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INTRODUCTION: This study compared the predictive ability of radiation-induced cataract between maximum point dose of the lens (Lens Dmax) ≥7 Gy, mean lens dose (Lens Dmean) ≥7 Gy, Lens Dmax ≥10 Gy, and Lens Dmean ≥10 Gy. METHODS: Patients aged 3-18 years received cranial irradiation or radiation therapy at head and neck area between January 2010 and December 2019 at our institute were included. Patients without baseline and/or follow-up eye examination were excluded. Receiver operating characteristic (ROC) curves identified potential predictors and Cox regression analysed correlations between potential factors and cataract occurrence. RESULTS: Sixty-three patients (122 eyes) were analysed. Cataracts were detected in 14 eyes (11.5%). Median follow-up time was 4 years (range 0.5-10 years), with cataract developing in a median of 2.5 years (range 0.3-7 years). Three patients (21.4%) developed grade ≥3 cataract. Lens Dmean ≥10 Gy was associated with cataract formation. CONCLUSION: Lens Dmean ≥10 Gy showed the highest ability for predicting radiation-induced cataract in paediatric patients. Net reclassification improvement (NRI) suggested that changing lens dose constraint from Dmax <7 Gy to Dmean <10 Gy would miss 7% of cataract cases but avoid 28% of unnecessary restrictions. Adopting a mean lens dose <10 Gy was suggested as a constraint for lens dose.
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BACKGROUND: Radiation therapy (RT) is the core part of cancer multidisciplinary management which causes myelosuppression. The current standard or RT among HIV-positive cancer patients who are immuno-compromised does not differ from that of HIV-negative ones. OBJECTIVE: To determine the effects of radiation therapy on immunological and virological status among HIV-infected cancer patients. MATERIAL AND METHOD: A prospective observational study was conducted of HIV-infected cancer patients who received definitive RT in seven hospitals in Thailand. Blood samples were taken to determine immune status using CD4%, and virological status was identified using plasma HIV-RNA viral load (HIV-VL) assay: at baseline before RT at the last week of RT completion; and at the 6-month follow-up visit. Additional CD4% test was performed at the 3-month follow-up visit. RESULTS: Ninety HIV-infected cancer patients from seven hospitals in Thailand were included in the analysis. The median age was 40 years old (range 19-61). Seventy-six patients (84.4%) were female and 65 (72.2%) were cases of invasive cervical cancers. Eighty-seven percent of patients had been receiving antiretroviral treatment (ART) before RT The mean CD4% at baseline, RT completion, 3-month and 6-month follow-up visits, were 18.7%, 20.1%, 16.8% and 17.1%, respectively. The proportion of CD4% reduction in the non-ART group was higher than that of the ART group throughout the period, particularly at the 3-month follow-up visit (100% vs. 29.7%, p = 0.0004). Six cases had a HIV-VL increase of more than 10 times (1-log10) at completion of RT: 3 of these were non-ART and 3 were ART-uncontrolled viral suppression. CONCLUSION: RT had a suppressive effect on immunological status in HIV-infected cancer patients, particularly in the subacute period among those who were not on ART HIV-disease progression was observed during radiation treatment in HIV-infected cancer patients without ART and those with ART-uncontrolled viral suppression.
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Infecciones por VIH/inmunología , Neoplasias/radioterapia , Adulto , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/inmunología , Estudios Prospectivos , TailandiaRESUMEN
OBJECTIVE: To describe effects of radiation therapy (RT) on immunological status (CD4 cell counts) and disease progression among HIV-positive cancer patients. MATERIAL AND METHOD: This prospective observational study was conducted among HIV-positive cancer patients who received RT for curative intention of cancer in five selected hospitals in Thailand. All subjects received external beam radiation therapy, according to standard clinical practice guidelines of RT. Blood samples were taken 4 times for complete blood count, CD4 cell count and plasma HIV RNA viral load (HIV-VL) assays before and in the last week of RT, then three and six months after completion of RT. RESULTS: This preliminary study reported immunological status and HIV-VL before and the last week of RT, among 29 HIV-positive female cancer patients enrolled from August 22, 2009 to June 30, 2010. The median age was 38 years (range 30-54). 27 patients (93 percent) had invasive cervical cancer. 26 patients (90 percent) were on antiretroviral treatment (ART). The mean baseline white blood cell (WBC) count, lymphocyte percentage were 6,771.7 cells/microL and 31.7 percent respectively. The mean baseline CD4 cell count and CD4%, 387.8 cells/microL and 17.5 percent respectively. In the last week of RT, 25 subjects (86 percent) had CD4 count less than 200 cells/microL. The last week, mean WBC count, and mean lymphocyte percentage decreased to 3,902.8 cells/microL and 17.5 percent respectively. Mean CD4 count number decreased to 157.7 cells/microL, but the mean CD4 % did not change. Four patients (14 percent) had increased HIV-VL after RT, of these two were not on ART and two were on ART for more than 1 year. CONCLUSION: The CD4 cell count was not a good surrogate for prediction of immunologic status of HIV-positive cancer patients during RT.
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Infecciones por VIH/inmunología , VIH-1/efectos de la radiación , Neoplasias/radioterapia , ARN Viral/efectos de la radiación , Carga Viral/efectos de la radiación , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Progresión de la Enfermedad , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , VIH-1/inmunología , Humanos , Persona de Mediana Edad , Neoplasias/complicaciones , Estudios Prospectivos , ARN Viral/sangre , Tailandia , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effectiveness of clinical practice guideline (CPG) for nasopharyngeal carcinoma (NPC) and oropharyngeal carcinoma (OPC) on reducing acute toxicity during concurrent chemoradiation (CRT). MATERIAL AND METHOD: The prospective study enrolled 74 patients diagnosed of NPC and OPC that underwent concurrent CRT. The feasibility of CPG was evaluated. RESULTS: Each checkpoint in CPG is feasible with 76% compliance of three in four points and 24% complete allpoints. Overall grade 3 or 4 skin reaction and mucositis are 9 and 8% respectively. CONCLUSION: CPG that consisted of preventive methods to reduce acute skin and oral mucosa toxicities in NP and OP patients is easy to follow with 24 to 100% compliance. This can be feasible with consideration about immobilization device and energy treatment machine.
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Antineoplásicos/efectos adversos , Carcinoma de Células Escamosas/terapia , Cisplatino/efectos adversos , Neoplasias Nasofaríngeas/terapia , Neoplasias Orofaríngeas/terapia , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Quimioterapia Adyuvante/efectos adversos , Terapia Combinada , Esquema de Medicación , Femenino , Adhesión a Directriz , Humanos , Masculino , Persona de Mediana Edad , Mucositis/etiología , Neoplasias Nasofaríngeas/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Estudios Prospectivos , Traumatismos por Radiación/prevención & control , Dosificación Radioterapéutica , Radioterapia Adyuvante/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Concurrent chemoradiation is the standard treatment for locally advanced cervical cancer. This study was a preliminary result of a randomized two arms, prospective, open-label phase III trial comparing the activity and safety of the concurrent chemoradiation of Tegafur-Uracil and carboplatin or carboplatin alone in locally advanced cervical cancer. MATERIALS AND METHODS: The stage IIB-IIIB cervical cancer patients were randomized to have Tegafur-Uracil 225 mg/m(2)/day orally, 5 days a week and carboplatin 100 mg/m(2) IV over 30-60 min, weekly on day 1 concurrent with standard radiotherapy (Group A) or carboplatin alone concurrent with standard radiotherapy (Group B). RESULTS: Four hundred and sixty-nine patients were randomized to Group A (n=234) or Group B (n=235). The tumor response at 3-month follow-up time showed no significant difference. The only prognostic factor to improve the complete response rate was the hemoglobin level. The patients in Group A, who had Hb <10 gm/dL had the relatively better change to complete response of 1.48 compared to that in Group B (P 0.025, 95% CI 1.07, 2.04). No severe toxicity or adverse event had been reported. The median follow-up time for Group A and Group B was 12.6 and 11.8 months, respectively. There was no statistical difference in PFS and OS. CONCLUSION: Concurrent chemoradiation by Tegafur-Uracil and carboplatin showed no difference in tumor response rate or treatment toxicity compared to carboplatin alone. The combination drugs might have benefit in poor prognostic patients such as the baseline Hb <10 gm/dL.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/uso terapéutico , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/radioterapia , Carboplatino/administración & dosificación , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Tegafur/administración & dosificación , Uracilo/administración & dosificaciónRESUMEN
BACKGROUND: Amifostine has a potential role for salivary gland protection in head and neck cancer patients who had radiotherapy. MATERIAL AND METHOD: Sixty-seven head and neck cancer patients were randomized to receive radiotherapy or radiotherapy plus Amifostine. The efficacy of the treatment was determined by a questionnaire evaluating dryness of mouth and the oral comfort, the RTOG/EORTC acute/late radiation morbidity scoring criteria, collection of the whole saliva and the 99mTc-pertecnetate scintigraphy of the salivary glands. RESULTS: Amifostine significantly reduced the mean questionnaire scores from 6.49 to 3.73, the incidence of grade > or = 2 mucositis from 75% to 36% and acute xerostomia from 82% to 39%. The salivary gland function returned to normal at a rate of 36.3% in the Amifostine group versus 9.1% in the control group. CONCLUSION: Amifostine is effective in reducing the incidence and severity of acute mucositis, acute and late xerostomia in head and neck cancer patients.
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Amifostina/uso terapéutico , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeza y Cuello/radioterapia , Traumatismos por Radiación/prevención & control , Protectores contra Radiación/uso terapéutico , Glándulas Salivales/efectos de la radiación , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no ParamétricasRESUMEN
UNLABELLED: The present study was to evaluate the efficacy and toxicity of concurrent radiation therapy and irinotecan in patients with stage IIIB cervical cancer. Fifteen patients with no prior radiation therapy and chemotherapy were enrolled in the study. These patients received 50 Gy of external radiation to whole the pelvis, 50 Gy with an additional dose of 6-10 Gy to the parametrium and 1 or 2 sessions of intracavitary Cesium-137. Weekly intravenous infusion of 40 mg/m2 irinotecan was given for 5 cycles during the course of radiation therapy. Of 14 evaluable patients, 4 (28.6%) achieved complete response and 7 (50.0%) achieved partial response. Treatment-related toxicity included grade 1 & 2 anemia, grade 1 & 2 leucopenia, grade 1 & 2 neutropenia and 7.1 per cent grade 3 diarrhea. No grade 4 toxicity or treatment-related death occurred in the present study. CONCLUSION: Irinotecan is a promising new cytotoxic agent in treatment concurrently with radiation therapy in newly diagnosed locally advanced cervical cancer. This modality of treatment appeared to be effective with acceptable toxicity.