1
|
Chua KLM, Chu PL, Tng DJH, Soo KC, Chua MLK. Repurposing Proton Beam Therapy through Novel Insights into Tumour Radioresistance. Clin Oncol (R Coll Radiol) 2021; 33:e469-e481. [PMID: 34509347 DOI: 10.1016/j.clon.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022]
Abstract
Despite improvements in radiotherapy, radioresistance remains an important clinical challenge. Radioresistance can be mediated through enhanced DNA damage response mechanisms within the tumour or through selective pressures exerted by the tumour microenvironment (TME). The effects of the TME have in recent times gained increased attention, in part due to the success of immune modulating strategies, but also through improved understanding of the downstream effects of hypoxia and dysregulated wound healing processes on mediating radioresistance. Although we have a better appreciation of these molecular mechanisms, efforts to address them through novel combination approaches have been scarce, owing to limitations of photon therapy and concerns over toxicity. At the same time, proton beam therapy (PBT) represents an advancement in radiotherapy technologies. However, early clinical results have been mixed and the clinical strategies around optimal use and patient selection for PBT remain unclear. Here we highlight the role that PBT can play in addressing radioresistance, through better patient selection, and by providing an improved toxicity profile for integration with novel agents. We will also describe the developments around FLASH PBT. Through close examination of its normal tissue-sparing effects, we will highlight how FLASH PBT can facilitate combination strategies to tackle radioresistance by further improving toxicity profiles and by directly mediating the mechanisms of radioresistance.
Collapse
Affiliation(s)
- K L M Chua
- Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - P L Chu
- Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - D J H Tng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - K C Soo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - M L K Chua
- Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore.
| |
Collapse
|
2
|
Soo KC, Lee KS, Ooi SY, Darwina A, Sannasey S, Lee HG. Disseminated Melioidosis with Spinal Intraosseous Abscess. Med J Malaysia 2021; 76:251-253. [PMID: 33742639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.
Collapse
Affiliation(s)
- K C Soo
- Hospital Queen Elizabeth, Infectious Disease Unit, Kota Kinabalu, Sabah, Malaysia
| | - K S Lee
- Hospital Queen Elizabeth, Infectious Disease Unit, Kota Kinabalu, Sabah, Malaysia
| | - S Y Ooi
- Hospital Queen Elizabeth, Infectious Disease Unit, Kota Kinabalu, Sabah, Malaysia
| | - A Darwina
- Hospital Queen Elizabeth, Department of Radiology, Kota Kinabalu, Sabah, Malaysia
| | - S Sannasey
- Hospital Queen Elizabeth, Department of Radiology, Kota Kinabalu, Sabah, Malaysia
| | - H G Lee
- Hospital Queen Elizabeth, Infectious Disease Unit, Kota Kinabalu, Sabah, Malaysia.
| |
Collapse
|
3
|
Liang ZG, Tan HQ, Zhang F, Rui Tan LK, Lin L, Lenkowicz J, Wang H, Wen Ong EH, Kusumawidjaja G, Phua JH, Gan SA, Sin SY, Ng YY, Tan TW, Soong YL, Fong KW, Park SY, Soo KC, Wee JT, Zhu XD, Valentini V, Boldrini L, Sun Y, Chua ML. Comparison of radiomics tools for image analyses and clinical prediction in nasopharyngeal carcinoma. Br J Radiol 2019; 92:20190271. [PMID: 31453720 PMCID: PMC6774600 DOI: 10.1259/bjr.20190271] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: Radiomics pipelines have been developed to extract novel information from radiological images, which may help in phenotypic profiling of tumours that would correlate to prognosis. Here, we compared two publicly available pipelines for radiomics analyses on head and neck CT and MRI in nasopharynx cancer (NPC). Methods and materials: 100 biopsy-proven NPC cases stratified by T- and N-categories were enrolled in this study. Two radiomics pipeline, Moddicom (v. 0.51) and Pyradiomics (v. 2.1.2) were used to extract radiomics features of CT and MRI. Segmentation of primary gross tumour volume was performed using Velocity v. 4.0 by consensus agreement between three radiation oncologists. Intraclass correlation between common features of the two pipelines was analysed by Spearman’s rank correlation. Unsupervised hierarchical clustering was used to determine association between radiomics features and clinical parameters. Results: We observed a high proportion of correlated features in the CT data set, but not for MRI; 76.1% (51 of 67 common between Moddicom and Pyradiomics) of CT features and 28.6% (20 of 70 common) of MRI features were significantly correlated. Of these, 100% were shape-related for both CT and MRI, 100 and 23.5% were first-order-related, 61.9 and 19.0% were texture-related, respectively. This interpipeline heterogeneity affected the downstream clustering with known prognostic clinical parameters of cTN-status and GTVp. Nonetheless, shape features were the most reproducible predictors of clinical parameters among the different radiomics modules. Conclusion: Here, we highlighted significant heterogeneity between two publicly available radiomics pipelines that could affect the downstream association with prognostic clinical factors in NPC Advances in knowledge: The present study emphasized the broader importance of selecting stable radiomics features for disease phenotyping, and it is necessary prior to any investigation of multicentre imaging datasets to validate the stability of CT-related radiomics features for clinical prognostication.
Collapse
Affiliation(s)
- Zhong-Guo Liang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Fan Zhang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Lloyd Kuan Rui Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Li Lin
- Division of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | | | - Haitao Wang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Enya Hui Wen Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | | | - Jun Hao Phua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Soon Ann Gan
- Division of Cancer Informatics, National Cancer Centre Singapore, Singapore
| | - Sze Yarn Sin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yan Yee Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Terence Wee Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Joseph Tien Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Xiao-Dong Zhu
- Division of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | | | | | - Ying Sun
- Division of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Melvin Lee Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| |
Collapse
|
4
|
Guan P, Wong SF, Lim JQ, Ng CCY, Soong PL, Sim CQX, Ong CK, Rajasegaran V, Myint SS, Lee JY, Tan HK, Iyer NG, Soo KC, Teh BT, Tay ABG. Mutational Signatures in Mandibular Ameloblastoma Correlate with Smoking. J Dent Res 2019; 98:652-658. [PMID: 30917298 DOI: 10.1177/0022034519837248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ameloblastoma is a rare tumor of odontogenic epithelium, the low incidence rate of which precludes statistical determination of its molecular characterizations. Despite recent genomic and transcriptomic profiling, the etiology of ameloblastomas remains poorly understood. Risk factors of ameloblastoma development are also largely unknown. Whole exome sequencing was performed on 11 mandibular ameloblastoma samples. We identified 2 convergent mutational signatures in ameloblastoma: 1) a signature found in multiple types of lung cancers with probable etiology of tobacco carcinogens (COSMIC signature 4) and 2) a signature present in gingivobuccal oral squamous cell carcinoma and correlated with tobacco-chewing habits (COSMIC signature 29). These mutational signatures highlight tobacco usage or related mutagens as one possible risk factor of ameloblastoma, since the association of BRAF mutations and smoking was demonstrated in multiple studies. In addition to BRAF hotspot mutations (V600E), we observed clear inter- and intratumor heterogeneities. Interestingly, prior to BRAF mutation, important genes regulating odontogenesis mutated (e.g., corepressor BCOR), possibly playing important roles in tumorigenesis. Furthermore, recurrent mutations in the CDC73 gene, the germline mutations of which predispose patients to the development of jaw tumors, were found in 2 patients, which may lead to recurrence if not targeted by therapeutic drugs. Our unbiased profiling of coding regions of ameloblastoma genomes provides insights to the possible etiology of mandibular ameloblastoma and highlights potential disease risk factors for screening and prevention, especially for Asian patients. Because of the limited sample size and incomplete habitual, dietary, and occupational data, a causal link between tobacco usage and ameloblastoma still requires further investigations.
Collapse
Affiliation(s)
- P Guan
- 1 Integrated Biostatistics and Bioinformatics Programme, Duke-NUS Medical School, Singapore.,2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,3 Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - S F Wong
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - J Q Lim
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,4 Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - C C Y Ng
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - P L Soong
- 5 Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - C Q X Sim
- 5 Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - C K Ong
- 4 Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - V Rajasegaran
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - S S Myint
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - J Y Lee
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - H K Tan
- 6 Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - N G Iyer
- 6 Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - K C Soo
- 6 Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - B T Teh
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,7 Cancer Science Institute of Singapore, National University of Singapore, Singapore.,8 Institute of Molecular and Cell Biology, Singapore.,9 Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore.,10 SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore
| | - A B G Tay
- 5 Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| |
Collapse
|
5
|
Thong PS, Lee K, Toh HJ, Dong J, Tee CS, Low KP, Chang PH, Bhuvaneswari R, Tan NC, Soo KC. Correction: Early assessment of tumor response to photodynamic therapy using combined diffuse optical and diffuse correlation spectroscopy to predict treatment outcome. Oncotarget 2019; 10:1602. [PMID: 30899428 PMCID: PMC6422179 DOI: 10.18632/oncotarget.26742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Kijoon Lee
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Nanyang Technological University, Singapore
- Current address: Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Hui-Jin Toh
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Jing Dong
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Nanyang Technological University, Singapore
- Current address: Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Chuan-Sia Tee
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Kar-Perng Low
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Pui-Haan Chang
- Division of Medical Sciences, National Cancer Centre, Singapore
| | | | - Ngian-Chye Tan
- Division of Surgical Oncology, National Cancer Centre, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre, Singapore
| |
Collapse
|
6
|
Yeo ELL, Li YQ, Soo KC, Wee JTS, Chua MLK. Combinatorial strategies of radiotherapy and immunotherapy in nasopharyngeal carcinoma. Chin Clin Oncol 2018; 7:15. [PMID: 29764160 DOI: 10.21037/cco.2018.04.05] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/18/2018] [Indexed: 11/06/2022]
Abstract
Immunotherapy and radiation therapy (RT) have each demonstrated clinical success in the treatment of nasopharyngeal carcinoma (NPC) when utilized independently. Several characteristics of NPC make it particularly well suited for immunotherapeutic strategies, such as the association with viral infections like EBV and human papilloma virus (HPV), upregulation of PD-L1 expression, and the high number of tumor infiltrating lymphocytes. Immune checkpoint blockade is one such immunotherapeutic strategy that is gaining popularity rapidly. However, clinical benefit of immunotherapy using immune checkpoint inhibitors has been limited to only a small subset of patients with existing T cell responses. Additionally, they are frequently associated with dose-limiting immune-related toxicities. On the other hand, RT is a conventional strategy for NPC treatment, which has demonstrated high efficacy in local tumor control and has also been reported to exhibit immune modulatory effects. However, the abscopal effect of RT alone, i.e., the regression of distant metastases outside of the irradiation field, remains a rare phenomenon. Furthermore, RT treatment efficacy is also limited by radioresistance and radiation-related toxicities. Hence, the combination of RT and immunotherapy has the potential to improve treatment efficacy over either individual therapies alone. Here, we reviewed the clinical problem in locally advanced and recurrent/metastatic NPC, and discussed how combinatorial RT and immunotherapeutic strategies can be relevant to NPC treatment in each clinical scenario by examining the underlying mechanisms involved in the different strategies.
Collapse
Affiliation(s)
- Eugenia L L Yeo
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - You Quan Li
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Joseph T S Wee
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Melvin L K Chua
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore; Division of Radiation Oncology, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.
| |
Collapse
|
7
|
Tan JSH, Lin X, Chua KLM, Lam PY, Soo KC, Chua MLK. Exploiting molecular genomics in precision radiation oncology: a marriage of biological and physical precision. Chin Clin Oncol 2017; 6:S19. [PMID: 28917257 DOI: 10.21037/cco.2017.06.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 11/06/2022]
Abstract
Achieving local tumour control is paramount for cure in head and neck and prostate cancers. With the transition to precision radiotherapy (RT) techniques, survival rates have improved in the majority of these cancers, but a substantial proportion of 30-40% still relapse following primary treatment. Recent large-scale molecular profiling studies have revealed unique biological events that could explain for tumour aggression and resistance to therapies, redefining the molecular taxonomy of head and neck and prostate cancers. Here, we reviewed the key findings from these studies, highlighting those relevant for clinical stratification. We also proposed novel combinatorial clinicomolecular models to identify subsets of patients with aggressive localised tumours and limited metastases, and to inform on the optimal management of these patients using molecular targeted agents, immunotherapy, and RT.
Collapse
Affiliation(s)
- Janice S H Tan
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Xiaotian Lin
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
| | - Kevin L M Chua
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Paula Y Lam
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore; Oncology Academic Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore; Oncology Academic Program, Duke-NUS Graduate Medical School, Singapore, Singapore.
| |
Collapse
|
8
|
Thong PSP, Lee K, Toh HJ, Dong J, Tee CS, Low KP, Chang PH, Bhuvaneswari R, Tan NC, Soo KC. Early assessment of tumor response to photodynamic therapy using combined diffuse optical and diffuse correlation spectroscopy to predict treatment outcome. Oncotarget 2017; 8:19902-19913. [PMID: 28423634 PMCID: PMC5386732 DOI: 10.18632/oncotarget.15720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/16/2017] [Indexed: 12/30/2022] Open
Abstract
Photodynamic therapy (PDT) of cancer involves the use of a photosensitizer that can be light-activated to eradicate tumors via direct cytotoxicity, damage to tumor vasculature and stimulating the body's immune system. Treatment outcome may vary between individuals even under the same regime; therefore a non-invasive tumor response monitoring system will be useful for personalization of the treatment protocol. We present the combined use of diffuse optical spectroscopy (DOS) and diffuse correlation spectroscopy (DCS) to provide early assessment of tumor response. The relative tissue oxygen saturation (rStO2) and relative blood flow (rBF) in tumors were measured using DOS and DCS respectively before and after PDT with reference to baseline values in a mouse model. In complete responders, PDT-induced decreases in both rStO2 and rBF levels were observed at 3 h post-PDT and the rBF remained low until 48 h post-PDT. Recovery of these parameters to baseline values was observed around 2 weeks after PDT. In partial responders, the rStO2 and rBF levels also decreased at 3 h post PDT, however the rBF values returned toward baseline values earlier at 24 h post-PDT. In contrast, the rStO2 and rBF readings in control tumors showed fluctuations above the baseline values within the first 48 h. Therefore tumor response can be predicted at 3 to 48 h post-PDT. Recovery or sustained decreases in the rBF at 48 h post-PDT corresponded to long-term tumor control. Diffuse optical measurements can thus facilitate early assessment of tumor response. This approach can enable physicians to personalize PDT treatment regimens for best outcomes.
Collapse
Affiliation(s)
| | - Kijoon Lee
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore.,Nanyang Technological University, Singapore.,Current address: Daegu Gyeongbuk Institute of Science and Technology, Korea
| | - Hui-Jin Toh
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Jing Dong
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore.,Nanyang Technological University, Singapore.,Current address: Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, USA
| | - Chuan-Sia Tee
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Kar-Perng Low
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Pui-Haan Chang
- Division of Medical Sciences, National Cancer Centre, Singapore
| | | | - Ngian-Chye Tan
- Division of Surgical Oncology, National Cancer Centre, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre, Singapore
| |
Collapse
|
9
|
Tay GCA, Iyer NG, Ong WS, Tai D, Ang MK, Ha TC, Soo KC, Tan HK. Outcomes and Prognostic Factors of Radiation-Induced and De Novo Head and Neck Squamous Cell Carcinomas. Otolaryngol Head Neck Surg 2016; 154:880-7. [DOI: 10.1177/0194599816631726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/20/2016] [Indexed: 11/16/2022]
Abstract
Objective We sought to compare clinical outcomes, pathological features, treatment patterns, and survival outcomes between radiation-induced squamous cell carcinoma (RISCC) and de novo SCC (DNSCC) of the head and neck, as well as identify prognostic factors in these patients. Study Design Case-control study. Setting Tertiary medical center. Subjects and Methods Retrospective case-control analysis of 34 RISCCs and 136 DNSCCs matched by age at diagnosis, sex, smoking status, and primary tumor site. Results Median latency of RISCC development was 13 years. Radiation-induced squamous cell carcinomas were more likely to present with node-negative disease than DNSCCs (70.6% vs 42.9%; P = .024). A greater proportion of DNSCCs was treated with curative intent (92.6% vs 79.4%; P = .048) and achieved no residual disease posttreatment (82.2% vs 41.2%; P < .001) compared with RISCCs. Patients with RISCC had poorer overall survival (OS) (median, 1.67 vs 5.03 years; P = .018) and disease-specific survival (DSS) (median, 1.67 vs 8.65 years; P = .001) than those with DNSCC. Among patients who underwent curative treatment with no residual disease after treatment, there were, however, no survival differences between RISCC and DNSCC. Conclusion In our cohort, RISCCs have a poorer prognosis than DNSCCs. However, those able to undergo curative treatment and have no residual disease after treatment have comparable survival outcomes. Locoregional control of these tumors appears paramount in achieving the best outcomes for patients with RISCC.
Collapse
Affiliation(s)
- Gerald Ci-An Tay
- Department of General Surgery, Singapore General Hospital, Singapore
| | | | - Whee-Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - David Tai
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Tam Cam Ha
- Medical Education, Research & Evaluation Department (MERE), Duke-NUS Graduate Medical School Singapore, Singapore
| | - Khee-Chee Soo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Hiang Khoon Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| |
Collapse
|
10
|
Thong PSP, Bhuvaneswari R, Chang PH, Low KP, Idris NM, Bunte RM, Zhang Y, Soo KC. The use of surface-modified upconversion nanoparticles for near-infrared-activated photodynamic therapy of oral cancer. Photodiagnosis Photodyn Ther 2015. [DOI: 10.1016/j.pdpdt.2015.07.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
11
|
Ong W, Zhao R, Lui B, Tan W, Ebrahimi A, Clark JR, Soo KC, Tan NC, Tan HK, Iyer NG. Prognostic significance of lymph node density in squamous cell carcinoma of the tongue. Head Neck 2015; 38 Suppl 1:E859-66. [PMID: 25917601 DOI: 10.1002/hed.24113] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The prognostic significance of lymph node density in oral squamous cell carcinoma (OSCC) has been well recognized. However, its use in a specific subsite of the tongue has not been evaluated. The purpose of this study was to determine the prognostic significance of lymph node density in tongue squamous cell carcinoma (SCC). METHODS A retrospective analysis of 99 patients with tongue SCC who underwent primary curative resection and neck dissection was conducted. Overall survival (OS) and disease-specific survival (DSS) was used to evaluate the prognostic significance of lymph node density. RESULTS Lymph node density (using a cutoff of 0.06) was shown to be an independent predictor of OS and DSS. The impact of lymph node density on OS and DSS remained significant on multivariate analysis, whereas conventional nodal staging was not. An alternative staging strategy incorporating depth of invasion and lymph node density performs better than conventional TNM staging in predicting survival. CONCLUSION Our data suggest that lymph node density is a reliable and applicable predictor of prognosis in patients with tongue SCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E859-E866, 2016.
Collapse
Affiliation(s)
- Wilson Ong
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - Runfeng Zhao
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - Benjamin Lui
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - Winson Tan
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - Ardalan Ebrahimi
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Khee-Chee Soo
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - Ngian-Chye Tan
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - Hiang-Khoon Tan
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| | - N Gopalakrishna Iyer
- Division of Surgical Oncology, Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore
| |
Collapse
|
12
|
Tan T, Lim WT, Fong KW, Cheah SL, Soong YL, Ang MK, Ng QS, Tan D, Ong WS, Tan SH, Yip C, Quah D, Soo KC, Wee J. Concurrent chemo-radiation with or without induction gemcitabine, Carboplatin, and Paclitaxel: a randomized, phase 2/3 trial in locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2015; 91:952-60. [PMID: 25832687 DOI: 10.1016/j.ijrobp.2015.01.002] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/29/2014] [Accepted: 01/02/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare survival, tumor control, toxicities, and quality of life of patients with locally advanced nasopharyngeal carcinoma (NPC) treated with induction chemotherapy and concurrent chemo-radiation (CCRT), against CCRT alone. PATIENTS AND METHODS Patients were stratified by N stage and randomized to induction GCP (3 cycles of gemcitabine 1000 mg/m(2), carboplatin area under the concentration-time-curve 2.5, and paclitaxel 70 mg/m(2) given days 1 and 8 every 21 days) followed by CCRT (radiation therapy 69.96 Gy with weekly cisplatin 40 mg/m(2)), or CCRT alone. The accrual of 172 was planned to detect a 15% difference in 5-year overall survival (OS) with a 5% significance level and 80% power. RESULTS Between September 2004 and August 2012, 180 patients were accrued, and 172 (GCP 86, control 86) were analyzed by intention to treat. There was no significant difference in OS (3-year OS 94.3% [GCP] vs 92.3% [control]; hazard ratio 1.05; 1-sided P=.494]), disease-free survival (hazard ratio 0.77, 95% confidence interval 0.44-1.35, P=.362), and distant metastases-free survival (hazard ratio 0.80, 95% confidence interval 0.38-1.67, P=.547) between the 2 arms. Treatment compliance in the induction phase was good, but the relative dose intensity for concurrent cisplatin was significantly lower in the GCP arm. Overall, the GCP arm had higher rates of grades 3 and 4 leukopenia (52% vs 37%) and neutropenia (24% vs 12%), but grade 3 and 4 acute radiation toxicities were not statistically different between the 2 arms. The global quality of life scores were comparable in both arms. CONCLUSION Induction chemotherapy with GCP before concurrent chemo-irradiation did not improve survival in locally advanced NPC.
Collapse
Affiliation(s)
- Terence Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.
| | - Wan-Teck Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kam-Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Shie-Lee Cheah
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yoke-Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Quan-Sing Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Daniel Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Whee-Sze Ong
- Division of Clinical Trial and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Sze-Huey Tan
- Division of Clinical Trial and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Connie Yip
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Daniel Quah
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Khee-Chee Soo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Joseph Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| |
Collapse
|
13
|
Iyer NG, Tan DSW, Tan VKM, Wang W, Hwang J, Tan NC, Sivanandan R, Tan HK, Lim WT, Ang MK, Wee J, Soo KC, Tan EH. Randomized trial comparing surgery and adjuvant radiotherapy versus concurrent chemoradiotherapy in patients with advanced, nonmetastatic squamous cell carcinoma of the head and neck: 10-year update and subset analysis. Cancer 2015; 121:1599-607. [PMID: 25639864 DOI: 10.1002/cncr.29251] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The current study was performed to report the long-term results of a trial comparing concurrent chemotherapy and radiotherapy (CCRT) with surgery and adjuvant radiotherapy (RT) in patients with stage III/IV nonmetastatic head and neck squamous cell carcinoma. METHODS Patients with stage III/IV resectable head and neck squamous cell carcinoma were randomized to surgery followed by RT or CCRT. The trial was halted prematurely due to poor accrual. Human papillomavirus status was tested on archival material using polymerase chain reaction sequencing. RESULTS Of the total of 119 patients, 60 patients were randomized to primary surgery (S arm) and 59 patients were randomized to CCRT (C arm). Human papillomavirus status was tested in 75 patients, and only 3 were found to be positive. The median follow-up for surviving patients was 13 years. Analysis of the entire cohort demonstrated no statistically significant difference in overall survival and disease-specific survival (DSS): 5-year rates were 45% versus 35% for overall survival (P = .262) and 56% versus 46% for DSS (P = .637) for the S arm and C arm, respectively. Analysis by subsites indicated that this difference favoring the S arm was mainly driven by survival data among patients with cancers of the oral cavity and maxillary sinus. For patients with oral cavity cancer, survival was significantly better in those who underwent primary surgery compared with CCRT; the 5-year DSS rate was 68% versus 12% for the S arm and C arm, respectively (P = .038). For patients with cancers of the maxillary sinus, the 5-year DSS rate was 71% for patients on the S arm and 0% for patients on the C arm (P = .05). CONCLUSIONS These long-term results demonstrate a significant advantage for primary surgery in patients with cancers of the oral cavity or maxillary sinus, providing strong support for primary surgery as the main modality of treatment for these subsites. In other subsites, CCRT and surgery with adjuvant RT were found to demonstrate similar efficacy for survival in patients with advanced resectable tumors.
Collapse
Affiliation(s)
- N Gopalakrishna Iyer
- Department of Surgical Oncology, National Cancer Centre, Singapore; Cancer Therapeutics Research Laboratory, National Cancer Centre, Singapore
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Chia CS, Ong WS, Li XJ, Soong YL, Chong FT, Tan HK, Soo KC, Qian CN, Teh BT, Iyer NG. Serglycin expression: An independent marker of distant metastases in nasopharyngeal carcinoma. Head Neck 2015; 38:21-8. [PMID: 24995621 DOI: 10.1002/hed.23841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) has a high propensity for metastasis. The purpose of this study was for us to determine whether serglycin expression can be used to predict distant metastases. METHODS Serglycin expression of tumor tissue of 112 patients with NPC was assessed based on percentage of tumor cells expressing serglycin, staining intensity, percentage of tumor-infiltrated lymphocyte (TIL) expressing serglycin and TIL-staining intensity. RESULTS Risk factors for distant metastases include sex, smoking status, tumor intensity, and TIL percentage for serglycin. The odds of distant metastases was 4.13 and 0.18 in patients with strong tumor intensity and >50% TIL percentage, respectively. Based on a nomogram incorporating predictors, patients were stratified into 2 prognostic groups. The proportion of distant metastases in the high-risk group (strong tumor intensity and ≤50% TIL percentage) was 78% versus 19% in the low risk group (p < .001). CONCLUSION Patients with NPC with tumors showing strong tumor intensity and low TIL percentage with serglycin may be at high risk for distant metastases.
Collapse
Affiliation(s)
- Claramae Shulyn Chia
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Wee Kim Wee Laboratory of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Xin Jian Li
- National Cancer Centre Singapore-VARI Translational Research Program, National Cancer Centre Singapore, Singapore.,State Key Laboratory of Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, Guangzhou, China
| | - Yoke-Lim Soong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Fui Teen Chong
- Wee Kim Wee Laboratory of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Hiang-Khoon Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Wee Kim Wee Laboratory of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Khee-Chee Soo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Chao-Nan Qian
- National Cancer Centre Singapore-VARI Translational Research Program, National Cancer Centre Singapore, Singapore.,State Key Laboratory of Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, Guangzhou, China
| | - Bin-Tean Teh
- National Cancer Centre Singapore-VARI Translational Research Program, National Cancer Centre Singapore, Singapore
| | - N Gopalakrishna Iyer
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Wee Kim Wee Laboratory of Surgical Oncology, National Cancer Centre Singapore, Singapore
| |
Collapse
|
15
|
Dong J, Toh HJ, Thong PSP, Tee CS, Bi R, Soo KC, Lee K. Hemodynamic monitoring of Chlorin e6-mediated photodynamic therapy using diffuse optical measurements. J Photochem Photobiol B 2014; 140:163-72. [PMID: 25146878 DOI: 10.1016/j.jphotobiol.2014.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/04/2014] [Accepted: 07/30/2014] [Indexed: 02/08/2023]
Abstract
Tumor response during photodynamic therapy (PDT) is heavily dependent on treatment parameters such as light dose, photosensitizer concentration, and tissue oxygenation. Therefore, it is desirable to have a real-time hemodynamic monitoring device in order to fine-tune the parameters and improve PDT efficacy. In this paper, such a tumor response monitoring system was built incorporating both frequency domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS), which enables concurrent monitoring of tissue oxygenation (StO₂), total hemoglobin concentration (THC) and relative blood flow (rBF). The tumor metabolic rate of oxygen (TMRO₂) was calculated by using the hemodynamic parameters. Mouse models bearing xenograft tumors were subjected to chlorin e6 (Ce6)-mediated PDT, and the four parameters were monitored with varying treatment conditions. The results show (1) At 3 h post-PDT, rStO₂, rBF and rTMRO₂ exhibited sharp PDT-induced decreases in responders (>40% reduction in tumor volume). Statistically significant difference between responders and non-responders were observed in rStO₂ and rBF, but not in rTMRO₂. (2) Non-responders show gradual recovery of rStO₂, rBF and rTMRO₂ from ∼24 h post-PDT, while responder group did not show recovery up until 48 h post-PDT. Long-term study results up to 2 weeks are also shown. It suggests the hybrid diffuse optical system is not only capable of real-time treatment monitoring, but also able to extract tumor metabolic rate of oxygen to provide more insights about therapy mechanism. Translation of this technique to the clinic will make a quick prognosis feasible and help with treatment optimization.
Collapse
Affiliation(s)
- Jing Dong
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457, Singapore
| | - Hui Jin Toh
- Division of Medical Sciences, National Cancer Centre Singapore, 169610, Singapore
| | - Patricia S P Thong
- Division of Medical Sciences, National Cancer Centre Singapore, 169610, Singapore
| | - Chuan Sia Tee
- Division of Medical Sciences, National Cancer Centre Singapore, 169610, Singapore
| | - Renzhe Bi
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre Singapore, 169610, Singapore
| | - Kijoon Lee
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457, Singapore; School of Basic Science, Daegu Gyeongbuk Institute of Science & Technology, Daegu 711-873, Republic of Korea.
| |
Collapse
|
16
|
Teo MCC, Ching Tan GH, Lim C, Chia CS, Tham CK, Soo KC. Colorectal peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: the experience of a tertiary Asian center. Asian J Surg 2014; 38:65-73. [PMID: 25059814 DOI: 10.1016/j.asjsur.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/01/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Compared with intravenous chemotherapy, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in patients with recurrent colorectal disease confined to the peritoneum. We report our experience with CRS and HIPEC for colorectal cancer patients with peritoneal carcinomatosis, evaluating prognostic factors for disease-free survival (DFS), overall survival (OS), and perioperative morbidity and mortality. METHODS All patients who underwent CRS and HIPEC were included in our study. Clinical characteristics, operative data, and 30-day morbidity and mortality were collected and evaluated. RESULTS Between January 2001 and December 2012, there were 35 consecutive patients who underwent CRS and HIPEC at our institution. Thirty-three patients (94%) had optimal cytoreduction. No 30-day mortality was reported, but 14 patients had postoperative complications. The median DFS was 9.4 months (95% confidence interval 5.5-18.7 months), and DFS at 1 year, 3 years, and 5 years were 43.8%, 22.3%, and 22.3%, respectively. The median OS was calculated to be 27.1 months (95% confidence interval 15.3-39.1), and the OS at 1 year, 3 years, and 5 years were 83.7%, 38.2%, and 19.1%, respectively. CONCLUSION CRS and HIPEC can provide survival benefit, with reasonable morbidity and mortality for Asian patients with peritoneal carcinomatosis from colorectal cancer. Patient selection and perioperative management of the patients are key to the success of the procedure.
Collapse
Affiliation(s)
- Melissa Ching Ching Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore; Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore.
| | - Grace Hwei Ching Tan
- Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore
| | - Cindy Lim
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Claramae Shulyn Chia
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Chee Kian Tham
- Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Khee-Chee Soo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore; Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore
| |
Collapse
|
17
|
Ng JC, Wang W, Chua MJ, Tan MS, Tan NC, Soo KC, Tan HK, Iyer NG. Subcutaneous injection is a simple and reproducible option to restore parathyroid function after total parathyroidectomy in patients with secondary hyperparathyroidism. Surgery 2014; 155:682-8. [DOI: 10.1016/j.surg.2013.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
|
18
|
Chung AYF, Ooi LLPJ, Machin D, Tan SB, Goh BKP, Wong JS, Chen YM, Li PCN, Gandhi M, Thng CH, Yu SWK, Tan BS, Lo RHG, Htoo AMM, Tay KH, Sundram FX, Goh ASW, Chew SP, Liau KH, Chow PKH, Tay KH, Tan YM, Cheow PC, Ho CK, Soo KC. Adjuvant hepatic intra-arterial iodine-131-lipiodol following curative resection of hepatocellular carcinoma: a prospective randomized trial. World J Surg 2014; 37:1356-61. [PMID: 23463394 DOI: 10.1007/s00268-013-1970-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of the present study was to determine whether intrahepatic injection of (131)I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC). METHODS From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4-6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan-Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong. RESULTS The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46-1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51-1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by (131)I-lipiodol and hepatic artery dissection during angiography. CONCLUSIONS The randomized trial provides insufficient evidence to recommend the routine use of (131)I-lipiodol in these patients.
Collapse
Affiliation(s)
- A Y F Chung
- General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Chow PKH, Poon DYH, Khin MW, Singh H, Han HS, Goh ASW, Choo SP, Lai HK, Lo RHG, Tay KH, Lim TG, Gandhi M, Tan SB, Soo KC. Multicenter phase II study of sequential radioembolization-sorafenib therapy for inoperable hepatocellular carcinoma. PLoS One 2014; 9:e90909. [PMID: 24614178 PMCID: PMC3948695 DOI: 10.1371/journal.pone.0090909] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/02/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The safety and tolerability of sequential radioembolization-sorafenib therapy is unknown. An open-label, single arm, investigator-initiated Phase II study (NCT0071279) was conducted at four Asia-Pacific centers to evaluate the safety and efficacy of sequential radioembolization-sorafenib in patients with hepatocellular carcinoma (HCC) not amenable to curative therapies. METHODS Sorafenib (400 mg twice-daily) was initiated 14 days post-radioembolization with yttrium-90 (90Y) resin microspheres given as a single procedure. The primary endpoints were safety and tolerability and best overall response rate (ORR) using RECIST v1.0.Secondary endpoints included: disease control rate (complete [CR] plus partial responses [PR] and stable disease [SD]) and overall survival (OS). RESULTS Twenty-nine patients with Barcelona Clinic Liver Cancer (BCLC) stage B (38%) or C (62%) HCC received a median of 3.0 GBq (interquartile range, 1.0) 90Y-microspheres followed by sorafenib (median dose/day, 600.0 mg; median duration, 4.1 months). Twenty eight patients experienced ≥1 toxicity; 15 (52%) grade ≥3. Best ORR was 25%, including 2 (7%) CR and 5 (18%) PR, and 15 (54%) SD. Disease control was 100% and 65% in BCLC stage B and C, respectively. Two patients (7%) had sufficient response to enable radical therapy. Median survivals for BCLC stage B and C were 20.3 and 8.6 months, respectively. CONCLUSIONS This study shows the potential efficacy and manageable toxicity of sequential radioembolization-sorafenib. TRIAL REGISTRATION ClinicalTrials.gov NCT00712790.
Collapse
Affiliation(s)
- Pierce K. H. Chow
- National Cancer Centre, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail:
| | | | - Maung-Win Khin
- Yangon Gastrointestinal and Liver Centre, Yangon, Myanmar
| | | | - Ho-Seong Han
- Seoul National University Bundang Hospital, Bundang, South Korea
| | | | - Su-Pin Choo
- Singapore General Hospital, Singapore, Singapore
| | - Hee-Kit Lai
- National Cancer Centre, Singapore, Singapore
| | | | | | | | - Mihir Gandhi
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Singapore Clinical Research Institute, Singapore, Singapore
| | - Say-Beng Tan
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Singapore Clinical Research Institute, Singapore, Singapore
| | - Khee-Chee Soo
- National Cancer Centre, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | | |
Collapse
|
20
|
Tian B, Khoo D, Tay AC, Soo KC, Tan NC, Tan HK, Iyer NG. Management of orocutaneous fistulas using a vacuum-assisted closure system. Head Neck 2013; 36:873-81. [PMID: 23733717 DOI: 10.1002/hed.23393] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 03/27/2013] [Accepted: 05/21/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The vacuum-assisted closure (VAC) system has been used to manage complicated wounds. The purpose of this study was to describe a novel technique in using the VAC system for orocutaneous fistulas. METHODS A retrospective study was performed on 10 patients treated at the National Cancer Centre, Singapore, who developed postoperative orocutaneous fistulas. Hydrogum dental paste was used as a sealant together with the VAC system to close the fistulas. We used either the RENASYS or VAC ATS system with 50 mm Hg to 125 mm Hg continuous suction. RESULTS The 10 patients developed 11 fistulas. The median age of this cohort was 67 years (range, 33-80 years). Nine patients had successful closure of their fistulas with VAC therapy whereas 1 patient had unsuccessful VAC therapy and required flap reconstruction. The median time to fistula closure was 19 days (range, 6-36 days). The median time to radiotherapy after surgery was 46 days (range, 26-62 days). CONCLUSION VAC therapy is an effective treatment option for orocutaneous fistulas.
Collapse
Affiliation(s)
- Brian Tian
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | | | | | | | | |
Collapse
|
21
|
Yeang MS, Tay K, Ong WS, Thiagarajan A, Tan DSW, Ha TC, Teo PTH, Soo KC, Tan HK, Iyer NG. Outcomes and prognostic factors of post-irradiation and de novo sarcomas of the head and neck: a histologically matched case-control study. Ann Surg Oncol 2013; 20:3066-75. [PMID: 23604715 DOI: 10.1245/s10434-013-2979-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study was designed to compare post-irradiation sarcomas (PIS) and de novo sarcomas (DN) of the head and neck in terms of tumor characteristics, prognostic factors, and survival outcomes. METHODS All (N=83) head and neck sarcoma patients treated at National Cancer Centre, Singapore (Feb 2002-May 2011) were included: DN (N=60; 72%); PIS (N=23; 28%). Clinicopathologic features and outcomes of all patients and histologically matched pairs were compared. Prognostic factors were identified using univariate and multivariate analyses. RESULTS Median age, gender, smoking status, and tumor size were not significantly different. Significant differences were seen in histology (most prevalent: PIS-sarcoma-NOS; DN-angiosarcoma) and tumor subsite (most prevalent: PIS-nasal cavity and sinuses; DN-skin). Median latency of PIS development was 16.7 years. PIS patients had shorter overall survival (OS) and disease-specific survival (DSS) compared with DN patients, most clearly seen on histologically matched pair analysis: 2-year OS (PIS: 54%; DN: 83%; P=0.028). Multivariate analyses showed that age>50 years (hazard ratio (HR)=3.68; P=0.007), ever-smokers (HR=2.79; P=0.017), and larger tumor-size (cm) (HR=1.12; P=0.045) were associated with worse OS, and age at >50 years (HR=2.77; P=0.04) and ever-smokers (HR=2.94; P=0.021) were associated with worse DSS. When treated with curative intent, no significant survival difference was noted between DN and PIS patients. CONCLUSIONS In our cohort, PIS constituted 28% of head and neck sarcomas. Poorer prognosis traditionally associated with PIS compared with DN was not seen amongst patients treated with curative intent.
Collapse
Affiliation(s)
- Ming Sheng Yeang
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Tay G, Tan HK, Thiagarajan A, Soo KC, Iyer NG. Squamous cell carcinoma of the ear arising in patients after radiotherapy for nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2013; 271:149-56. [DOI: 10.1007/s00405-013-2495-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/10/2013] [Indexed: 11/27/2022]
|
23
|
Dong J, Bi R, Ho JH, Thong PSP, Soo KC, Lee K. Diffuse correlation spectroscopy with a fast Fourier transform-based software autocorrelator. J Biomed Opt 2012; 17:97004-1. [PMID: 23085922 DOI: 10.1117/1.jbo.17.9.097004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Diffuse correlation spectroscopy (DCS) is an emerging noninvasive technique that probes the deep tissue blood flow, by using the time-averaged intensity autocorrelation function of the fluctuating diffuse reflectance signal. We present a fast Fourier transform (FFT)-based software autocorrelator that utilizes the graphical programming language LabVIEW (National Instruments) to complete data acquisition, recording, and processing tasks. The validation and evaluation experiments were conducted on an in-house flow phantom, human forearm, and photodynamic therapy (PDT) on mouse tumors under the acquisition rate of ∼400 kHz. The software autocorrelator in general has certain advantages, such as flexibility in raw photon count data preprocessing and low cost. In addition to that, our FFT-based software autocorrelator offers smoother starting and ending plateaus when compared to a hardware correlator, which could directly benefit the fitting results without too much sacrifice in speed. We show that the blood flow index (BFI) obtained by using a software autocorrelator exhibits better linear behavior in a phantom control experiment when compared to a hardware one. The results indicate that an FFT-based software autocorrelator can be an alternative solution to the conventional hardware ones in DCS systems with considerable benefits.
Collapse
Affiliation(s)
- Jing Dong
- Nanyang Technological University, Division of Bioengineering, School of Chemical and Biomedical Engineering, Singapore 637457, Singapore
| | | | | | | | | | | |
Collapse
|
24
|
Huynh H, Choo SP, Toh HC, Tai WM, Chung AYF, Chow PKH, Ong R, Soo KC. Comparing the efficacy of sunitinib with sorafenib in xenograft models of human hepatocellular carcinoma: mechanistic explanation. Curr Cancer Drug Targets 2012; 11:944-53. [PMID: 21834756 DOI: 10.2174/156800911797264716] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/27/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common and third deadliest malignancy. Sorafenib has demonstrated 44% survival advantage over placebo and has emerged as a standard of care in advanced HCC. The therapeutic effects of sorafenib are however transient and hence additional treatment options are warranted. In this study, we aimed to compare the efficacy of sunitinib relative to sorafenib, two potent inhibitors of protein tyrosine kinases involved in tumor growth, metastasis, or angiogenesis. We reported that sorafenib and sunitinib suppressed tumor growth, angiogenesis, cell proliferation, and induced apoptosis in both orthotopic and ectopic models of HCC. However, the antitumor effect of 50 mg/kg sorafenib was greater than that of 40 mg/kg sunitinib. Sorafenib inhibited p-eIF4E Ser209, p-p38 Thr180/Tyr182 and reduced survivin expression. This was not seen with sunitinib. In addition, the antitumor and apoptotic effects of sorafenib, which are associated with upregulation of fast migrating Bim and ASK1 and downregulation of survivin, were greater than that of sunitinib. These observations explained in part the apparent superior anti-tumor activity of sorafenib compared to sunitinib. In conclusion, sunitinib demonstrated an inferior anti-tumor activity compared to sorafenib in ectopic and orthotopic models of human HCC. It remains to be seen whether such observations would be recapitulated in humans.
Collapse
Affiliation(s)
- H Huynh
- Laboratory of Molecular Endocrinology, Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, 11 Hospital Drive, Singapore.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Thong PSP, Tandjung SS, Movania MM, Chiew WM, Olivo M, Bhuvaneswari R, Seah HS, Lin F, Qian K, Soo KC. Toward real-time virtual biopsy of oral lesions using confocal laser endomicroscopy interfaced with embedded computing. J Biomed Opt 2012; 17:056009. [PMID: 22612132 DOI: 10.1117/1.jbo.17.5.056009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Oral lesions are conventionally diagnosed using white light endoscopy and histopathology. This can pose a challenge because the lesions may be difficult to visualise under white light illumination. Confocal laser endomicroscopy can be used for confocal fluorescence imaging of surface and subsurface cellular and tissue structures. To move toward real-time "virtual" biopsy of oral lesions, we interfaced an embedded computing system to a confocal laser endomicroscope to achieve a prototype three-dimensional (3-D) fluorescence imaging system. A field-programmable gated array computing platform was programmed to enable synchronization of cross-sectional image grabbing and Z-depth scanning, automate the acquisition of confocal image stacks and perform volume rendering. Fluorescence imaging of the human and murine oral cavities was carried out using the fluorescent dyes fluorescein sodium and hypericin. Volume rendering of cellular and tissue structures from the oral cavity demonstrate the potential of the system for 3-D fluorescence visualization of the oral cavity in real-time. We aim toward achieving a real-time virtual biopsy technique that can complement current diagnostic techniques and aid in targeted biopsy for better clinical outcomes.
Collapse
|
26
|
Tan WJ, Chia CS, Tan HK, Soo KC, Iyer NG. Prognostic Significance of Invasion Depth in Oral Tongue Squamous Cell Carcinoma. ACTA ACUST UNITED AC 2012; 74:264-70. [DOI: 10.1159/000343796] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 09/04/2012] [Indexed: 11/19/2022]
|
27
|
Lim L, Chow P, Wong CY, Chung A, Chan YH, Wong WK, Soo KC. Doctor–patient communication, knowledge, and question prompt lists in reducing preoperative anxiety – A randomized control study. Asian J Surg 2011; 34:175-80. [DOI: 10.1016/j.asjsur.2011.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/14/2011] [Accepted: 09/22/2011] [Indexed: 10/28/2022] Open
|
28
|
Tan EH, Goh C, Lim WT, Soo KC, Khoo ML, Tan T, Tan DSW, Ang MK, Ng QS, Tan PH, Lim A, Hwang J, Teng YHF, Lim TH, Tan SH, Baskaran N, Hui KM. Gefitinib, cisplatin, and concurrent radiotherapy for locally advanced head and neck cancer: EGFR FISH, protein expression, and mutational status are not predictive biomarkers. Ann Oncol 2011; 23:1010-6. [PMID: 21768327 DOI: 10.1093/annonc/mdr327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Gefitinib was demonstrated to be synergistic with cisplatin and radiotherapy (RT) in in vitro studies. Biomarkers predictive of response to gefitinib in squamous cell head and neck cancer is still lacking. METHODS Thirty-one patients with locally advanced and easily accessible primary tumor sites for biopsies were recruited. Gefitinib was started 3 weeks before the start of cisplatin/concurrent radiotherapy (CTRT) and continued during the CTRT phase and thereafter for 4 months as consolidation phase. Two baselines and a repeat tumor sample were taken after 2 weeks of gefitinib alone to study its impact on tumor gene expression. Epidermal growth factor receptor (EGFR) protein expression, FISH and mutational status, and matrix metallopeptidase 11 (MMP11) protein expression were correlated with response and survival outcome. RESULTS The overall response rate to gefitinib alone was 9.7%. The survival outcome is as follows: median disease free 1.3 years, median survival time 2.4 years, 3-year disease free 42.9%, and 3-year overall survival 48.4%. EGFR FISH, protein expression, and mutational status did not predict for response nor survival outcome of patients. Although MMP11 overexpression did not predict for response, it predicted significantly for a poorer survival outcome. CONCLUSIONS Gefitinib can be combined safely with cisplatin/RT. More studies are needed to uncover predictive biomarkers of benefit to gefitinib.
Collapse
Affiliation(s)
- E-H Tan
- Department of Medical Oncology, National Cancer Centre, Singapore.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Goh BKP, Chow PKH, Tan YM, Cheow PC, Chung YFA, Soo KC, Wong WK, Ooi LLPJ. Validation of five contemporary prognostication systems for primary pancreatic endocrine neoplasms: results from a single institution experience with 61 surgically treated cases. ANZ J Surg 2010; 81:79-85. [PMID: 21299804 DOI: 10.1111/j.1445-2197.2010.05403.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Presently, several systems for the prognostication of pancreatic endocrine neoplasms (PENs) exist and the most appropriate classification system has not been clearly defined. This study aims to validate the performance of the 2004 World Health Organization (WHO), European Neuroendocrine Tumor Society (ENETS), Memorial Sloan-Kettering Cancer Center (MSKCC), American Joint Committee for Cancer (AJCC) TNM staging and Bilimoria criteria in a cohort of patients with PENs who underwent surgery at a single institution. METHODS This study is a retrospective review of 61 consecutive patients who underwent surgical treatment for PEN. Actuarial disease-specific survival (DSS) of all 61 patients and recurrence-free survival (RFS) of 53 patients who had curative resection were analysed. RESULTS On univariate analyses, tumour size ≥50 mm, non-curative resection, lymph node involvement, presence of distant metastases, presence of necrosis, mitotic count ≥2/10 hpf and poor differentiation were associated with decreased DSS. Tumour size ≥50 mm, lymph node involvement, lymphovascular invasion, presence of necrosis and mitotic count ≥2/10 hpf were associated with decreased actuarial RFS. All five staging systems were useful in stratifying the 61 patients according to actuarial DSS. However, the MSKCC grading and ENETS grading systems were not statistically significant in stratifying DSS in the 61 patients. In the 53 patients who underwent curative resection, the WHO, ENETS, MSKCC, AJCC staging and the MSKCC grading systems were successful in stratifying the patients according to actuarial RFS. However, the Bilimoria scoring and ENETS grading systems were not useful in prognosticating these 53 patients. CONCLUSION All five classification systems were useful for the prognostication of surgically treated PENs in our patient cohort.
Collapse
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Singapore.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Lee SY, Ooi AS, Qian CN, Hwang SG, Teh BT, Soo KC. Abstract 2238: A novel prognostic marker in patients with squamous cell carcinoma of the tongue: high endothelial venules. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
AIMS: To evaluate tumor-induced vascularization in regional lymph nodes (LN) of patients with tongue carcinoma by studying the morphological and functional alterations of high endothelial venules (HEV) and its correlation to clinico-pathological features.
BACKGROUND: Squamous cell carcinoma (SCC) of the tongue is one of the most prevalent tumors of the head and neck region. The extent of LN metastasis is a major determinant for the staging and the most reliable adverse prognostic factor. Primary tumors can induce lymphatics and vasculature reorganizations within sentinel LN before the arrival of cancer cells and these key blood vessels are identified as HEV. The morphological altera[[Unsupported Character - Codename ­]]tion of HEV in the presence of a cancer, coupled with the increased proliferation rate of the endothelial cells, results in a functional shift of HEV from immune response mediator to blood-flow carrier.
METHODS: This study is based on 65 consecutive patients with tongue SCC who underwent primary surgical treatment at Singapore General Hospital from January 2001 to December 2005. The patients were categorized into 2 groups (Cases and Controls) based on the presence of malignancy in their cervical lymph nodes. A review of the patients’ pathological and clinical data was performed from a prospective database. Immunohistochemical staining of the tissue blocks for HEV and high-power-field image analysis were performed and analyzed with correlation to the patients’ clinico-pathological features.
RESULTS: The total number of HEVs is significantly associated to disease-free interval when controlling for the group (p=0.022) as well as combining both groups as one cohort (p=0.023). There also a similar association comparing the HEV parameters to overall survival.
CONCLUSION: Our results suggest that the HEV possibly plays a key role in the pathogenesis of lymphatic and subsequent distant metastases. Confirmation of this hypothesis would offer a novel therapeutic approach to preventing metastasis by blocking the remodeling processes of HEV in LN.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2238.
Collapse
Affiliation(s)
- Ser Yee Lee
- 1Singapore General Hospital, Singapore, Singapore
| | | | | | | | | | | |
Collapse
|
31
|
Bhuvaneswari R, Thong PSP, Gan YY, Soo KC, Olivo M. Evaluation of hypericin-mediated photodynamic therapy in combination with angiogenesis inhibitor bevacizumab using in vivo fluorescence confocal endomicroscopy. J Biomed Opt 2010; 15:011114. [PMID: 20210440 DOI: 10.1117/1.3281671] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Photodynamic therapy (PDT) is an alternative cancer treatment modality that offers localized treatment using a photosensitizer and light. However, tumor angiogenesis is a major concern following PDT-induced hypoxia as it promotes recurrence. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), thus preventing angiogenesis. The combination of PDT with antiangiogenic agents such as bevacizumab has shown promise in preclinical studies. We use confocal endomicroscopy to study the antiangiogenic effects of PDT in combination with bevacizumab. This technique offers in vivo surface and subsurface fluorescence imaging of tissue. Mice bearing xenograft bladder carcinoma tumors were treated with PDT, bevacizumab, or PDT and bevacizumab combination therapy. In tumor regression experiments, combination therapy treated tumors show the most regression. Confocal fluorescence endomicroscopy enables visualization of tumor blood vessels following treatment. Combination therapy treated tumors show the most posttreatment damage with reduced cross-sectional area of vessels. Immunohistochemistry and immunofluorescence studies show that VEGF expression is significantly downregulated in the tumors treated by combination therapy. Overall, combining PDT and bevacizumab is a promising cancer treatment approach. We also demonstrate that confocal endomicroscopy is useful for visualization of vasculature and evaluation of angiogenic response following therapeutic intervention.
Collapse
MESH Headings
- Angiogenesis Inhibitors/pharmacology
- Animals
- Anthracenes
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Bevacizumab
- Fluorescent Antibody Technique
- Hypoxia
- Immunohistochemistry
- Male
- Mice
- Mice, Inbred BALB C
- Microscopy, Confocal/methods
- Microscopy, Fluorescence/methods
- Neoplasms, Experimental/blood supply
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/pathology
- Neovascularization, Pathologic/drug therapy
- Perylene/analogs & derivatives
- Perylene/pharmacology
- Photochemotherapy/methods
- Radiation-Sensitizing Agents/pharmacology
- Vascular Endothelial Growth Factor A/metabolism
- Xenograft Model Antitumor Assays
Collapse
|
32
|
Huynh H, Ngo VC, Choo SP, Poon D, Koong HN, Thng CH, Toh HC, Zheng L, Ong LC, Jin Y, Song IC, Chang APC, Ong HS, Chung AYF, Chow PKH, Soo KC. Sunitinib (SUTENT, SU11248) suppresses tumor growth and induces apoptosis in xenograft models of human hepatocellular carcinoma. Curr Cancer Drug Targets 2009; 9:738-47. [PMID: 19754358 DOI: 10.2174/156800909789271530] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common and third deadliest primary neoplasm. Since HCC is a particularly vascular solid tumor, we determined the antitumor and antiangiogenic activities of sunitinib malate, a potent inhibitor of two receptors involved in angiogenesis - vascular endothelial growth factor receptor (VEGFR) and platelet-derived growth factor receptor (PDGFR). In the present study, we reported that treatment of HepG2 and SK-Hep-1 cells with sunitinib led to growth inhibition and apoptosis in a dose-dependent fashion. Sunitinib inhibited phosphorylation of VEGFR-2 at Tyr951 and PDGFR-beta at Tyr1021 both in vitro and in vivo. Sunitinib also suppressed tumor growth of five patient-derived xenografts. Sunitinib-induced tumor growth inhibition was associated with increased apoptosis, reduced microvessel density and inhibition of cell proliferation. This study provides a strong rationale for further clinical investigation of sunitinib in patients with hepatocellular carcinoma.
Collapse
Affiliation(s)
- H Huynh
- Humphrey Oei Institute of Cancer Research, National Cancer Centre of Singapore, Singapore.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Goh BKP, Ooi LLPJ, Cheow PC, Tan YM, Ong HS, Chung YFA, Chow PKH, Wong WK, Soo KC. Accurate preoperative localization of insulinomas avoids the need for blind resection and reoperation: analysis of a single institution experience with 17 surgically treated tumors over 19 years. J Gastrointest Surg 2009; 13:1071-7. [PMID: 19291334 DOI: 10.1007/s11605-009-0858-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 02/26/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Presently, the need for and choice of preoperative localization tests for insulinomas remain controversial. We report the results from a single institution experience whereby the management policy adopted was that of accurate preoperative localization before surgical exploration. MATERIALS AND METHODS From 1990 to 2008, 17 patients with a clinical and biochemical diagnosis of an insulinoma who underwent surgery were retrospectively reviewed. The diagnosis of all insulinomas were confirmed pathologically. RESULTS All tumors were localized preoperatively and an average of 2.2 preoperative localization studies including 1.4 noninvasive studies and 0.8 invasive studies were utilized per patient. Invasive localization modalities were more sensitive (92%) than noninvasive modalities in localizing insulinomas (71%). Intra-arterial calcium stimulation with hepatic venous sampling was the most sensitive invasive modality (100%), whereas magnetic resonance imaging was the most sensitive noninvasive modality (63%). Fifteen of 17 tumors (88%) were localized intraoperatively via inspection/palpation and/or intraoperative ultrasonography. Both insulinomas which were not localized intraoperatively were localized correctly to the distal pancreas via preoperative transhepatic portal venous sampling. None of the patients required a blind resection or surgical reexploration for failed localization. All 17 patients underwent complete surgical resection which included eight enucleations and nine distal pancreatectomies with a cure rate of 94% (16/17) at a median follow-up of 35 (range, 1-217) months. The postoperative morbidity and long-term outcome of enucleation was similar to distal pancreatectomy despite a higher rate of microscopic margin involvement. CONCLUSION Accurate preoperative localization of insulinomas is useful as it eliminates the need for blind distal pancreatectomy and avoids reoperation. Complete surgical resection is the treatment of choice, and whenever possible, a pancreas-sparing approach such as enucleation should be adopted.
Collapse
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Hepatocellular carcinoma is a disease of great concern. Surgery is the treatment of choice, but there is still a high recurrence rate after resection. OBJECTIVES To determine the benefits and harms of neoadjuvant and adjuvant therapies compared to surgery alone or surgery and placebo/supportive therapy after curative resection for operable hepatocellular carcinoma. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, Chinese Biomedical Database, and US National Cancer Institute's Physician's Data Query Trials Database until 2005. References of the identified trials were also searched for identifying further trials. SELECTION CRITERIA Randomised and quasi-randomised trials that compared hepatocellular carcinoma patients who were given and not given neoadjuvant/adjuvant therapy as a supplement to curative liver resection. DATA COLLECTION AND ANALYSIS Data were extracted independently by two authors and discrepancies resolved by consensus. The survival and disease-free survival curves were compared using their one, two, three, four, and five-year survival rates, median survival times, and the result of the significance tests (P-values). MAIN RESULTS A total of 12 randomised trials were identified, totaling 843 patients. The size of the randomised clinical trials ranged from 30 to 155 patients. Both preoperative (neoadjuvant) and postoperative (adjuvant), systemic and locoregional (+/- embolisation), chemo- and immunotherapy interventions were tested. Treatment regimens and patients selected were not comparable, so no pooling was done. Only one regimen using preoperative transcatheter arterial chemoembolisation with doxorubicin was similar in two trials. Four of the twelve trials reported survival benefit at five years when given adjuvant or neoadjuvant therapy. Disease-free survival was reported in nine trials, and the estimated hazard ratios show that disease-free survival was significant in two trials at five years. These two trials had not shown a survival advantage, but the recurrence was significantly lower in patients given adjuvant or neoadjuvant therapy. The highest toxicity rate was in a trial using oral 1-hexylcarbamoyl 5-fluorouracil which resulted in 12 out of 38 patients being withdrawn from the trial because of adverse events. AUTHORS' CONCLUSIONS There is no clear evidence for efficacy of any of the adjuvant and neo-adjuvant protocols reviewed, but there is some evidence to suggest that adjuvant therapy may be beneficial offering prolonged disease-free survival. In order to detect a realistic treatment advantage, larger trials with lower risk of systematic error will have to be conducted.
Collapse
Affiliation(s)
- Miny Samuel
- Research Triangle Institute-Health Solutions, Williams House, Lloyd Street North, Manchester Science Park, Manchester, UK, M15 6SE
| | | | | | | | | |
Collapse
|
35
|
Samuel M, Chow PKH, Chan Shih-Yen E, Machin D, Soo KC. Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev 2009. [PMID: 19160192 DOI: 10.1002/14651858.cd001199.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hepatocellular carcinoma is a disease of great concern. Surgery is the treatment of choice, but there is still a high recurrence rate after resection. OBJECTIVES To determine the benefits and harms of neoadjuvant and adjuvant therapies compared to surgery alone or surgery and placebo/supportive therapy after curative resection for operable hepatocellular carcinoma. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, Chinese Biomedical Database, and US National Cancer Institute's Physician's Data Query Trials Database until 2005. References of the identified trials were also searched for identifying further trials. SELECTION CRITERIA Randomised and quasi-randomised trials that compared hepatocellular carcinoma patients who were given and not given neoadjuvant/adjuvant therapy as a supplement to curative liver resection. DATA COLLECTION AND ANALYSIS Data were extracted independently by two authors and discrepancies resolved by consensus. The survival and disease-free survival curves were compared using their one, two, three, four, and five-year survival rates, median survival times, and the result of the significance tests (P-values). MAIN RESULTS A total of 12 randomised trials were identified, totaling 843 patients. The size of the randomised clinical trials ranged from 30 to 155 patients. Both preoperative (neoadjuvant) and postoperative (adjuvant), systemic and locoregional (+/- embolisation), chemo- and immunotherapy interventions were tested. Treatment regimens and patients selected were not comparable, so no pooling was done. Only one regimen using preoperative transcatheter arterial chemoembolisation with doxorubicin was similar in two trials. Four of the twelve trials reported survival benefit at five years when given adjuvant or neoadjuvant therapy. Disease-free survival was reported in nine trials, and the estimated hazard ratios show that disease-free survival was significant in two trials at five years. These two trials had not shown a survival advantage, but the recurrence was significantly lower in patients given adjuvant or neoadjuvant therapy. The highest toxicity rate was in a trial using oral 1-hexylcarbamoyl 5-fluorouracil which resulted in 12 out of 38 patients being withdrawn from the trial because of adverse events. AUTHORS' CONCLUSIONS There is no clear evidence for efficacy of any of the adjuvant and neo-adjuvant protocols reviewed, but there is some evidence to suggest that adjuvant therapy may be beneficial offering prolonged disease-free survival. In order to detect a realistic treatment advantage, larger trials with lower risk of systematic error will have to be conducted.
Collapse
Affiliation(s)
- Miny Samuel
- Research Triangle Institute-Health Solutions, Williams House, Lloyd Street North, Manchester Science Park, Manchester, UK, M15 6SE
| | | | | | | | | |
Collapse
|
36
|
Goh BKP, Tan YM, Chung YFA, Cheow PC, Ong HS, Chan WH, Chow PKH, Soo KC, Wong WK, Ooi LLPJ. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. ACTA ACUST UNITED AC 2008; 143:956-65. [PMID: 18936374 DOI: 10.1001/archsurg.143.10.956] [Citation(s) in RCA: 219] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To critically analyze a large single-institution experience with distal pancreatectomy (DP), with particular attention to the risk factors, outcome, and management of the postoperative pancreatic fistula (PF). DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS A total of 232 consecutive patients with pancreatic or extrapancreatic disease necessitating DP over 21 years. INTERVENTIONS Twenty-one patients underwent spleen-preserving DP, 117 underwent DP with splenectomy, and 94 underwent DP with multiorgan resection. MAIN OUTCOME MEASURES The perioperative and postoperative data of patients who underwent DP were analyzed. This included factors associated with postoperative morbidity with particular attention to the PF (defined by the International Study Group of Pancreatic Fistula) and changing trends in operative and perioperative data during the study period. RESULTS The overall operative morbidity and mortality were 47% (107 patients) and 3% (7 patients), respectively. During the study period, the rates of resection increased from 3 cases to 23 per year, and increasingly these were performed for smaller and incidental lesions. The morbidity rate remained unchanged, but there was a decline in postoperative stay and the need for care in the intensive care unit. Pancreatic fistulas occurred in 72 patients (31%); 41 (18%) were grade A, 13 (6%) grade B, and 18 (8%) grade C. Increased weight, higher American Society of Anesthesiologists score, blood loss greater than 1 L, increased operation time, decreased albumin level, and sutured closure of the stump without main duct ligation were associated with a postoperative PF on univariate analysis. A DP with splenectomy was associated with a higher incidence of grade B or C PF and non-PF-related complications. Ninety-two percent of PFs were successfully managed nonoperatively. Clinical outcomes correlated well with PF grading, as evidenced by the progressive increase in outcome measures such as postoperative stay, readmissions, reoperations, radiologic interventions, and non-PF-related complications from grade A to C PFs. CONCLUSIONS Pancreatic fistula is the most common complication after DP and its incidence varies depending on the definition applied. Several risk factors for developing a PF were identified. Splenic preservation after DP is safe. The grade of a PF correlates well with clinical outcomes, and most PFs may be managed nonoperatively.
Collapse
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Singapore.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Thong PSP, Olivo M, Kho KW, Bhuvaneswari R, Chin WWL, Ong KW, Soo KC. Immune response against angiosarcoma following lower fluence rate clinical photodynamic therapy. J Environ Pathol Toxicol Oncol 2008; 27:35-42. [PMID: 18551894 DOI: 10.1615/jenvironpatholtoxicoloncol.v27.i1.40] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tumor response to photodynamic therapy (PDT) is dependent on treatment parameters used. In particular, the light fluence rate may be an important determinant of the treatment outcome. In this clinical case report, we describe the response of angiosarcoma to PDT carried out using different fluence rates and drug and light doses. A patient with recurrent multifocal angiosarcoma of the head and neck was recruited for PDT. A new generation chlorin-based photosensitizer, Fotolon, was administered at a dose of 2.0 to 5.7 mg/kg. The lesions were irradiated with 665 nm laser light for a light dose of 65 to 200 J/cm2 delivered at a fluence rate of 80 or 150 mW/cm2. High dose PDT carried out at a high fluence rate resulted in local control of the disease for up to a year; however, the disease recurred and PDT had to be repeated. PDT of new lesions carried out at a lower fluence rate resulted in tumor eradication. More significantly, it also resulted in spontaneous remission of neighboring and distant untreated lesions. Repeat PDT carried out on a recurrent lesion at a lower fluence rate resulted in eradication of both treated and untreated lesions despite the lower total light dose delivered. Immunohistochemical examination of biopsy samples implies that PDT could have activated a cell-mediated immune response against untreated lesions. Subsequent histopathological examination of the lesion sites showed negative for disease. Our clinical observations show that lower fluence rate PDT results in better outcome and also indicate that the fluence rate, rather than the total light dose, is a more crucial determinant of the treatment outcome. Specifically, lower fluence rate PDT appears to activate the body's immune response against untreated lesions.
Collapse
|
38
|
Thong PSP, Ong KW, Goh NSG, Kho KW, Manivasager V, Bhuvaneswari R, Olivo M, Soo KC. Photodynamic-therapy-activated immune response against distant untreated tumours in recurrent angiosarcoma. Lancet Oncol 2007; 8:950-2. [PMID: 17913664 DOI: 10.1016/s1470-2045(07)70318-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
39
|
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, with no effective treatment for most individuals who succumb to this neoplasm. We report that treatment of primary HCC cells with the mitogen-activated protein/extracellular signal-regulated kinase (ERK) kinase 1/2 inhibitor AZD6244 (ARRY-142886) plus doxorubicin led to synergistic growth inhibition and apoptosis. In vivo administration of AZD6244, doxorubicin, or the combination of AZD6244 and doxorubicin in mice bearing 5-1318 HCC xenografts resulted in approximately 52% +/- 15%, 12% +/- 9%, and 76% +/- 7% growth inhibition, respectively. AZD6244-inhibited tumor growth was associated with increased apoptosis, inactivation of ERK1/2, inhibition of cell proliferation, and down-regulation of cell cycle regulators, including cyclin D1, cdc-2, cyclin-dependent kinases 2 and 4, cyclin B1, and c-Myc. The AZD6244-doxorubicin combined protocol not only promoted apoptosis but also induced a synergistic effect not seen in single-agent-treated tumors, including increased expression of the p130 RB tumor suppressor gene. Our study provides a strong rationale for clinical investigation of combination therapy with the mitogen-activated protein/ERK kinase 1/2 inhibitor AZD6244 and doxorubicin in patients with HCC.
Collapse
MESH Headings
- Animals
- Antibiotics, Antineoplastic/pharmacology
- Apoptosis/drug effects
- Benzimidazoles/pharmacology
- Blotting, Western
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/pathology
- Cell Cycle/drug effects
- Cell Line, Tumor/drug effects
- Cell Line, Tumor/metabolism
- Cell Line, Tumor/pathology
- Cell Proliferation/drug effects
- Crk-Associated Substrate Protein/metabolism
- Cyclins/metabolism
- Doxorubicin/pharmacology
- Drug Therapy, Combination
- Fluorescent Antibody Technique
- Humans
- In Situ Nick-End Labeling
- Liver Neoplasms/drug therapy
- Liver Neoplasms/pathology
- Male
- Mice
- Mice, SCID
- Survival Rate
- Transplantation, Heterologous
Collapse
Affiliation(s)
- Hung Huynh
- Laboratory of Molecular Endocrinology, Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore 169610.
| | | | | |
Collapse
|
40
|
Abstract
Bochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood, but may rarely be detected in adults. The treatment of choice is operative repair due to the risk of visceral herniation and strangulation.
Collapse
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Rd, Singapore 169608.
| | | | | | | |
Collapse
|
41
|
Sreedharan S, Pang CE, Chan GSW, Soo KC, Lim DTH. Follicular thyroid carcinoma presenting as axial skeletal metastases. Singapore Med J 2007; 48:640-4. [PMID: 17609826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Common modes of presentation of follicular thyroid carcinoma include a solitary thyroid nodule and cervical lymphadenopathy. We report four patients who presented with axial skeletal metastases rather than the usual neck lumps. METHODS A review of a database of 389 cases of thyroid cancer, managed by our department from 1990 to 2003, was perfomed. Based on each patient's presenting clinical feature, patients for the case series were selected. RESULTS Four of the 389 patients presented with axial skeletal metastases - three were in the scalp while the fourth was in the sacral region. The histology of all four cases was that of follicular thyroid carcinoma. Despite widespread metastases at presentation, the overall survival rates of these patients remained relatively good. CONCLUSION Patients presenting with lesions suspicious of secondary malignancy in the axial skeleton should be clinically evaluated for thyroid cancer. This is especially important if the patient belongs to a high risk age group and has highly vascular lesions.
Collapse
Affiliation(s)
- S Sreedharan
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | | | |
Collapse
|
42
|
Goh BKP, Chung YFA, Ng DCE, Selvarajan S, Soo KC. Positron emission tomography with 2-deoxy-2-[18f] fluoro-D-glucose in the detection of malignancy in intraductal papillary mucinous neoplasms of the pancreas. JOP 2007; 8:350-4. [PMID: 17495366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A 79-year-old Indian male was admitted with upper abdominal discomfort of 1-year duration which was associated with loss of weight and appetite. Serum tumor markers, including carcinoembryonic antigen and carbohydrate antigen 19-9, were within normal limits. A computed tomographic scan demonstrated a cystically dilated and tortuous pancreatic duct measuring 1.9 cm, suggestive of an intraductal papillary mucinous neoplasm. Fusion positron emission tomography/computed tomography with 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography (FDG-PET/CT) which was subsequently performed confirmed a metabolically active focus within the pancreatic head mass with a standard uptake value (SUVmax) of 3.5 compatible with carcinoma. A total pancreatectomy was performed and the final histology demonstrated a main-duct type intraductal papillary mucinous neoplasm with a focus of high-grade dysplasia compatible with carcinoma-in-situ. These images illustrate the emerging utility of FDG-PET/CT in the preoperative detection of malignancy in intraductal papillary mucinous neoplasm.
Collapse
Affiliation(s)
- Brian K P Goh
- Departments of Surgery, Nuclear Medicine, and Pathology, Singapore General Hospital. Singapore, Singapore.
| | | | | | | | | |
Collapse
|
43
|
Kang GCW, Soo KC, Lim DTH. Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience. Ann Acad Med Singap 2007. [DOI: 10.47102/annals-acadmedsg.v36n4p233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: We present a series of head and neck extracranial non-vestibular schwannomas treated during a ten-year period, assessing epidemiology, presenting signs and symptoms, location, nerve of origin, diagnostic modalities, treatment and clinical outcome.
Materials and Methods: Clinical records of all patients with head and neck schwannomas treated at our department from April 1995 to July 2005 were retrospectively reviewed.
Results: There was female predominance (67%). The mean age at diagnosis was 48 years. Sixteen (76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in the parapharyngeal space. The most common nerves of origin were the vagus and the cervical sympathetic chain. The tumour may masquerade as a cervical lymph node and other myriad conditions. Treatment for all but 2 cases was complete excision with nerve preservation. Two cases of facial schwannoma required sacrifice of the affected nerve portion with nerve reconstruction. All facial schwannoma patients suffered postoperative facial palsy with only partial resolution (mean final House-Brackman grade, 3.25/6). Among non-facial schwannoma patients, postoperative neural deficit occurred in 12 with partial to complete resolution in 7. The median follow-up period was 24 months. No schwannoma was malignant and none recurred.
Conclusion: Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin, but for extensive tumour or facial schwannomas, subtotal resection or nerve sacrifice with reconstruction and rehabilitation are considerations. Surgery on intraparotid facial schwannomas carries considerable morbidity and conservative management has a place in treatment. Early recognition of facial schwannomas is key to optimal treatment.
Key words: Asian, Extracranial non-vestibular, Head and neck schwannomas, Single institution
Collapse
|
44
|
Abstract
INTRODUCTION Patients diagnosed with peritoneal carcinomatous usually survive for less than 6 months. Cytoreductive surgery allows relief of the obstruction and improvement in functional status, while intraperitoneal chemotherapy infusion provides high local concentrations of chemotherapeutic agents. Our institutional experience is reviewed to assess the selection criteria, peri-operative complications, and outcomes. MATERIALS AND METHODS We carried out a retrospective review of nine patients who had undergone aggressive cytoreductive surgery and hyperthermic intra- and early post-operative chemotherapy by a single surgeon between April 2000 and October 2004. The inclusion criteria were: (1) a demonstrated absence of extra-peritoneal and hepatic spread, (2) fitness of the patient and ability to tolerate cytoreductive surgery and intra-operative chemotherapy, and (3) the presence of a primary tumor originating form the gastro-intestinal tract (colonic, appendiceal, and gastric primaries). RESULTS Seven women and two men, with a median age of 55 years, were treated. The median duration of the operation was 12 hours and 55 minutes. Seven of the nine patients required the insertion of at least one chest tube. All patients were monitored in the surgical intensive care unit (SICU) for a median of 1 day, started on feeds after a median of 6 days, and were hospitalized for a median of 16 days (range:11-18 days). There was no peri-operative mortality and only one major peri-operative complication (11.1%). At the time of analysis, the median follow-up was 16 months (range: 2-40 months), and the median disease-free survival was 8 months, with four of the nine patients showing no evidence of recurrence. To date, all of the patients are still alive. A 1-year survival rate of 100% is also documented. CONCLUSIONS This article describes our initial experience with peritonectomy and intra-operative, intra-peritoneal chemotherapy infusion. Our initial problems included difficulty with leakage of the chemotherapeutic agents into the thoracic cavity that had to be overcome by the early insertion of chest-tubes. With appropriate patient selection, cytoreductive surgery with the infusion of intra-operative chemotherapy can be considered to be a therapeutic option for some patients with diffuse peritoneal metastases, and good disease-free and overall survival can be achieved with minimal morbidity.
Collapse
Affiliation(s)
- M Teo
- Department of Surgical, National Cancer Centre of Singapore, Singapore.
| | | | | | | | | |
Collapse
|
45
|
Kang GCW, Soo KC, Lim DTH. Extracranial non-vestibular head and neck schwannomas: a ten-year experience. Ann Acad Med Singap 2007; 36:233-8. [PMID: 17483850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION We present a series of head and neck extracranial non-vestibular schwannomas treated during a ten-year period, assessing epidemiology, presenting signs and symptoms, location, nerve of origin, diagnostic modalities, treatment and clinical outcome. MATERIALS AND METHODS Clinical records of all patients with head and neck schwannomas treated at our department from April 1995 to July 2005 were retrospectively reviewed. RESULTS There was female predominance (67%). The mean age at diagnosis was 48 years. Sixteen (76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in the parapharyngeal space. The most common nerves of origin were the vagus and the cervical sympathetic chain. The tumour may masquerade as a cervical lymph node and other myriad conditions. Treatment for all but 2 cases was complete excision with nerve preservation. Two cases of facial schwannoma required sacrifice of the affected nerve portion with nerve reconstruction. All facial schwannoma patients suffered postoperative facial palsy with only partial resolution (mean final House-Brackman grade, 3.25/6). Among non-facial schwannoma patients, postoperative neural deficit occurred in 12 with partial to complete resolution in 7. The median follow-up period was 24 months. No schwannoma was malignant and none recurred. CONCLUSION Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin, but for extensive tumour or facial schwannomas, subtotal resection or nerve sacrifice with reconstruction and rehabilitation are considerations. Surgery on intraparotid facial schwannomas carries considerable morbidity and conservative management has a place in treatment. Early recognition of facial schwannomas is key to optimal treatment.
Collapse
Affiliation(s)
- Gavin C W Kang
- Department of General Surgery, Singapore General Hospital, Singapore
| | | | | |
Collapse
|
46
|
Sreedharan S, Tan YM, Tan SG, Soo KC, Wong WK. Clinical spectrum and surgical management of acute mesenteric ischaemia in Singapore. Singapore Med J 2007; 48:319-23. [PMID: 17384879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Acute mesenteric ischaemia (AMI) is a surgical emergency with a dismal prognosis. Much of the literature concerning this condition is from the West. This study aims to present a single-centre Asian experience of management of patients with AMI and the immediate outcome following surgical treatment. METHODS This is a retrospective study of patients managed for AMI in our department between 1990 and 2003. The data was obtained from a prospectively-collected surgical data base as well as from clinical case records. RESULTS 65 patients were managed by our department for AMI over 14 years. The median age of this patient group was 69 years, with a high prevalence of cardiovascular diseases. The majority of patients presented with abdominal pain, distension and vomiting. The commonest subtype of AMI was caused by mesenteric arterial occlusion; this subtype also had the highest in-hospital mortality. Our overall in-hospital mortality for all 65 patients was 55.4 percent. CONCLUSION Clinical suspicion, especially in a patient with the relevant risk factors, remains the mainstay of appropriate early management of AMI. Our patient demographics, coexistent diseases and commonest subtype of AMI were similar to that reported in the Western literature. In this paper, we also suggest a management algorithm for patients with suspected AMI.
Collapse
Affiliation(s)
- S Sreedharan
- Department of General Surgery, Singapore General Hospital, Block 6, Level 7, Outram Road, Singapore 169608
| | | | | | | | | |
Collapse
|
47
|
Thong PSP, Olivo M, Kho KW, Zheng W, Mancer K, Harris M, Soo KC. Laser confocal endomicroscopy as a novel technique for fluorescence diagnostic imaging of the oral cavity. J Biomed Opt 2007; 12:014007. [PMID: 17343482 DOI: 10.1117/1.2710193] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Malignancies of the oral cavity are conventionally diagnosed by white light endoscopy, biopsy, and histopathology. However, it is often difficult to distinguish between benign and premalignant or early lesions. A laser confocal endomicroscope (LCE) offers noninvasive, in vivo surface and subsurface fluorescence imaging of tissue. We investigate the use of an LCE with a rigid probe for diagnostic imaging of the oral cavity. Fluorescein and 5-aminolevulinic acid (ALA) were used to carry out fluorescence imaging in vivo and on resected tissue samples of the oral cavity. In human subjects, ALA-induced protoporphyrin IX (PpIX) fluorescence images from the normal tongue were compared to images obtained from patients with squamous cell carcinoma (SCC) of the tongue. Using rat models, images from normal rat tongues were compared to those from carcinogen-induced models of SCC. Good structural images of the oral cavity were obtained using ALA and fluorescein, and morphological differences between normal and lesion tissue can be distinguished. The use of a pharmaceutical-grade solvent Pharmasolve enhanced the subsurface depth from which images can be obtained. Our initial results show that laser confocal fluorescence endomicroscopy has potential as a noninvasive optical imaging method for the diagnosis of oral cavity malignancies.
Collapse
Affiliation(s)
- Patricia Soo-Ping Thong
- National Cancer Center, Division of Medical Sciences, 11 Hospital Drive, Singapore, Singapore 169610
| | | | | | | | | | | | | |
Collapse
|
48
|
Wan WH, Tan KY, Ng C, Tay KH, Mancer K, Tay MH, Chia WKJ, Soo KC, Ooi LL. Metastatic malignant phaeochromocytoma: A rare entity that underlies a therapeutic quandary. Asian J Surg 2006; 29:294-302. [PMID: 17098666 DOI: 10.1016/s1015-9584(09)60106-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Phaeochromocytoma is a rare condition that provides a diagnostic challenge as a result of its variable presentation. Treatment of metastatic malignant phaeochromocytoma is also not well defined owing to its rarity. We present four such cases and a review of the literature. The database of the Singapore Cancer Registry was used to trace all cases of metastatic malignant phaeochromocytoma from 1984 to 2004, and the case records were then reviewed retrospectively. There were four patients with metastatic malignant phaeochromocytoma seen in Singapore in the last 20 years. Their variable clinical courses were reviewed and compared with current knowledge and overseas experience in the literature. We further discuss the difficulties in diagnosis, and the dilemma in appropriate management of such cases. Phaeochromocytoma remains a commonly missed diagnosis unless a high index of suspicion is maintained. Malignant phaeochromocytoma has a variable clinical course. There is a place for radical surgery if this can render the patient free of gross disease, or when it can achieve symptom control for palliation and improvement in quality of life. In the metastatic context, debulking surgery does not appear to be of curative benefit, although it may be undertaken for good palliation.
Collapse
Affiliation(s)
- Wei-Hwang Wan
- Department of General Surgery, Changi General Hospital, Singapore.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Tan YM, Chung AYF, Soo KC. Large Pyogenic Liver Abscess. Ann Surg 2006. [DOI: 10.1097/00000658-200607000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
|