induction group, and $69.4\~75.4\;Gy$ (median 70.8 Gy) for concurrent group. Follow-up time was $9\~116$ months (median 40.5 months) for induction group, $14\~29$ months (median 21 months) for concurrent group, respectively. Results : Overall 2 year survival rate (2YSR) for all patients was $78.7\%$. According to treatment modality, 2YSR were $77\%$ for induction group, $87\%$ for concurrent group (p>0.05). 2 year disease-free survival rate were $56\%$ and $81\%\;(p>0.05)$, respectively. Complete response to treatment were $75.5\%$ for induction group and $91.7\%$ for concurrent group, but there was no statistical difference. The incidence of grade $3\~4$ hematologic toxicity during radiotherapy was not differ between two groups, but grade 2 leukopenia was more frequent in concurrent group $(18\%\;vs\;66.7\%)$Grade $3\~4$ mucositis was more frequent in concurrent group $(4.0\%\;vs\;33.3\%)$. Overall incidence of grade $3\~4$ acute toxicity during radiotherapy was more frequent in concurrent group $(6.0\%\;vs\;41.7\%,\;p=0.005)$. Conclusion : Concurrent chemo-radiotherapy showed a trend of improvement in short-term survival and in treatment response when compared with induction chemotherapy-radiotherapy in locally advanced nasopharyngeal carcinoma. More controlled randomized trial are needed.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.1
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• pp.77-81
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• 2015

Background: The aim of the study was to determine whether the expression of baseline phosphorus (P) and magnesium (Mg) levels were prognostic in terms of stage and overall survival (OS) in newly diagnosed non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Materials and Methods: Retrospectively, 130 patients were selected at the time of diagnosis oflung cancer (100 with NSCLC and 30 with SCLC), before the initialization of any chemo-radiotherapy. The median age was 67 (range 29-92). IA, IB, IIA, IIB, IIIA, IIIB and IV stages were present in 3, 4, 19, 6, 25, 8, and 65 patients, respectively. After centrifugation, the levels of serum P and Mg were measured using the nephelometric method/ photometry and evaluated before any type of treatment. Results: Higher than normal levels of P were found in 127/130 patients, while only four patients had elevated Mg serum values. In terms of Spearman test, higher P serum values correlated with either stage (rho=- 0.334, p<0.001) or OS (rho=-0.212, p=0.016). Additionally, a significant negative correlation of Mg serum levels was found with stage of disease (rho=-0.135, P=0.042). On multivariate cox-regression survival analysis, only stage (p<0.01), performance status (p<0.01) and P serum (p=0.045) showed a significant prognostic value. Conclusions: Our study indicated that pre-treatment P serum levels in lung cancer patients are higher than the normal range. Moreover, P and Mg serum levels are predictive of stage of disease. Along with stage and performance status, the P serum levels had also a significant impact on survival. This information may be important for stratifying patients to specific treatment protocols or intensifying their therapies. However, larger series are now needed to confirm our results.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.7025-7029
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• 2015

Background: The optimal sequence and extent of multimodality therapy remains to be defined for extrapulmonary small cell carcinoma because of its rarity. The purpose of our study was to assess the response to neoadjuvant chemotherapy followed by chemoradiation/radiation in patients with extrapulmonary small cell carcinoma. Materials and Methods: Four consecutively diagnosed patients were included in this study. The primary tumor site was oropharynx in three patients and esophagus in one. The patients with the limited disease were treated with chemotherapy followed by concurrent chemoradiation (n=2) or radiotherapy (n=1). The patient with the extensive disease with the primary site in vallecula was treated with chemotherapy and palliative radiotherapy to the metastatic site. Results: The median follow-up was 22.5 months (range, 8-24 months). Three patients with the limited disease (base of tongue, n=2; esophagus, n=1) were in complete remission. The patient with the extensive disease died of loco-regional tumor progression at 8 months from the time of diagnosis. Conclusions: The combination of chemotherapy and radiotherapy is the preferred therapeutic approach for patients with extrapulmonary small cell carcinoma. Induction chemotherapy followed by concurrent chemoradiation or radiation provides a good loco-regional control in patients with limited disease.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.797-802
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• 2015

Background: The purpose of this study was to prospectively evaluate the predictive value of perfusion computed tomography (CT) for response of local advanced esophageal carcinoma to radiotherapy and chemotherapy. Materials and Methods: Before any treatment, forty-three local advanced esophageal squamous cell carcinomas were prospectively evaluated by perfusion scan with 16-row CT from June 2009 to January 2012. Perfusion parameters, including perfusion (BF), peak enhanced density (PED), blood volume (BV), and time to peak (TTP) were measured using Philips perfusion software. Seventeen cases received definitive radiotherapy and 26 received concurrent chemo-radiotherapy. The response was evaluated by CT scan and esophagography. Differences in perfusion parameters between responders and non-responders were analyzed, and ROCs were used to assess predictive value of the baseline parameters for treatment response. Results: There were 25 responders (R) and 18 non-responders (NR). Responders showed significantly higher BF (R:34.1 ml/100g/min vs NR: 25.0 ml/100g/min, p=0.001), BV (23.2 ml/100g vs 18.3 ml/100g, p=0.009) and PED (32.5 HU vs 28.32HU, P=0.003) than non-responders. But the baseline TTP (R: 38.2s vs NR: 44.10s, p=0.172) had no difference in the two groups. For baseline BF, a threshold of 36.1 ml/100g/min achieved a sensitivity of 56%, and a specificity of 94.4% for detection of clinical responders from non-responders. Conclusions: The results suggest that the perfusion CT can provide some helpful information for identifying tumors that may respond to radio-chemotherapy.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.265-276
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• 2000

Purpose : Between January 1983 and December 1988, 218 female Patients with known breast cancer and positive axillary nodes were treated with adjuvant radiotherapy and chemotherapy following radical mastectomy. Treatment results were retrospectively analysed at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University of College of Medicine. Materials and Methods : The patients were classified into 3 groups; group I included II patients treated with adjuvant chemotherapy alone; in group 2, 52 patients treated with radiotherapy alone; and in group 3, n patients treated with combined chemo-radiotherapy. The mean age was 44 years and ranged from 27 to 70. The median follow-up time was 51 months. Results :Seven-year relapse free and overall survival rates were 56$\%$ and 67$\%$; in group 1, 50$\%$ and 56$\%$ in group 2, 51$\%$ and 65$\%$ and in group 3, 62$\%$ and 75$\%$ respectively. This difference was not statistically significant(p<0.05). The loco-regional failure rates were 13$\%$ and distant failure rates were 33$\%$. There was less risk of loco-regional failure in group 2 and 3 which included radiotherapy (p<0.05). But there was no significantly difference in the rates of distant failure( p>0.05). By univariate analysis, the only significant prognostic factor affecting relapse-free survival was the percentage of positive axillary nodes; and the overall survival significantly correlated with the primary tumor site, the number or percentage of positive axillary nodes, and stage. But in multivariate analysis, the only significant prognostic factor was treatment modality. By univariate analysis of prognostic factors affecting the rates of overall failure and distant failure, the significant prognostic factors was the percentage of positive axillary nodes; and the risk of the loco-regional failure significantly correlated with the treatment modality. Conclusion :In conclusion, these results suggest a potential for decreasing the risk of loco-regional failure with the addition of postoperative radiotherapy to chemotherapy in the premenopausal patients, and in the patients with number or percentage of positive nodes more than 4 or 1/3. The results of this study suggest that the combined chemo-radiotherapy as adjuvant treatment following radical mastectomy was the most effective modaliw in groups of 2$\~$5 cm sized tumor, stage IIB, and in patients with more than 4 or 1/3 of number or percentage of positive nodes.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.237-244
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• 2001

Purpose : To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. Method and Materials : From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by $39.6\~45\;Gy$ pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. Results : The Patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients $(81\%)$ successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients $(58\%)$ were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were $80\%\;and\;14\%$, respectively (u=0.001). Conclusion : In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

• Journal of Chest Surgery
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• v.26 no.12
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• pp.934-939
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• 1993

Mediastinal lymph node involvement [N2 disease] is generally accepted as an important factor influencing the outcome of patients with lung cancer.The long-term survival rates of completely resected patients with N2 disease are frequently reported from 15% to 30%.To improve the management and the outcome of patients with resectable N2 disease, we analyzed the survival rates and the prognostic factors for resected N2 lung cancer. Between August 1989 and September 1993, we experienced 27 patients with N2 disease of 115 surgically treated lung cancer at the Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University Medical School. Of these 27 N2 disease 4 had only an exploratory thoracotomy, and 23 underwent pulmonary resection by pneumonectomy[15], bilobectomy[3], lobectomy[4] and sleeve lobectomy[1].All of resected 23 patients received postoperative adjuvant chemotherapy[3], radiotherapy[2] or combined chemo-radiotherapy[18].Complete follow-up was obtained in 23 patients and median survival was 22 months and overall 1-year and 2-year survival rates by Kaplan-Meir method were 65 % and 45 %, respectively. Survival differences according to histology, tumor location, number of positive nodal station and operative method were not significant, statistically. Conclusively, we think that in resectable N2 lung cancer, complete tumor resection and mediastinal lymph node dissection, and postoperative adjuvant therapy should be done to improve the survival.