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Tam VCW, Ching JCF, Yip SST, Kwong VHY, Chan CPL, Wong KCW, Lee SWY. Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey. Front Oncol 2024; 14:1378973. [PMID: 38694788 PMCID: PMC11061844 DOI: 10.3389/fonc.2024.1378973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Alongside the improved survival of nasopharyngeal cancer (NPC), late radiation toxicities are alarmingly hampering survivors' quality of life. A patient-reported symptom burden survey is lacking to address the unmet need for symptom management among local NPC survivors. Methods A single-center cross-sectional survey was conducted on 211 NPC survivors who had completed radiation therapy for three to 120 months. We employed the Chinese version M. D. Anderson Symptom Inventory - Head & Neck Module (MDASI-HN-C), Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN-C), and a question extracted from the Cancer Survivors' Unmet Needs Measure (CaSUN). Results Two hundred valid responses were collected. Participants suffered from at least four moderate to severe symptoms (mean = 4.84, SD = 4.99). The top five severe symptoms were dry mouth, mucus problems, difficulty swallowing or chewing, teeth or gum problems, and memory problems. MDASI-HN-C subscales were negatively correlated with the physical, emotional, functional, and HN-specific domains of the FACT-HN-C. The unmet need for symptom management was positively associated with symptom burden, either general symptoms (Adjusted odds ratio [ORadj] = 1.566, 95% CI = 1.282 - 1.914, p < 0.001) or top-5 symptoms (ORadj = 1.379, 95% CI = 1.185 - 1.604, p < 0.001), while negatively associated with post-RT time (ORadj = 0.981, 95% CI [0.972, 0.991], p < 0.001). Conclusion Virtually all NPC survivors suffer from late toxicities, which interplay with survivors' perceptions intricately to affect their unmet needs for symptom management. Personalized supportive care strategies with regular assessments and stratifications are warranted.
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Affiliation(s)
- Victor C. W. Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Jerry C. F. Ching
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Sindy S. T. Yip
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Virginia H. Y. Kwong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Catherine P. L. Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kenneth C. W. Wong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Shara W. Y. Lee
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Poon DMC, Tan GM, Chan K, Chan MTY, Chan TW, Kan RWM, Lam MHC, Leung CLH, Wong KCW, Kam KKH, Ng CF, Chiu PKF. Addressing the risk and management of cardiometabolic complications in prostate cancer patients on androgen deprivation therapy and androgen receptor axis-targeted therapy: consensus statements from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology. Front Oncol 2024; 14:1345322. [PMID: 38357197 PMCID: PMC10864500 DOI: 10.3389/fonc.2024.1345322] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/27/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Androgen deprivation therapy (ADT) is the foundational treatment for metastatic prostate cancer (PCa). Androgen receptor (AR) axis-targeted therapies are a new standard of care for advanced PCa. Although these agents have significantly improved patient survival, the suppression of testosterone is associated with an increased risk of cardiometabolic syndrome. This highlights the urgency of multidisciplinary efforts to address the cardiometabolic risk of anticancer treatment in men with PCa. Methods Two professional organizations invited five urologists, five clinical oncologists, and two cardiologists to form a consensus panel. They reviewed the relevant literature obtained by searching PubMed for the publication period from April 2013 to April 2023, to address three discussion areas: (i) baseline assessment and screening for risk factors in PCa patients before the initiation of ADT and AR axis-targeted therapies; (ii) follow-up and management of cardiometabolic complications; and (iii) selection of ADT agents among high-risk patients. The panel convened four meetings to discuss and draft consensus statements using a modified Delphi method. Each drafted statement was anonymously voted on by every panelist. Results The panel reached a consensus on 18 statements based on recent evidence and expert insights. Conclusion These consensus statements serve as a practical recommendation for clinicians in Hong Kong, and possibly the Asia-Pacific region, in the management of cardiometabolic toxicities of ADT or AR axis-targeted therapies in men with PCa.
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Affiliation(s)
- Darren M. C. Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong SAR, China
| | - Guang-Ming Tan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kuen Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong SAR, China
| | - Marco T. Y. Chan
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong SAR, China
| | - Tim-Wai Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR, China
| | | | - Martin H. C. Lam
- Hong Kong Integrated Oncology Centre, Hong Kong, Hong Kong SAR, China
| | | | - Kenneth C. W. Wong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kevin K. H. Kam
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Peter K. F. Chiu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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3
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Chung C, Yeung VTY, Wong KCW. Prognostic and predictive biomarkers with therapeutic targets in breast cancer: A 2022 update on current developments, evidence, and recommendations. J Oncol Pharm Pract 2023; 29:1343-1360. [PMID: 35971313 DOI: 10.1177/10781552221119797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate and validate the recent and emerging data for prognostic and predictive biomarkers with therapeutic targets in breast cancer. DATA SOURCES A literature search from January 2015 to March 2022 was performed using the key terms breast cancer, clinical practice guidelines, gene mutations, genomic assay, immune cancer therapy, predictive and/or prognostic biomarkers, and targeted therapies. STUDY SELECTION AND DATA EXTRACTION Relevant clinical trials, meta-analyses, seminal articles, and published evidence- and consensus-based clinical practice guidelines in the English language were identified, reviewed and evaluated. DATA SYNTHESIS Breast cancer is a biologically heterogeneous disease, leading to wide variability in treatment responses and survival outcomes. Biomarkers for breast cancer are evolving from traditional biomarkers in immunohistochemistry (IHC) such as estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor type 2 (HER2) to genetic biomarkers with therapeutic implications (e.g. breast cancer susceptibility gene 1/2 [BRCA1/2], estrogen receptor α [ESR1] gene mutation, HER2 gene mutation, microsatellite instability [MSI], phosphatidylinositol 3-kinase catalytic subunit 3Cα [PIK3CA] gene mutation, neurotrophic tyrosine receptor kinase [NTRK] gene mutation). In addition, current data are most robust for biomarkers in immunotherapy (e.g. programmed cell death receptor ligand-1 [PD-L1], microsatellite instability-high [MSI-H] or deficient mismatch repair [dMMR]). Oncotype DX assay remains the best validated gene expression assay that is both predictive and prognostic whereas MammaPrint is prognostic for genomic risk. CONCLUSIONS Biomarker-driven therapies have the potential to confer greater therapeutic advantages than standard-of-care therapies. The purported survival benefits associated with biomarker-driven therapies should be weighed against their potential harms.
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Affiliation(s)
- Clement Chung
- Department of Pharmacy, Houston Methodist West Hospital, Houston, TX, USA
| | - Vanessa T Y Yeung
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kenneth C W Wong
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong SAR
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4
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Lam WKJ, King AD, Miller JA, Liu Z, Yu KJ, Chua MLK, Ma BBY, Chen MY, Pinsky BA, Lou PJ, Woo JKS, Hsu WL, Simon J, Doolan DL, Waterboer T, Hui EP, Li H, Tsang RK, Wong KCW, Goh JP, Vlantis AC, Ai QY, Wong LM, Abdullah V, Lin JC, Chen CJ, Pfeiffer RM, Le QT, Lee AWM, Ji M, Cao S, Ma J, Chan ATC, Chan KCA, Hildesheim A. Recommendations for Epstein-Barr virus-based screening for nasopharyngeal cancer in high- and intermediate-risk regions. J Natl Cancer Inst 2023; 115:355-364. [PMID: 36723440 PMCID: PMC10086631 DOI: 10.1093/jnci/djad012] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/29/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
A meeting of experts was held in November 2021 to review and discuss available data on performance of Epstein-Barr virus (EBV)-based approaches to screen for early-stage nasopharyngeal carcinoma (NPC) and methods for the investigation and management of screen-positive individuals. Serum EBV antibody and plasma EBV DNA testing methods were considered. Both approaches were found to have favorable performance characteristics and to be cost-effective in high-risk populations. In addition to endoscopy, use of magnetic resonance imaging (MRI) to investigate screen-positive individuals was found to increase the sensitivity of NPC detection with minimal impact on cost-effectiveness of the screening program.
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Affiliation(s)
- W K Jacky Lam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Centre for Novostics, Hong Kong Science Park, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jacob A Miller
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Zhiwei Liu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Melvin L K Chua
- Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ming Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - John K S Woo
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wan-Lun Hsu
- Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Julia Simon
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Denise L Doolan
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Hui Li
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kenneth C W Wong
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Julian P Goh
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Qi Yong Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Lun M Wong
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Victor Abdullah
- Department of Otorhinolaryngology, Hong Kong Children's Hospital, Hong Kong SAR, China.,The Hong Kong College of Otorhinolaryngologists, Hong Kong SAR, China
| | - Jin Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Anne W M Lee
- Clinical Oncology Center, Shenzhen Key Laboratory for cancer metastasis and personalized therapy, The University of Hong Kong-Shenzhen Hospital, Guangdong, China.,Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China
| | - Mingfang Ji
- Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan, China
| | - Sumei Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - K C Allen Chan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,Centre for Novostics, Hong Kong Science Park, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Allan Hildesheim
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
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5
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Lai KKH, Li EYM, Chan RYC, Wong KCW, Yu JKS, Cheuk W, Hui YH, Cheng ACO, Chin JKY, Ip SK, Chan WH, Kwok JSW, Lam WC, Io IYF, Mak TST, Li KKW, Lam NM, Yip WWK, Young AL, Chan E, Ko CKL, Ko STC, Yuen HKL, Tham CCY, Pang CP, Chong KKL. Malignancies in Immunoglobulin G4-related ophthalmic disease. Eur J Ophthalmol 2023; 33:171-181. [PMID: 35675196 DOI: 10.1177/11206721221102274] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/11/2023]
Abstract
PURPOSE Clinical phenotypes in Immunoglobulin G4-related disease (IgG4-RD) according to the patterns of affecting organs have different risks of malignancies. We attempt to determine the association of malignancies with IgG4-related ophthalmic disease (IgG4-ROD). DESIGN Retrospective cohort study. METHODS Review of medical records, orbital images and histopathology reports in a territory-wide cohort of biopsy proven IgG4-ROD patients from 2005-2019. FINDINGS Among 122 patients who had biopsies taken from adnexal lesions including lacrimal glands (n = 108), orbital mass (n = 30), infiltrated orbital fat (n = 10), conjunctiva (n = 2) or extraocular muscles (n = 3), 13% (16/122) developed malignancies over 73 ± 48months' follow-up. There were 9 cases of ocular adnexal lymphoma (OAL) and 7 extra-orbital malignancies. Compared with the general population, the incidence of OAL was significantly higher (standardized incidence ratios, SIRs = 10.0, 95%CI = 4.5-17.6) while that of extra-orbital malignancies was similar. The SIRs was highest within the first year (SIR = 46.7, 95%CI = 18.5-87.6) when 7 OAL were concomitantly diagnosed. Patients who developed OAL or extra-orbital malignancies were older than other patients at IgG4-ROD diagnosis (64.9 ± 7.1, 68.3 ± 8.5 versus 55.2 ± 15.0 years, P < 0.05). Asymmetric lacrimal gland enlargement (78% versus 13%), lack of frontal (0% versus 12%) or infraorbital nerve enlargement (0% versus 36%) were associated with OAL (all P < 0.05). Pre-treatment serum IgG4 level or extra-orbital IgG4-RD involvement was similar among patients with or without malignancies. CONCLUSION In this biopsy-proven IgG4-ROD cohort, 7% developed OAL which was 10 times higher than the general population. Patients with asymmetric lacrimal gland enlargement or without trigeminal nerves involvement radiologically were associated with OAL.
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Affiliation(s)
- Kenneth K H Lai
- Department of Ophthalmology, 66380Tung Wah Eastern Hospital, Hong Kong
| | | | - Regine Y C Chan
- Department of Ophthalmology and Visual Sciences, 13621Prince of Wales Hospital, Hong Kong
| | - Kenneth C W Wong
- Department of Clinical Oncology, 13621Prince of Wales Hospital, Hong Kong
| | - Jimmy K S Yu
- Department of Clinical Oncology, 13621Prince of Wales Hospital, Hong Kong
| | - W Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | - Y H Hui
- Department of Nuclear Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Andy C O Cheng
- Department of Ophthalmology, 13620Hong Kong Sanatorium & Hospital, Hong Kong
| | - Joyce K Y Chin
- Department of Ophthalmology and Visual Sciences, 13621Prince of Wales Hospital, Hong Kong
| | - S K Ip
- Department of Ophthalmology, 36658Tuen Mun Hospital, Hong Kong
| | - W H Chan
- Department of Ophthalmology, 36658Tuen Mun Hospital, Hong Kong
| | - Jeremy S W Kwok
- Department of Ophthalmology, Grantham Hospital, Hong Kong.,Department of Ophthalmology, 25809The University of Hong Kong, Hong Kong
| | - W C Lam
- Department of Ophthalmology, Grantham Hospital, Hong Kong.,Department of Ophthalmology, 25809The University of Hong Kong, Hong Kong
| | - Ida Y F Io
- Department of Ophthalmology, 36611Caritas Medical Center, Hong Kong
| | - Theresa S T Mak
- Department of Ophthalmology, 36621United Christian Hospital, Hong Kong
| | - Kenneth K W Li
- Department of Ophthalmology, 36621United Christian Hospital, Hong Kong
| | - N M Lam
- 71113Hong Kong Eye Hospital, Hong Kong
| | - Wilson W K Yip
- Department of Ophthalmology and Visual Sciences, 13621Prince of Wales Hospital, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, 13621Prince of Wales Hospital, Hong Kong
| | - Edwin Chan
- Department of Ophthalmology, 66380Tung Wah Eastern Hospital, Hong Kong
| | - Callie K L Ko
- Department of Ophthalmology, 66380Tung Wah Eastern Hospital, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, 66380Tung Wah Eastern Hospital, Hong Kong
| | - Hunter K L Yuen
- 71113Hong Kong Eye Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, 26451The Chinese University of Hong Kong, Hong Kong
| | - Clement C Y Tham
- Department of Ophthalmology and Visual Sciences, 26451The Chinese University of Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, 26451The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, 13621Prince of Wales Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, 26451The Chinese University of Hong Kong, Hong Kong
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6
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Chan WYK, Lee PPW, Cheuk DKL, Yeung EWM, Wong KCW, Li CK, Chan GCF, Leung W. Blinatumomab with donor lymphocyte infusions post haploidentical hematopoietic stem cell transplantation as salvage therapy for relapsed refractory acute lymphoblastic leukemia post chimeric antigen receptor T-cell therapy. Pediatr Blood Cancer 2023; 70:e29852. [PMID: 35727716 DOI: 10.1002/pbc.29852] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Wilson Y K Chan
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Pamela P W Lee
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel K L Cheuk
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Eva W M Yeung
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Kenneth C W Wong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - C K Li
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Godfrey C F Chan
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wing Leung
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and The University of Hong Kong, Hong Kong Special Administrative Region, China
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7
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Chu VWS, Kan MWK, Lee LKY, Wong KCW, Chan ATC. Magnetic-field-modulated radiotherapy (MagMRT) in inhomogeneous medium and its potential applications. Biomed Phys Eng Express 2022; 8. [PMID: 36130477 DOI: 10.1088/2057-1976/ac9390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the effects of magnetic field gradients on the dose deposition in an inhomogeneous medium and to present the benefits offered by magnetic-field-modulated radiotherapy (MagMRT) under multiple radiation beams. APPROACH Monte Carlo simulations were performed using the Geant4 simulation toolkit with a 7 MV photon beam from an Elekta Unity system. A water cuboid embedded with material slabs of water, bone, lung or air was used to study the effects of MagMRT within inhomogeneous medium. Two cylindrical water phantoms, with and without a toroidal lung insert embedded, were used to study the effects of MagMRT under single, opposing or four cardinal radiation beams. Optimized magnetic field variations in the form of a wavelet were used to induce dose modulation within the material slabs or at the iso-center of the phantoms. MAIN RESULTS The magnitudes of the dose enhancement and reduction induced by the magnetic field gradients become more prominent in a medium of lower density. A maximum dose increase of 6.5% and a decrease of 4.8% were found inside bone, while an increase of 20.4% and a decrease of 13.9% were found in lung tissue. Under multiple radiation beams, the dose enhancement can be induced at the iso-center while the dose reduction occurs in regions around the tumor. For the case with four cardinal beams irradiating a homogeneous water cylinder, an 8.4% of dose enhancement and a 2.4% of dose reduction were found. When a toroidal lung insert was embedded, a maximum dose enhancement of 9.5% and a reduction of 17.0% were produced for anterior-posterior opposing fields. SIGNIFICANCE With an optimized magnetic field gradient, MagMRT can induce a dose boost to the target while producing a better sparing to the surrounding normal tissue, resulting in a sharper dose fall-off in all directions outside the target volume.
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Affiliation(s)
- Vivien W S Chu
- Clinical Oncology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, 000, HONG KONG
| | - Monica W K Kan
- Clinical Oncology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, 000, HONG KONG
| | - Louis K Y Lee
- CUHK Medical Centre, 12 Chak Cheung Street, Ma Liu Shui, Shatin, New Territories, Hong Kong, 000, HONG KONG
| | - Kenneth C W Wong
- Clinical Oncology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, 000, HONG KONG
| | - Anthony T C Chan
- Clinical Oncology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, 000, HONG KONG
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8
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Wong KCW, Hui EP, Lo KW, Lam WKJ, Johnson D, Li L, Tao Q, Chan KCA, To KF, King AD, Ma BBY, Chan ATC. Nasopharyngeal carcinoma: an evolving paradigm. Nat Rev Clin Oncol 2021; 18:679-695. [PMID: 34194007 DOI: 10.1038/s41571-021-00524-x] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
The past three decades have borne witness to many advances in the understanding of the molecular biology and treatment of nasopharyngeal carcinoma (NPC), an Epstein-Barr virus (EBV)-associated cancer endemic to southern China, southeast Asia and north Africa. In this Review, we provide a comprehensive, interdisciplinary overview of key research findings regarding NPC pathogenesis, treatment, screening and biomarker development. We describe how technological advances have led to the advent of proton therapy and other contemporary radiotherapy approaches, and emphasize the relentless efforts to identify the optimal sequencing of chemotherapy with radiotherapy through decades of clinical trials. Basic research into the pathogenic role of EBV and the genomic, epigenomic and immune landscape of NPC has laid the foundations of translational research. The latter, in turn, has led to the development of new biomarkers and therapeutic targets and of improved approaches for individualizing immunotherapy and targeted therapies for patients with NPC. We provide historical context to illustrate the effect of these advances on treatment outcomes at present. We describe current preclinical and clinical challenges and controversies in the hope of providing insights for future investigation.
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Affiliation(s)
- Kenneth C W Wong
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwok-Wai Lo
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Wai Kei Jacky Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - David Johnson
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Lili Li
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Qian Tao
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwan Chee Allen Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ann D King
- Department of Diagnostic Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
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Chu VWS, Kan MWK, Wong KCW, Lee LKY, Chan ATC. Towards magnetic-field-modulated radiotherapy (MagMRT) with an MR-LINAC-a Monte Carlo study. Phys Med Biol 2021; 66. [PMID: 34587609 DOI: 10.1088/1361-6560/ac2b83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/10/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Abstract
Objective.The feasibility of magnetic-field-modulated radiotherapy (MagMRT) with an MR-LINAC was investigated by studying the effects of dose enhancement and reduction using a transverse magnetic field with a longitudinal gradient applied along a photon radiation beam.Approach.Geant4 simulation toolkit was used to perform Monte Carlo simulations on a water phantom with the energy spectrum of a 7 MV flattening-filter-free photon beam from an Elekta Unity system as the source of radiation. Linear magnetic field gradients with magnitudes ranged from 1 to 6 T cm-1and spatial extents of 1-3 cm were used to study the dependence of dose modulation on these two parameters. The effects of radiation field size and the ability of dose modulation through optimizing the waveform of magnetic field variation were also explored.Main results.Our results show that dose enhancement and reduction can be achieved by applying a transverse magnetic field with a longitudinal field gradient along a photon beam. The steeper the gradient, the more prominent is the effect. A dose enhancement of 33% and a dose reduction of 22% are found for a magnetic gradient of 6 T cm-1and -6 T cm-1respectively. The spatial extent of the dose modulation effect which is greater than 3% is found to be around 1-2 cm. Both the dose enhancement and reduction effects are independent of the radiation field sizes, but they exhibit different behaviors with the spatial extents of the gradient. Multiple locations of dose enhancement and reduction can be produced by modulating the waveform of the magnetic field variation along the radiation beam, demonstrating a vast degree of freedom in the modulation aspect of MagMRT.Significance.MagMRT is a conceptually feasible and promising new radiotherapy modulation technique along the direction of the radiation beam.
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Affiliation(s)
- Vivien W S Chu
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.,Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Monica W K Kan
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.,Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kenneth C W Wong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.,Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Louis K Y Lee
- CUHK Medical Centre, Hong Kong SAR, People's Republic of China
| | - Anthony T C Chan
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.,Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.,State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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10
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Hui EP, Ma BBY, Lam WKJ, Chan KCA, Mo F, Ai QYH, King AD, Wong CH, Wong KCW, Lam DCM, Tong M, Poon DMC, Li L, Lau TKH, Wong KH, Lo YMD, Chan ATC. Dynamic Changes of Post-Radiotherapy Plasma Epstein-Barr Virus DNA in a Randomized Trial of Adjuvant Chemotherapy Versus Observation in Nasopharyngeal Cancer. Clin Cancer Res 2021; 27:2827-2836. [PMID: 33692028 DOI: 10.1158/1078-0432.ccr-20-3519] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the dynamic changes in plasma Epstein-Barr virus (pEBV) DNA after radiotherapy in nasopharyngeal cancer (NPC). EXPERIMENTAL DESIGN We conducted a randomized controlled trial of adjuvant chemotherapy versus observation in patients with NPC who had detectable pEBV DNA at 6 weeks post-radiotherapy. Randomized patients had a second pEBV DNA checked at 6 months post-randomization. The primary endpoint was progression-free survival (PFS). RESULTS We prospectively enrolled 789 patients. Baseline post-radiotherapy pEBV DNA was undetectable in 573 (72.6%) patients, and detectable in 216 (27.4%) patients, of whom 104 (13.2%) patients were eligible for randomization to adjuvant chemotherapy (n = 52) versus observation (n = 52). The first post-radiotherapy pEBV DNA had a sensitivity of 0.48, specificity of 0.81, area under receiver-operator characteristics curve (AUC) of 0.65, false positive (FP) rate of 13.8%, and false negative (FN) rate of 14.4% for disease progression. The second post-radiotherapy pEBV DNA had improved sensitivity of 0.81, specificity of 0.75, AUC of 0.78, FP rate of 14.3%, and FN rate of 8.1%. Patients with complete clearance of post-radiotherapy pEBV DNA (51%) had survival superior to that of patients without post-radiotherapy pEBV DNA clearance (5-year PFS, 85.5% vs. 23.3%; HR, 9.6; P < 0.0001), comparable with patients with initially undetectable post-radiotherapy pEBV DNA (5-year PFS, 77.1%), irrespective of adjuvant chemotherapy or observation. CONCLUSIONS Patients with NPC with detectable post-radiotherapy pEBV DNA who experienced subsequent pEBV DNA clearance had superior survival comparable with patients with initially undetectable post-radiotherapy pEBV DNA. Post-radiotherapy pEBV DNA clearance may serve as an early surrogate endpoint for long-term survival in NPC.
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Affiliation(s)
- Edwin Pun Hui
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Brigette B Y Ma
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - W K Jacky Lam
- Department of Chemical Pathology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K C Allen Chan
- Department of Chemical Pathology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Frankie Mo
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Qi-Yong Hemis Ai
- Department of Imaging and Interventional Radiology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ann D King
- Department of Imaging and Interventional Radiology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Hang Wong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kenneth C W Wong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daisy C M Lam
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Macy Tong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Darren M C Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leung Li
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas K H Lau
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwan Hung Wong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Y M Dennis Lo
- Department of Chemical Pathology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anthony T C Chan
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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11
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Lan X, Chan JYK, Pu JJ, Qiao W, Pang S, Yang WF, Wong KCW, Kwong DLW, Su YX. Saliva electrolyte analysis and xerostomia-related quality of life in nasopharyngeal carcinoma patients following intensity-modulated radiation therapy. Radiother Oncol 2020; 150:97-103. [PMID: 32544605 DOI: 10.1016/j.radonc.2020.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Received: 02/07/2020] [Revised: 05/18/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Nasopharyngeal carcinoma (NPC) is one of the most common cancers in southern China and the first-line treatment is radiotherapy. Intensity-modulated radiation therapy (IMRT) can deliver high dose to cancer and low dose to normal tissue, but xerostomia is still one of the complications after IMRT. However, how the concentration of saliva electrolytes be affected by IMRT and the effects on the quality of life are still unknown. In this prospective study, 76 NPC patients were recruited from hospitals in Hong Kong to identify the change of saliva electrolytes and xerostomia-related quality of life before and after IMRT. METHODS AND MATERIALS Saliva and questionnaire were collected before IMRT, 1 month, 3 months, 6 months and 12 months after IMRT. The concentration of saliva electrolytes was detected using inductively coupled plasma-optical emission spectroscopy (ICP-OES). RESULTS Saliva flow rate significantly decreased after IMRT. Decrease in the mean value of pH was observed but the difference is not statistically significant. The concentrations of potassium, iodine, and calcium decreased and chloride concentration increased after IMRT, while the concentrations of sodium, magnesium, copper or zinc were kept at the same level before and after treatment. Xerostomia-related quality of life was adversely affected by IMRT, but partially recovered after 1 year. CONCLUSIONS Our study revealed the change of saliva electrolytes and xerostomia-related quality of life in patients undergone IMRT for NPC.
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Affiliation(s)
- Xinmiao Lan
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Jason Y K Chan
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Wei Qiao
- Dental Materials Science, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Siling Pang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Wei-Fa Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kenneth C W Wong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Special Administrative Region
| | - Dora L W Kwong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region.
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Chan SL, Chan AWH, Mo F, Ma BBY, Wong KCW, Lam D, Mok FST, Chan ATC, Mok T, Chan KCA. Association Between Serum Folate Level and Toxicity of Capecitabine During Treatment for Colorectal Cancer. Oncologist 2018; 23:1436-1445. [PMID: 29802221 DOI: 10.1634/theoncologist.2017-0637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 11/30/2017] [Accepted: 04/06/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Folate level was proposed to be a predictor for fluoropyrimidine-related toxicity. We conducted a prospective study to determine the association between serum and red-cell folate and capecitabine-related toxicity in patients with colorectal cancers. MATERIALS AND METHODS Eligibility criteria included diagnosis of colorectal cancers; eligible patients who were scheduled to undergo capecitabine monotherapy or capecitabine-oxaliplatin (CAPOX) for adjuvant or palliative purposes. Exclusion criteria included concomitant radiotherapy or chemotherapy other than capecitabine or CAPOX and creatinine clearance <30 mL/min. Fasting serum and red-cell folate were measured prior to chemotherapy. Capecitabine was administered at 2,500 mg/m2 per day (monotherapy) or 2,000 mg/m2 per day (CAPOX) for 14 days every 3 weeks. The toxicity of the first four cycles was documented by clinical investigators who were blinded to folate levels. RESULTS A total of 144 patients were recruited, of whom 126 were eligible; 40 patients had capecitabine alone, and 86 patients received CAPOX. The rates of grade 2 and grade 3 toxicity were 63.5% and 14.3%, respectively. Nausea and vomiting were the most common grade ≥2 adverse event (47.7%), followed by hand-foot syndrome (25.4%), diarrhea (23.1%), and neutropenia (22.3%). Combination with oxaliplatin (odds ratio [OR], 2.77; p = .043) and serum folate (OR, 10.33; p = .002) were independent predictors of grade ≥2 toxicity. Red-cell folate was not predictive of toxicity. For every 10 nmol/L increment in serum folate, the risk of grade ≥2 toxicity increased by 9%. CONCLUSION Serum folate level, but not red-cell folate, was associated with higher rate of grade ≥2 toxicity during capecitabine-based treatment. Excessive folate intake may be avoided before and during capecitabine-based chemotherapy. IMPLICATIONS FOR PRACTICE This is the first prospective study to evaluate the association between serum folate level and capecitabine-related toxicity in patients with colon cancers. It shows that higher serum folate level is associated with increased risks of moderate to severe toxicity during capecitabine-based treatment. Excessive folate intake should be avoided before and during capecitabine-based chemotherapy.
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Affiliation(s)
- Stephen L Chan
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory in Oncology in South China, Hong Kong
| | - Anthony W H Chan
- Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory in Oncology in South China, Hong Kong
| | - Frankie Mo
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Brigette B Y Ma
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory in Oncology in South China, Hong Kong
| | - Kenneth C W Wong
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Daisy Lam
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Florence S T Mok
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Anthony T C Chan
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory in Oncology in South China, Hong Kong
| | - Tony Mok
- Departments of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory in Oncology in South China, Hong Kong
| | - K C Allen Chan
- State Key Laboratory in Oncology in South China, Hong Kong
- Department of Chemical Pathology, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Poon DMC, Wong KCW. Lymph Node Response in a Patient With Metastatic Castration-resistant Prostate Cancer Treated With Radium-223. Clin Genitourin Cancer 2017; 16:e397-e401. [PMID: 29174502 DOI: 10.1016/j.clgc.2017.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Darren M C Poon
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Kenneth C W Wong
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Poon DMC, Kam M, Leung CM, Chau R, Wong S, Lee WY, Wong KCW, Yu B, Chan A. Dosimetric advantages and superior treatment delivery efficiency of RapidArc over conventional intensity-modulated radiotherapy in high-risk prostate cancer involving seminal vesicles and pelvic nodes. Clin Oncol (R Coll Radiol) 2013; 25:706-12. [PMID: 23954261 DOI: 10.1016/j.clon.2013.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 07/26/2012] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 11/27/2022]
Abstract
AIMS To compare the dosimetry and treatment delivery efficiency of RapidArc with conventional intensity-modulated radiotherapy (IMRT) in the treatment of high-risk prostate cancer. MATERIALS AND METHODS Fifteen patients with high-risk localised prostate cancer were studied. Sequential treatment was used. The initial planning target volume (PTV-L) included the prostate, seminal vesicles and pelvic lymphatics, whereas the prostate boost PTV (PTV-P) included the prostate and seminal vesicles only. The total prescription dose was 76 Gy (44 Gy to PTV-L, 32 Gy to PTV-P; 2 Gy/fraction). Two separate planning techniques were generated for each patient: seven static-field IMRT versus two-arc RapidArc. Dose-volume parameters for the organs at risk, conformity index and homogeneity index for the PTVs, the calculated monitor units and treatment delivery time for both techniques were compared. RESULTS RapidArc gave more conformal plans than IMRT for both PTVs. RapidArc gave a higher homogeneity index to the PTV-P and a similar homogeneity index to the PTV-L. The two techniques gave similar dosimetric results for the rectum, bladder and femoral heads. The mean dose (Dmean) and the maximum dose (Dmax) of the bowel space were reduced by 3.06 and 2.83%, respectively, with RapidArc. The V20 Gy, V30 Gy and V40 Gy for healthy tissues were reduced by 7.77, 14.25 and 17.55%, respectively, with RapidArc. The calculated treatment delivery time and monitor units were reduced by 74.09%/60.93% and 68.32%/48.06% for the PTV-L/PTV-P, respectively, with RapidArc. CONCLUSION RapidArc is better than conventional IMRT in terms of dosimetry and delivery efficiency for high-risk prostate cancer.
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Affiliation(s)
- D M C Poon
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Ng DK, Wong KCW, Chan CH, Ng EP. Development of the Chinese version of the Paediatric Allergic Disease Quality of Life Questionnaire: reliability and validity. Hong Kong Med J 2011; 17:460-464. [PMID: 22147315] [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: 05/31/2023] Open
Abstract
OBJECTIVE Paediatric Allergic Disease Quality of Life Questionnaire is a health-related assessment tool designed for children with allergic diseases. This study aimed to translate the original English version of the Questionnaire to Chinese and to provide psychometric evidence on the validity and reliability of the translated version. DESIGN Cross-sectional study. SETTING Out-patient clinic of a non-teaching hospital in Hong Kong. PARTICIPANTS The Paediatric Allergic Disease Quality of Life Questionnaire was translated to Chinese and then completed by a group of 115 Hong Kong Chinese children (66 male and 49 female; mean age, 11 years) with allergic disease(s). All subjects were asked to respond using visual analogue scales dealing with issues related to the perceived morbidity of allergic diseases. To assess test-retest reliability, 2 weeks later a subgroup of 16 individuals was retested with the same Questionnaire. RESULTS The internal consistency of the Chinese Paediatric Allergic Disease Quality of Life Questionnaire was satisfactory (Cronbach alpha=0.92). The correlation between the total Questionnaire score and the visual analogue scale score was moderately significant (Spearman's rho=0.49; 95% confidence interval, 0.34-0.62). Structural validity as studied by confirmatory factor analysis found that the structure of subscales was remarkably similar to the original English version. The intra-class correlation between the Questionnaire score from the first and the second test in the subgroup of 16 subjects was 0.75, indicating adequate repeatability. CONCLUSION The validity and reliability of the Chinese version of the Paediatric Allergic Disease Quality of Life Questionnaire was established for clinical use.
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Affiliation(s)
- Daniel K Ng
- Department of Paediatrics, Kwong Wah Hospital, Kowloon, Hong Kong.
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