• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.1121-1126
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• 2013

Background: Palliative chemotherapy with cisplatin/5-fluorouracil (5FU) is the commonest regimen employed for metastatic and recurrent head and neck squamous cell carcinoma (SCCHN) and nasopharyngeal carcinoma (NPC). However, this regimen is cumbersome requiring 5 days of admission to hospital. Carboplatin/5FU may be an alternative regimen without compromising survival and response rates. This study aimed to compare the efficacy and toxicity of carboplatin/5FU regimen with the cisplatin/5FU regimen. Materials and Methods: This retrospective study looked at patients who had palliative chemotherapy with either cisplatin/5FU or carboplatin/5FU for metastatic and recurrent SCCHN and NPC. It included patients who were treated at UKMMC from $1^{st}$ January 2004 to $31^{st}$ December 2009 with either palliative IV cispaltin 75 $mg/m^2$ D1 only plus IV 5FU 750 $mg/m^2$ D1-5 infusion or IV Carboplatin AUC 5 D1 only plus IV 5FU 500 $mg/m^2$ D1-2 infusion plus IV 5FU 500 $mg/m^2$ D1-2 bolus. The specific objectives were to determine the efficacy of palliative chemotherapy in terms of overall response rate (ORR), median progression free survival (PFS) and median overall survival (OS) and to evaluate the toxicities of both regimens. Results: A total of 41 patients were eligible for this study. There were 17 in the cisplatin/5FU arm and 24 in the carboplatin/5FU arm. The ORR was 17.7 % for cisplatin/5FU arm and 37.5 % for carboplatin/5FU arm (p-value=0.304). The median PFS was 7 months for cisplatin/5FU and 9 months for carboplatin/5FU (p-value=1.015). The median OS was 10 months for cisplatin/5FU arm and 12 months for carboplatin/5FU arm (p-value=0.110). There were 6 treatment-related deaths (6/41=14.6%), four in the carboplatin/5FU arm (4/24=16.7%) and 2 in the cisplatin/5FU arm (2/17=11.8%). Grade 3 and 4 hematologic toxicity was also more common with carboplatin/5FU group, this difference being predominantly due to grade 3-4 granulocytopenia (41.6% vs. 0), grade 3-4 anemia (37.5% vs. 0) and grade 3-4 thrombocytopenia (16.6% vs. 0). Conclusions: Carboplatin/5FU is not inferior to cisplatin/5FU with regard to its efficacy. However, there was a high rate of treatment-related deaths with both regimens. A better alternative needs to be considered.

• Journal of Digestive Cancer Research
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• v.3 no.1
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• pp.30-34
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• 2015

We report a case of a 55-year-old man who diagnosed with advanced gastric cancer (AGC), with A review of the literature. A 55-year old man was transferred to our hospital for further evaluation and treatment after being diagnosed with adenocarcinoma through endoscopic biopsy during a regular health examination. An abdominal computed tomography (CT) showed AGC, stage IIA (T3N3M0), while an endoscopic examination showed AGC, Borrmann type 2. The patient is currently under observation after undergoing radical subtotal gastrectomy with gastroduodenostomy and subsequent administration of oral chemotherapeutic agents. As an abdominal CT response assessment performed after surgery revealed new metastasis to the liver, the patient received palliative chemotherapy as progressive disease was suspected. After receiving chemotherapy in the order of FOLFOX (5-fluorouracil (5-FU)) + Leucovorin + Oxaliplatin), FOLFIRI (5-FU + Leucovorin + Irinotecan), EAP-II (Etoposide + Doxorubicin + Cisplatin), ELF (Etoposide + Leucovorin + 5-FU), TS-1 (Tegafur + Gimeracil) + Cisplatin, an abdominal CT response assessment showed progressive disease for which the regimen was altered to PFL (Paclitaxel + 5-FU + Leucovorin). The patient has currently completed his second cycle of chemotherapy and after an abdominal CT response assessment, further course of therapy will be decided.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3565-3568
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• 2013

Background: Cholangiocarcinoma is the most common cancer in males in Thailand. The outcome is poor although systemic chemotherapy has been used in attempts to improve disease control, quality of life and prolong survival in patient with unresectable and advanced disease. Materials and Methods: In this retrospective study the medical records of all patients diagnosed as having unresectable and metastatic cholangiocarcinoma and receiving systemic chemotherapy at Udonthani Cancer Hospital during January 2007 to December 2010 were reviewed. Results: Among the total of 105 patients, 21 received gemcitabine-based chemotherapy and 84 5FU-based chemotherapy. Most received platinum doublet regimens. 5FU-based regimens yielded an overall response rate (tumor control) of 23.8% and a median survival of 7.2 months while gemcitabine-based regimens yielded an overall response rate (tumor control) 19.1% and a median survival of 10.0 months. Conclusions: Tumor control and survival of patient with advanced cholangiocarcinoma treated with gemcitabine-based and 5FU-based chemotherapy do not markedly differ.

• Journal of Korean Biological Nursing Science
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• v.24 no.2
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• pp.86-94
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• 2022

Purpose: Patients experiencing chemotherapy-induced peripheral neuropathy (CIPN) apply various palliative care as well as drugs in their daily life to alleviate symptoms. There is a need to identify the influence of these efforts and patients' psychosocial status on the relief of CIPN symptoms. This short-term prospective study investigated how prescription drugs, non-pharmacological behaviors (exercise, massage, and heat therapy), and psychological states (social support, depression, and anxiety) affected CIPN symptoms. Methods: Participants scheduled to receive postoperative platinum or taxane-based chemotherapy were enrolled consecutively. CIPN was measured with the Neurotoxicity-12 subscale of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity-12 instrument. Data were collected three times during the 4 or 5 cycles of chemotherapy. Results: At the end of the 2nd chemotherapy cycle, 93.1% of participants reported CIPN symptoms. Multiple regression analyses showed that a heat therapy (β= -.34, p< .001), massage (β= -.21, p= .012), and walking 5 times or more per week (β= -.26, p= .021) provided relieve for CIPN symptoms. Depression (β= .19, p= .027) significantly exacerbated CIPN symptoms. Conclusion: These results suggested that a comprehensive management program that includes walking, heat therapy, massage, and mood therapy should be encouraged. Moreover, patients should be educated at chemotherapy initiation to understand appropriate interventions that can relieve CIPN symptoms.

• Journal of Hospice and Palliative Care
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• v.4 no.2
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• pp.130-136
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• 2001

Purpose : It is very important to endow the cancer patients underwent chemotherapy with satisfactory quality of life (QOL). However, little is known about the factors influencing QOL during chemotherapy. Therefore, we designed this study to find out the factors influencing QOL in the cancer patients who underwent chemotherapy. Methods : Ninety-seven cancer patients were studied, prospectively. The patients' characteristics were as follows; median age(range): 48(19{\sim}83) years, male:female; 57:40, PS:0,1/2,3;55/42 patients, diagnosis(number): lymphoma (28), lung cancer (22), gastrointestinal cancer (18), sarcoma (12), breast cancer (12), gynecological cancer (5), Stage: I,II/III.IV;37/60 patients. We used EORTC QLQ-C30 questionnaires to evaluate QOL. EORTC QLQ-C30 scores were performed before the onset of chemotherapy and after the end of 3 cycles of chemotherapy. The correlation of these scores with performance status (PS), diagnosis, disease stage, response to chemotherapy, and regimen related toxicity was evaluated. Results : The responder group (CR, PR) demonstrated marked improvement of social functional and emotional scales to non-responder group (SD,PD) (P=0.024, 0.045). Non-hematologic regimen related toxicity such as mucositis, nausea and vomiting was significantly correlated with pain scale change (P=0.043). Other factors had no notable correlation with QOL changes. Conclusion : Our preliminary study results may suggest as follows. The response to chemotherapy is associated with the change of social functional and emotional scales and the severity of non-hematologic regimen related toxicity is associated with pain scale change.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.23
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• pp.10165-10169
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• 2015

Background: Megestrol acetate (MA) is a steroid origin medicine often used for control of cachexia in oncologic palliative care. Thrombosis is a common problem in oncology patients. One question is whether MA can cause thrombosis. This retrospective, registry-based analysis was therefore conducted to assess thrombotic processes in oncology patients using MA concurrent with chemotherapy. Materials and Methods: Data on oncology patients at the metastatic stage using MA were obtained from the archives of our center. Outcomes of patients were evaluated for thromboembolic events (VTEs) during treatment. Results: Ninety-seven oncology patients with a median age of 62 (33-84) years were included. During the median follow-up of 17 months, 58 (59.8%) died leaving 39 (31.2%) still alive. Median overall survival (OS) was 19 months (6-180). Mean time of MA use was 8.69 months(${\pm}3.53$), with a median dose of 160mg (range 160-480mg). Eleven VTEs were detected after MA use, 4 of these in pancreatic cancer cases. The patients with thrombosis non-significantly had worse OS, than those without thrombosis (p=0.106). Conclusions: This trial revealed that the 11.3% of all patients developed thrombosis,who had been treated with MA and chemotherapy concomittantly. There was no statistically significant difference regarding to occurrence of thrombotic process, among the patients receiving different chemotherapy regimens with MA concomittantly. Pancreatic cancer seemed to be related to thrombosis rather than MA use.

• Radiation Oncology Journal
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• v.35 no.2
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• pp.144-152
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• 2017

Purpose: The role of radiotherapy (RT) was largely deserted after the introduction of platinum-based chemotherapy, but still survival rates are disappointingly low. This study focuses on assessing the clinical efficacy of RT in relation to chemotherapy resistance. Materials and Methods: From October 2002 to January 2015, 44 patients were diagnosed with epithelial ovarian cancer (EOC) and treated with palliative RT for persistent or recurrent EOC. All patients received initial treatment with optimal debulking surgery and adjuvant platinum-based chemotherapy. The biologically effective dose (BED) was calculated with ${\alpha}/{\beta}$ set at 10. Ninety-four sites were treated with RT with a median BED of 50.7 Gy (range 28.0 to 79.2 Gy). The primary end-point was the in-field local control (LC) interval, defined as the time interval from the date RT was completed to the date any progressive or newly recurring disease within the RT field was detected on radiographic imaging. Results: The median follow-up duration was 52.3 months (range 7.7 to 179.0 months). The 1-year and 2-year in-field LC rates were 66.0% and 55.0%, respectively. Comparisons of percent change of in-field tumor response showed similar distribution of responses among chemoresistant and chemosensitive tumors. On multivariate analysis of predictive factors for in-field LC analyzed by sites treated, $BED{\geq}50Gy$ (hazard ratio, 0.4; confidence interval, 0.2-0.9; p = 0.025) showed better outcomes. Conclusion: Regardless of resistance to platinum-based chemotherapy, RT can be a feasible treatment modality for patients with persistent of recurrent EOC. The specific role of RT using updated approaches needs to be reassessed.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1597-1602
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• 2014

The purpose of this study was to investigate whether whole-liver radiotherapy plus a tumor-boost dose with concurrent chemotherapy is beneficial for colorectal cancer patients with massive and multiple liver metastases. From January 2007 to December 2012, 19 patients who exhibited massive (with a longest diameter > 5 cm) and invasive liver metastases and multiple metastases were treated with radiotherapy and concurrent chemotherapy. The total radiation dose was 53.4 Gy (range 38.8 Gy-66.3 Gy). All of the patients received a continuous intravenous dose of 5 fluorouracil (5-FU) 225 mg/m2 concurrently with radiation. The median survival time was 19 months. The 1- and 2- year overall survival rates were 78.3% and 14.3%, respectively. Of all of the patients who presented with abdominal pain, 100% experienced a decrease in pain. Decreases in the rates of ascites and jaundice were confirmed by ultrasound and bilirubin levels. No cases of Grade 4 or 5 acute or late toxicity were recorded. There were only two cases of Grade 3 toxicity (elevated bilirubin). These data provide evidence that whole-liver radiotherapy plus a tumor-boost dose with concurrent chemotherapy is beneficial for colorectal cancer patients with massive and multiple liver metastases.

• Journal of Korean Traditional Oncology
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• v.27 no.1
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• pp.57-66
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• 2022

Objective: To report the improvements with Korean medicine-based integrative cancer therapies on adverse effects of adjuvant chemotherapy in non-small cell lung cancer patients. Method: There were two patients complained cough, rhinorrhea, numbness, general weakness, nausea and dyspepsia after chemotherapy. They got treated centered on Korean medicine including herbal medicine, acupuncture, electro-acupuncture, pharmacopuncture, moxibustion, hand and foot bath. They were also treated Western immunotherapies like Thymosin at regular intervals. The symptoms were measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care(EORTC QLQ C-15 PAL) and their subjective assessments. Results: Their chief complaints were relieved and their quality of life scores was improved even though they have been receiving chemotherapy continuously. Conclusion: These cases revealed a possibility that Korean medicine-based integrative cancer therapies could improve some symptoms after chemotherapy in non-small cell lung cancer.

• Journal of Gastric Cancer
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• v.20 no.4
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• pp.421-430
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• 2020

Purpose: Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. Materials and Methods: We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019. Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. Results: There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. Conclusions: We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).