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Chen F, Jen YM, He K, Yin ZS, Lee JC, Huang WY, Tang YH. Hypoglossal nerve delineation in nasopharyngeal carcinoma patients may reduce the radiation dose and damage to the nerve. Med Dosim 2023; 49:102-108. [PMID: 37858458 DOI: 10.1016/j.meddos.2023.09.001] [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] [Received: 01/15/2023] [Revised: 07/03/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
This study aims to establish a delineation guideline for the contouring of the hypoglossal nerve by dividing the nerve into different segments, and to test the possibility of a radiation dose reduction to the hypoglossal nerve in NPC patients receiving radiotherapy. Twenty NPC patients were selected arbitrarily. The hypoglossal nerves were delineated using anatomic landmarks and divided into the cisternal, intracanalicular, carotid, and transverse segments. The tumor coverage by radiation and dose-volume parameters of the nerve with and without various dose constraints to the hypoglossal nerve were compared. The hypoglossal nerve, which is invisible on CT images, can be delineated accurately with the assistance of several anatomic landmarks. Without a dose constraint to the hypoglossal nerve, the carotid space, intracanalicular, and transverse segments had high radiation dose-volumes. The dose-volume to the nerve, however, can be reduced when the nerve was defined and a dose constraint was given. The delineation of the hypoglossal nerve with its different segments is feasible. The carotid space, intracanalicular, and transverse segments received the highest dose, where the nerve damage was most likely located. The dose to the nerve can be reduced to less than 70 Gy using the intensity-modulated radiotherapy technique.
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Affiliation(s)
- Fen Chen
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Chenzhou, Hunan Province, China
| | - Yee-Min Jen
- Department of Radiation Oncology, Yee Zen General Hospital, Taoyuan City, Taiwan.
| | - Kui He
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Chenzhou, Hunan Province, China
| | - Zhao-Sheng Yin
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Chenzhou, Hunan Province, China
| | - Jih-Chin Lee
- Department of Otolaryngology Head & Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yong-Hong Tang
- Radiotherapy Center, Taoyuan Chinese Medicine Hospital, Changde, Hunan Province, China
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Zhang Y, Li X, Zhang Y, Ye Y, Jen YM, Pan X, Li X, Qin T, Li P, Lv C, Qi Y, Wang X, Yang Y, Ma T. Non-invasive high frequency oscillatory ventilation inhibiting respiratory motion in healthy volunteers. Sci Rep 2022; 12:22604. [PMID: 36585458 PMCID: PMC9803652 DOI: 10.1038/s41598-022-27288-3] [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: 04/07/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Precision radiotherapy needs to manage organ movements to prevent critical organ injury. The purpose of this study is to examine the feasibility of motion control of the lung by suppressing respiratory motion. The non-invasive high frequency oscillatory ventilation (NIHFOV) is a technique commonly used in the protection of lung for patients with acute lung disease. By using a very high respiratory frequency and a low tidal volume, NIHFOV allows gas exchange, maintains a constant mean airway pressure and minimizes the respiratory movements. We tested healthy volunteers NIHFOV to explore the optimal operational parameter setting and the best possible motion suppression achievable. This study was conducted with the approval of Institutional Review Boards of the Wuwei Cancer hospital (approval number: 2021-39) and carried out in accordance with Declaration of Helsinki. The study comprises two parts. Twenty three healthy volunteers participated in the first part of the study. They had 7 sessions of training with the NIHFOV. The duration of uninterrupted, continuous breathing under the NIHFOV and the optimal operational machine settings were defined. Eight healthy volunteers took part in the second part of the study and underwent 4-dimensional CT (4DCT) scanning with and without NIHFOV. Their respiratory waveform under free breathing (FB) and NIHFOV were recorded. The maximum range of motion of the diaphragm from the two scannings was compared, and the variation of bilateral lung volume was obtained to evaluate the impact of NIHFOV technique on lung volume. The following data were collected: comfort score, transcutaneous partial pressure of oxygen (PtcO2), transcutaneous partial pressure of carbon dioxide (PtcCO2), and pulse rate. Data with and without NIHFOV were compared to evaluate its safety, physiological impacts and effect of lung movement suppression. All the volunteers completed the training sessions eventlessly, demonstrating a good tolerability of the procedure. The median NIHFOV-on time was 32 min (22-45 min), and the maximum range of motion in the cephalic-caudal direction was significantly reduced on NIHFOV compared with FB (1.8 ± 0.8 cm vs 0.3 ± 0.1 cm, t = - 3.650, P = 0.003); the median range of motion was only 0.3 ± 0.1 cm on NIHFOV with a good reproducibility. The variation coefficient under NIHFOV of the right lung volume was 2.4% and the left lung volume was 9.2%. The PtcO2 and PtcCO2 were constantly monitored during NIHFOV. The medium PtcCO2 under NIHFOV increased lightly by 4.1 mmHg (interquartile range [IQR], 4-6 mmHg) compared with FB (t = 17.676, P < 0.001). No hypercapnia was found, PtcO2 increased significantly in all volunteers during NIHFOV (t = 25.453, P < 0.001). There was no significant difference in pulse rate between the two data sets (t = 1.257, P = 0.233). NIHFOV is easy to master in healthy volunteers to minimize respiratory movement with good tolerability and reproducibility. It is a feasible approach for lung motion control and could potentially be applied in accurate radiotherapy including carbon-ion radiotherapy through suppression of respiratory movement.
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Affiliation(s)
- Yanshan Zhang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Xiaojun Li
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yihe Zhang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yancheng Ye
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yee-Min Jen
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China ,Department of Radiation Oncology, Yee Zen General Hospital, 30, Yangxing North Rd, Yang Mei District, Tao Yuan City, Taiwan
| | - Xin Pan
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Xiaowei Li
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Tianyan Qin
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Pengqing Li
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Caixia Lv
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Ying Qi
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Xin Wang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yuling Yang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Tong Ma
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
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Qi Y, Pan X, Lyu C, Li W, Lu H, Li S, Zhang Y, Lu X, Chen D, Jen YM. A preliminary study on effect of carbon ion radiotherapy on bone marrow suppression. Radiation Medicine and Protection 2022. [DOI: 10.1016/j.radmp.2022.04.001] [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: 10/18/2022] Open
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Xiao J, Xu L, Ding Y, Wang W, Chen F, Zhou Y, Zhang F, Zhou Q, Wu X, Li J, Liang L, Jen YM. Does post-operative radiotherapy improve the treatment outcomes of intracranial hemangiopericytoma? A retrospective study. BMC Cancer 2021; 21:915. [PMID: 34384377 PMCID: PMC8359034 DOI: 10.1186/s12885-021-08594-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/06/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intracranial hemangiopericytoma is a rare disease and surgery is the mainstay treatment. Although postoperative adjuvant radiotherapy is often used, there are no reports comparing different radiotherapy techniques. The purpose of this study is to analyze the impact of post-operative radiotherapy and different radiotherapy technique on the results in patients with intracranial hemangiopericytoma (HPC). METHODS We retrospectively reviewed 66 intracranial HPC patients treated between 1999 and 2019 including 29 with surgery followed by radiotherapy (11 with intensity-modulated radiotherapy (IMRT) and 18 with stereotactic radiosurgery (SRS)) and 37 with surgery alone. Chi-square test was used to compare the clinical characteristic between the groups. The Kaplan-Meier method was used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariate Cox proportional hazards models were used to examine prognostic factors of survival. We also underwent a matched-pair analysis by using the propensity score method. RESULTS The crude local control rates were 58.6% in the surgery plus post-operative radiotherapy group (PORT) and 67.6% in the surgery alone group (p = 0.453). In the subgroup analysis of the PORT patients, local controls were 72.7% in the IMRT group and 50% in the SRS group (p = 0.228). The median OS in the PORT and surgery groups were 122 months and 98 months, respectively (p = 0.169). The median RFS was 96 months in the PORT group and 72 months in the surgery alone group (p = 0.714). Regarding radiotherapy technique, the median OS and RFS of the SRS group were not significantly different from those in the IMRT group (p = 0.256, 0.960). The median RFS were 112 and 72 months for pathology grade II and III patients, respectively (p = 0.001). Propensity score matching did not change the observed results. CONCLUSION In this retrospective analysis, PORT did not improve the local control rates nor the survivals. The local control rates after IMRT and SRS were similar even though the IMRT technique had a much higher biological dose compared with the SRS technique.
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Affiliation(s)
- Jianbiao Xiao
- Department of Pathology, Nanfang Hospital and School of Basic Medical Science, Southern Medical University, 1838, Guangzhoudadao Rd, Guangzhou, Guangdong Province, 510515, People's Republic of China
- Guangdong Province Key Laboratory of Molecular Tumor Pathology, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Lanwei Xu
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yi Ding
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wei Wang
- Department of Pathology, General Hospital of Southern Theater Command, People's Liberation Army of China, Guangzhou, China
| | - Fen Chen
- Radiotherapy Center, Chenzhou No.1 People's Hospital, Chenzhou, Hunan Province, China
| | - Yangshu Zhou
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Fengjiao Zhang
- Department of Radiotherapy, Shanghai Concord Medical Cancer Center, Shanghai, China
| | - Qiyuan Zhou
- Radiotherapy Center, Chenzhou No.1 People's Hospital, Chenzhou, Hunan Province, China
| | - Xuehui Wu
- Department of Pathology, Nanfang Hospital and School of Basic Medical Science, Southern Medical University, 1838, Guangzhoudadao Rd, Guangzhou, Guangdong Province, 510515, People's Republic of China
- Guangdong Province Key Laboratory of Molecular Tumor Pathology, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Junpeng Li
- Department of Obstetrics and Gynecology, General Hospital of Southern Theater Command, People's Liberation Army of China, Guangzhou, China
| | - Li Liang
- Department of Pathology, Nanfang Hospital and School of Basic Medical Science, Southern Medical University, 1838, Guangzhoudadao Rd, Guangzhou, Guangdong Province, 510515, People's Republic of China.
- Guangdong Province Key Laboratory of Molecular Tumor Pathology, Guangzhou, 510515, Guangdong Province, People's Republic of China.
| | - Yee-Min Jen
- Department of Radiation Oncology, Yee Zen General Hospital, 30, Yangxing North Rd, Yang Mei District, Tao Yuan City, Taiwan.
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Lee CC, Lee JC, Huang WY, Juan CJ, Jen YM, Lin LF. Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be a phantom tumor phenomenon. Medicine (Baltimore) 2021; 100:e24555. [PMID: 33663063 PMCID: PMC7909123 DOI: 10.1097/md.0000000000024555] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Some nasopharyngeal carcinoma (NPC) patients may present convincing radiological evidence mimicking residual or recurrent tumor after radiotherapy. However, by means of biopsies and long term follow-up, the radiologically diagnosed residuals/recurrences are not always what they appear to be. We report our experience on this "phantom tumor" phenomenon. This may help to avoid the unnecessary and devastating re-irradiation subsequent to the incorrect diagnosis.In this longitudinal cohort study, we collected 19 patients of image-based diagnosis of residual/recurrent NPC during the period from Feb, 2010 to Nov. 2016, and then observed them until June, 2019. They were subsequently confirmed to have no residual/recurrent lesions by histological or clinical measures. Image findings and pathological features were analyzed.Six patients showed residual tumors after completion of radiotherapy and 13 were radiologically diagnosed to have recurrences based on magnetic resonance imaging (MRI) criteria 6 to 206 months after radiotherapy. There were 3 types of image patterns: extensive recurrent skull base lesions (10/19); a persistent or residual primary lesion (3/19); lesions both in the nasopharynx and skull base (6/19). Fourteen patients had biopsy of the lesions. The histological diagnoses included necrosis/ inflammation in 10 (52.7%), granulation tissue with inflammation in 2, and reactive epithelial cell in 1. Five patients had no pathological proof and were judged to have no real recurrence/residual tumor based on the absence of detectable plasma EB virus DNA and subjective judgment. These 5 patients have remained well after an interval of 38-121 months without anti-cancer treatments.Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be unreliable. False positivity, the "phantom tumor phenomenon", is not uncommon in post-radiotherapy MRI. This is particularly true if the images show extensive skull base involvement at 5 years or more after completion of radiotherapy. MRI findings compatible with NPC features must be treated as a real threat until proved otherwise. However, the balance between under- and over-diagnosis must be carefully sought. Without a pathological confirmation, the diagnosis of residual or recurrent NPC must be made taking into account physical examination results, endoscopic findings and Epstein-Barr virus viral load. A subjective medical judgment is needed based on clinical and laboratory data and the unique anatomic complexities of the nasopharynx.
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Affiliation(s)
| | - Jih-Chin Lee
- Department of Otolaryngology Head & Neck Surgery
| | | | - Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital National Defense Medical Center, 323 Section 2 Cheng-Kong Road, Nei-Hu, Taipei
| | - Yee-Min Jen
- Department of Radiation Oncology
- Radiation Oncology Department, Yee Zen General Hospital, Yang Mei, Taiwan
| | - Li-Fan Lin
- Department of Nuclear Medicine, Tri-Service General Hospital National Defense Medical Center
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Chen F, Jen YM, He K, Yin Z, Shi J. Heart-sparing effect of postmastectomy radiotherapy for breast cancer patients: A dosimetric study of cardiac substructures. Med Dosim 2020; 45:246-251. [PMID: 32111451 DOI: 10.1016/j.meddos.2020.01.004] [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: 08/21/2019] [Revised: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
We investigated to what extent can the dose-volumes of the coronary artery and the cardiac substructures be reduced by using IMRT technique in left-sided breast cancer patients. We chose 40 pN2M0 patients treated with postmastectomy IMRT. The original treatment plans were retrieved and the (internal mammary nodes) IMNs and cardiac substructure delineations were added. Three sets of dose-volume parameters including the original plans without internal mammary irradiation (IMNI), the plans with IMNI, and the plans with dose constraints to the heart, were derived. In left-sided patients, when IMNI was included, the V30 for right ventricle (RV), left ventricle (LV), pulmonic valve (PV), and left anterior descending artery (LADA) were 56.37% ± 7.9%, 25.3% ± 7.3%, 48.3% ± 6.3%, and 69.7% ± 6.4%, respectively. Of the 4 main coronary arteries, LADA had the highest dose followed by the left main coronary artery (LMCA). LADA had a V40 of 62% ± 9.7% vs 13.5% ± 3.5%, and a V50 of 27.5% ± 4.7% vs 0, with and without IMNI. For the right-sided patients, the V30s for all the heart substructures were 0 with or without IMNI. When we set a dose constraint of V40 < 10% for the LADA in the left-sided patients, the PTV volumes covered by 50 Gy decreased by only 1%. IMNI increased the V30 of the right and left ventricle and significantly increased the V40 and V50 to the LADA of left-sided breast cancer patients. IMRT markedly reduces the dose to the main coronary arteries and the right and left ventricle.
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Affiliation(s)
- Fen Chen
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
| | - Yee-Min Jen
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China; Department of Radiation Oncology, Yee Zen General Hospital, Yang Mei, Taiwan.
| | - Kui He
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
| | - Zhaosheng Yin
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
| | - Junwen Shi
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
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Lin CS, Chen YW, Liu SC, Tsao CC, Lin KT, Lee SP, Fan CY, Liu MY, Shen PC, Jen YM. Treatment outcomes with whole-field versus split-field intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Head Neck 2018; 41:598-605. [DOI: 10.1002/hed.25328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/11/2018] [Accepted: 04/19/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
| | - Yuan-Wu Chen
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Shao-Cheng Liu
- Department of Otolaryngology - Head and Neck Surgery, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Chih-Cheng Tsao
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Steve P. Lee
- Department of Radiation Oncology, David Geffen School of Medicine; University of California; Los Angeles California
| | - Chao-Yueh Fan
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Ming-Yueh Liu
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Po-Chien Shen
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
- Department of Radiation Oncology; Yee Zen General Hospital; Taoyuan Taiwan
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Fan CY, Jen YM, Su YC, Chao HL, Lin CS, Huang WY, Lin MJ, Kao CH. Association between nasopharyngeal carcinoma and risk of optic neuropathy: A population-based cohort study. Head Neck 2018; 40:1977-1985. [PMID: 29663564 DOI: 10.1002/hed.25177] [Citation(s) in RCA: 3] [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: 11/29/2017] [Revised: 12/21/2017] [Accepted: 02/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the predictive factors of optic neuropathy among patients with nasopharyngeal carcinoma (NPC). METHODS The analysis included 16 297 patients with NPC and 65 187 controls. Each patient with NPC was randomly frequency-matched with 4 individuals without NPC by age, sex, and index year. Cox proportional hazard models were applied to measure the hazard ratios (HRs) and 95% confidence intervals (CIs) of optic neuropathy development associated with NPC. RESULTS The risk of optic neuropathy was significantly higher in the NPC cohort (adjusted HR [aHR] 3.42; 95% CI 2.85-4.09; P < .001). Independent risk factors for optic neuropathy among patients with NPC included stroke (aHR 1.7; 95% CI 1.07-2.7; P = .03) and receipt of chemotherapy (aHR 1.55; 95% CI 1.17-2.06; P = .002). CONCLUSION The risk of optic neuropathy was significantly higher in patients with NPC than in the general population.
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Affiliation(s)
- Chao-Yueh Fan
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Radiation Oncology, Yee Ren Hospital, Taoyuan, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Miao-Jung Lin
- Department of Radiation Oncology, LinKou Chang Gung Memorial Hospital, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Chao HL, Liu SC, Tsao CC, Lin KT, Lee S, Lo CH, Huang WY, Liu MY, Jen YM, Lin CS. Dose escalation via brachytherapy boost for nasopharyngeal carcinoma in the era of intensity-modulated radiation therapy and combined chemotherapy. J Radiat Res 2017; 58:654-660. [PMID: 28992206 PMCID: PMC5737244 DOI: 10.1093/jrr/rrx034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/24/2017] [Indexed: 05/17/2023]
Abstract
To investigate if dose escalation using intracavitary brachytherapy (ICBT) improves local control for nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiation therapy (IMRT) and concurrent chemoradiation treatment (CCRT). We retrospectively analyzed 232 patients with Stage T1-3 N0-3 M0 NPC who underwent definitive IMRT with or without additional ICBT boost between 2002 and 2013. For most of the 124 patients who had ICBT boost, the additional brachytherapy was given as 6 Gy in 2 fractions completed within 1 week after IMRT of 70 Gy. CCRT with or without adjuvant chemotherapy was used for 176 patients, including 88 with and 88 without ICBT boost, respectively. The mean follow-up time was 63.1 months. The 5-year overall survival and local control rates were 81.5% and 91.5%, respectively. ICBT was not associated with local control prediction (P = 0.228). However, in a subgroup analysis, 75 T1 patients with ICBT boost had significantly better local control than the other 71 T1 patients without ICBT boost (98.1% vs 85.9%, P = 0.020), despite having fewer patients who had undergone chemotherapy (60.0% vs 76.1%, P = 0.038). Multivariate analysis showed that both ICBT (P = 0.029) and chemotherapy (P = 0.047) influenced local control for T1 patients. Our study demonstrated that dose escalation with ICBT can improve local control of the primary tumor for NPC patients with T1 disease treated with IMRT, even without chemotherapy.
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Affiliation(s)
- Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Shao-Cheng Liu
- Department of Otolaryngology – Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Chih-Cheng Tsao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Steve P Lee
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, USA
| | - Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Ming-Yueh Liu
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
- Department of Radiation Oncology, Yee-Ren Hospital, No. 30, Lane 321, Yangxin North Road, Yangmei District, Taoyuan 326, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan
- Corresponding author: Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (R.O.C.). Tel: +886-2-8792-7122; Fax: +886-2-6600-2357;
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Lo CH, Yang JF, Liu MY, Jen YM, Lin CS, Chao HL, Huang WY. Survival and prognostic factors for patients with advanced hepatocellular carcinoma after stereotactic ablative radiotherapy. PLoS One 2017; 12:e0177793. [PMID: 28545098 PMCID: PMC5435316 DOI: 10.1371/journal.pone.0177793] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/03/2017] [Indexed: 01/14/2023] Open
Abstract
Objective To evaluate the survival outcomes and prognostic factors of patients with advanced hepatocellular carcinoma (HCC) who underwent stereotactic ablative radiotherapy (SABR). Methods This retrospective study evaluated patients with advanced HCC who underwent SABR between December 2007 and July 2015. All patients had Barcelona Clinic Liver Cancer stage C disease and Child–Turcotte–Pugh (CTP) class A–B function. In-field control (IFC), overall survival (OS), prognostic factors, and toxicity were evaluated. Results In this study of 89 patients, the 3-year IFC rate was 78.1%, and the 1-year and 3-year OS rates were 45.9% and 24.3%, respectively. The multivariate analysis revealed that CTP class, the presence of main portal vein tumor thrombosis, and the presence of extrahepatic spread were independent predictors of OS. The expected median OS values among patients with ≥2, 1, and 0 predictors were 4.2, 8.6, and 26.4 months, respectively (p <0.001). Conclusions SABR may be useful for patients with advanced HCC, and patient selection could be based on the CTP classification, main portal vein tumor thrombosis, and extrahepatic spread.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jen-Fu Yang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Yueh Liu
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Radiation Oncology, Yee Ren Hospital, Taoyuan, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Lo CH, Liu MY, Lee MS, Yang JF, Jen YM, Lin CS, Chao HL, Shen PC, Huang WY. Comparison Between Child-Turcotte-Pugh and Albumin-Bilirubin Scores in Assessing the Prognosis of Hepatocellular Carcinoma After Stereotactic Ablative Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 99:145-152. [PMID: 28816140 DOI: 10.1016/j.ijrobp.2017.04.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 01/06/2017] [Revised: 03/29/2017] [Accepted: 04/24/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the prognostic performance of the Child-Turcotte-Pugh (CTP) score and the albumin-bilirubin (ALBI) score in hepatocellular carcinoma (HCC) patients treated using stereotactic ablative radiation therapy (SABR). METHODS AND MATERIALS This retrospective study evaluated the data of patients with HCC who underwent SABR between December 2007 and June 2015. We collected pretreatment CTP and ALBI scores and analyzed their correlation with survival and liver toxicity. RESULTS This study included 152 HCC patients: 78.3% of CTP class A and 21.7% of CTP class B. The median ALBI score was -2.49 (range, -3.67 to -0.84) with 39.5% of grade 1, 56.6% of grade 2, and 3.9% of grade 3. The CTP classification and ALBI grade were significantly associated with overall survival (P<.001). Albumin-bilirubin grade (1 vs 2) had a trend to stratify CTP class A patients into 2 risk groups of mortality (P=.061). Combined CTP class and ALBI score could predict development of radiation-induced liver disease (2.4% in CTP A-ALBI < -2.76, 15.1% in CTP A-ALBI ≥ -2.76, and 25.8% in CTP B). CONCLUSION Albumin-bilirubin score is a potential predictor for both survival and liver toxicity. Complementary use of CTP and ALBI score could predict the risk of post-SABR liver toxicity. Further prospective studies are necessary before use of the ALBI score can become part of daily practice.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Yueh Liu
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Jen-Fu Yang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Radiation Oncology, Yee Ren Hospital, Taoyuan City, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Chien Shen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lin JC, Tsai JT, Chang CC, Jen YM, Li MH, Liu WH. Comparing treatment plan in all locations of esophageal cancer: volumetric modulated arc therapy versus intensity-modulated radiotherapy. Medicine (Baltimore) 2015; 94:e750. [PMID: 25929910 PMCID: PMC4603071 DOI: 10.1097/md.0000000000000750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to compare treatment plans of volumetric modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) for all esophageal cancer (EC) tumor locations.This retrospective study from July 2009 to June 2014 included 20 patients with EC who received definitive concurrent chemoradiotherapy with radiation doses >50.4 Gy. Version 9.2 of Pinnacle with SmartArc was used for treatment planning. Dosimetric quality was evaluated based on doses to several organs at risk, including the spinal cord, heart, and lung, over the same coverage of gross tumor volume.In upper thoracic EC, the IMRT treatment plan had a lower lung mean dose (P = 0.0126) and lung V5 (P = 0.0037) compared with VMAT; both techniques had similar coverage of the planning target volumes (PTVs) (P = 0.3575). In middle thoracic EC, a lower lung mean dose (P = 0.0010) and V5 (P = 0.0145), but higher lung V20 (P = 0.0034), spinal cord Dmax (P = 0.0262), and heart mean dose (P = 0.0054), were observed for IMRT compared with VMAT; IMRT provided better PTV coverage. Patients with lower thoracic ECs had a lower lung mean dose (P = 0.0469) and V5 (P = 0.0039), but higher spinal cord Dmax (P = 0.0301) and heart mean dose (P = 0.0020), with IMRT compared with VMAT. PTV coverage was similar (P = 0.0858) for the 2 techniques.IMRT provided a lower mean dose and lung V5 in upper thoracic EC compared with VMAT, but exhibited different advantages and disadvantages in patients with middle or lower thoracic ECs. Thus, choosing different techniques for different EC locations is warranted.
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Affiliation(s)
- Jang-Chun Lin
- From the Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University (J-CL, J-TT, C-CC, Y-MJ, M-HL); Department of Radiation Oncology, Tri-Service General Hospital, National Defense, Medical Center (J-CL); Graduate Institute of Medical Sciences (W-HL); and Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (W-HL)
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Lo CH, Huang WY, Lin KT, Lin MJ, Lin TP, Jen YM. Repeated stereotactic ablative radiotherapy using CyberKnife for patients with hepatocellular carcinoma. J Gastroenterol Hepatol 2014; 29:1919-25. [PMID: 25041220 DOI: 10.1111/jgh.12659] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM This study aimed to evaluate the outcomes and toxicities of repeated stereotactic ablative radiotherapy (SABR) in hepatocellular carcinoma (HCC). METHODS Fourteen HCC patients with local recurrence (18 lesions) after liver SABR received repeated radiotherapy with SABR using CyberKnife. No patients experienced radiation-induced liver disease after the first SABR course. The median first SABR dose was 41 Gy (range, 34-60 Gy); the median second SABR dose, 40 Gy (range, 25-50 Gy); and the median interval, 12.9 months. Local recurrence was divided into in-field recurrence and out-field recurrence. RESULTS Objective responses were observed in 11 tumors (61.1%), including five tumors (27.8%) with complete responses. Intrahepatic out-field failure was the main cause of treatment failure (7 of 14 patients). In-field failure had developed in 1 of 18 tumors (5.6%), resulting in a 2-year in-field failure-free rate of 88.2%. The median time to progression was 14.0 months, with 1- and 2-year progression-free survival rates of 68.6% and 42.9%, respectively. One- and two-year overall survival rates were 76% and 59.1%, respectively. Of the 14 patients, one developed radiation-induced liver disease and three showed progression of the Child-Turcotte-Pugh class after the second SABR course. Other toxicities were generally mild and tolerable. CONCLUSION Repeated SABR in selected HCC patients is feasible with acceptable toxicity.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Huang WY, Lin CC, Jen YM, Chang YJ, Hsiao CW, Yang MH, Lin CS, Sung FC, Liang JA, Kao CH. Association between colonic diverticular disease and colorectal cancer: a nationwide population-based study. Clin Gastroenterol Hepatol 2014; 12:1288-94. [PMID: 24361412 DOI: 10.1016/j.cgh.2013.11.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS We investigated whether a diagnosis of colonic diverticular disease is associated with an increased risk for subsequent development of colorectal cancer (CRC) in a nationwide population-based retrospective study. METHODS We identified 41,359 individuals diagnosed with colonic diverticular disease as inpatients from 2000 through 2009 from the Taiwan National Health Insurance Research Database (study cohort) and collected data for 165,436 randomly selected additional subjects, matched by sex, age, and baseline year (comparison cohort). Data were collected until individuals developed CRC or withdrew from the National Health Insurance system, or until December 31, 2010. Cumulative incidences and hazard ratios (HRs) of CRC development were determined. To assess for ascertainment bias, we conducted an analysis excluding the first 12 months of follow-up evaluation. RESULTS The risk of CRC was significantly higher in the study cohort than in the comparison cohort (HR adjusted for age, sex, and comorbidities, 4.54; 95% confidence interval, 4.19-4.91; P < .0001). In a sensitivity analysis, we excluded the first 12 months of follow-up evaluation after a diagnosis of colonic diverticular disease; subsequent incidence rates for CRC in the study and comparison cohorts were 15.13 and 15.74 per 10,000 person-years, respectively (adjusted HR, 0.96; 95% confidence interval, 0.83-1.11). CONCLUSIONS Colonic diverticular disease is not associated with an increased risk of subsequent CRC after the first year of diagnosis of colonic diverticular disease. An increased risk was observed in the first year, possibly owing to misclassification and screening effects.
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Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology-Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Shun Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University Hospital, Taichung, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Nuclear Medicine and Positron Emission Tomography Center, China Medical University Hospital, Taichung, Taiwan.
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Lo CH, Huang WY, Chao HL, Lin KT, Jen YM. Novel application of stereotactic ablative radiotherapy using CyberKnife ® for early-stage renal cell carcinoma in patients with pre-existing chronic kidney disease: Initial clinical experiences. Oncol Lett 2014; 8:355-360. [PMID: 24959276 PMCID: PMC4063570 DOI: 10.3892/ol.2014.2129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 09/24/2013] [Accepted: 04/24/2014] [Indexed: 12/25/2022] Open
Abstract
The treatment of renal cell carcinoma (RCC) in patients diagnosed with chronic kidney disease (CKD) requires particular care in order to preserve the remaining renal function. The present study aimed to investigate the potential of a novel nephron-sparing treatment, which is capable of targeting tumors embedded deep within tissues. The present study analyzed three patients, with pre-existing CKD and multiple comorbidities, who were successfully treated for stage I RCC using the CyberKnife® stereotactic ablative radiotherapy (SABR) system. The total prescribed dose was 40 Gy in five fractions administered over five consecutive days. Treatment efficiency was determined using computed tomography scans of the tumors and periodic measurements of the glomerular filtration rate over a period of 12–40 months. Local control, defined as a radiologically stable condition, was achieved in all patients. Lung metastasis was observed in one patient nine months after SABR; however, the side-effects were generally mild and self-limiting. One patient developed renal failure 26 months after SABR, while the severity of CKD was only marginally altered in the other two patients and renal failure did not occur. In conclusion, in the present study, SABR with CyberKnife® was observed to be well tolerated in the patients, with an acceptable acute toxicity effect. Therefore, it may represent a potential therapeutic option for patients with early-stage RCC who have previously been diagnosed with CKD, but for whom other nephron-sparing treatments are contraindicated.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
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Lin KT, Huang WY, Lin CC, Jen YM, Lin CS, Lo CH, Kao CH. Subsequent risk of nasopharyngeal carcinoma among patients with allergic rhinitis: a nationwide population-based cohort study. Head Neck 2014; 37:413-7. [PMID: 24435940 DOI: 10.1002/hed.23617] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 08/08/2013] [Revised: 11/05/2013] [Accepted: 01/10/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the risk of nasopharyngeal carcinoma (NPC) after a diagnosis of allergic rhinitis. METHODS We identified 67,532 patients with allergic rhinitis (allergic rhinitis cohort) and a 135,064 control cohort with the same mean age and sex ratio by using a Taiwan Longitudinal Health Insurance Database (LHID) sample from 2000 to 2005. RESULTS After adjusting for the possible confounding factors of the study, the allergic rhinitis cohort had a 2.33-fold higher risk of developing NPC than did the comparison cohort. The frequency of allergic rhinitis visits was correlated with the risk of subsequent NPC. Patients with 4 or more allergic rhinitis visits per year were significantly associated with increasingly developing NPC risk. CONCLUSION Patients with allergic rhinitis might be associated with subsequent NPC in Taiwan. Those who had repeated visits for allergic rhinitis had even higher risk for NPC. Physicians should be aware of the link when assessing patients with allergic rhinitis.
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Affiliation(s)
- Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Ho ST, Lin KS, Jen YM, Chao TY, Lin YS, Wang LH, Lin CJ, Su YC. Prevention of acute radiation-associated toxicity by traditional Chinese medicine Tianwang buxin mini-pills in patients with head and neck cancer. J Med Sci 2014. [DOI: 10.4103/1011-4564.139185] [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: 11/04/2022] Open
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Jen YM, Lin CS, Chang WC, Lin HH, Huang WY, Chao HL, Chen CM, Su YF, Lin KT, Lin JC. The outcome of cyberknife treatment for primary or metastatic malignant lung tumors. J Med Sci 2014. [DOI: 10.4103/1011-4564.139183] [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: 11/04/2022] Open
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Lo CH, Cheng SN, Lin KT, Jen YM. Successful treatment of infantile fibrosarcoma spinal metastasis by chemotherapy and stereotactic hypofractionated radiotherapy. J Korean Neurosurg Soc 2013; 54:528-31. [PMID: 24527200 PMCID: PMC3921285 DOI: 10.3340/jkns.2013.54.6.528] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/28/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022] Open
Abstract
We report a case of infantile fibrosarcoma in an 8-month-old boy manifested as a right-sided lower leg mass. Repeated local recurrence and distant metastasis were noted during the following three-year period. Whole body fluoro-deoxyglucose positron emission tomography scan revealed an asymptomatic metastasis involving the fourth lumbar vertebrae. The patient received chemotherapy (VAC regimen) with Cyberknife® stereotactic hypofractionated radiotherapy (26 Gy; 4 fractions). This treatment reduced tumor size by 23% without acute radiation toxicity even after 33 months. This case suggests that combining chemotherapy and this form of radiotherapy may be safe and effective against childhood spinal metastasis.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
| | - Shin-Nan Cheng
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
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Huang WY, Kao CH, Huang WS, Chen CM, Chang LP, Lee MS, Chao HL, Chiu CH, Lo CH, Jen YM. 18F-FDG PET and combined 18F-FDG-contrast CT parameters as predictors of tumor control for hepatocellular carcinoma after stereotactic ablative radiotherapy. J Nucl Med 2013; 54:1710-6. [PMID: 23970365 DOI: 10.2967/jnumed.112.119370] [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] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED The application of stereotactic ablative radiotherapy (SABR) to hepatocellular carcinoma (HCC) is emerging. To identify pretreatment prognostic indicators is crucial for patient selection and optimal individual therapy. The aim of this study was to determine whether (18)F-FDG PET and a combined (18)F-FDG-contrast CT parameter could be useful tools to predict tumor control for patients with HCC treated by SABR. METHODS We retrospectively identified 31 patients (41 tumors) who underwent (18)F-FDG PET before SABR between November 2007 and September 2011. (18)F-FDG PET parameters were collected as prognostic indicators, including visual PET scale (+/-), maximal standardized uptake value (SUV) of the tumor (T SUV max), ratio of T SUV max to maximal normal-liver SUV, ratio of T SUV max to mean normal-liver SUV, and score combining tumor volume and T SUV max (CT/(18)F-FDG PET score). They underwent SABR with a median dose of 42 Gy (ranging from 30 to 50 Gy) in 4-5 fractions. (18)F-FDG PET parameters and clinical factors were tested as predictors of tumor control and patient survival. RESULTS The median follow-up time was 18 mo. Among the parameters examined, T SUV max and CT/(18)F-FDG PET score were significantly correlated with tumor control. T SUV max with a cutoff value of 3.2 was the most significant prognostic indicator. The 4-y control rate was 86.2% in tumors with a T SUV max of 3.2 or less but only 37.5% in those with a T SUV max of more than 3.2 (adjusted hazard ratio, 9.40; 95% confidence interval, 1.18-74.76; P = 0.034). CT/(18)F-FDG PET score (≤ 4 vs. >4) was also a significant predictor of tumor control after SABR. Tumors with a CT/(18)F-FDG PET score of more than 4 had a 5.23-fold risk of tumor failure. After adjustment for factors of sex, American Joint Committee on Cancer stage, Cancer of the Liver Italian Program score, and Child-Pugh classification, tumors with a score of more than 4 had a 4.96-fold risk of failure after SABR, compared with tumors with a score of 4 or less. For overall survival, none was statistically significant. CONCLUSION The use of (18)F FDG PET to predict tumor control is feasible. T SUV max with a cutoff value of 3.2 is the best prognostic indicator. We suggest that (18)F-FDG PET may be a reference for prognostic prediction, patient selection, and radiation dose adjustment for HCC patients treated with SABR.
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Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Cheng CC, Chiu SC, Jen YM, Chang HC, Chung HW, Liu YJ, Chiu HC, Chen CY, Huang GS, Juan CJ. Parotid perfusion in nasopharyngeal carcinoma patients in early-to-intermediate stage after low-dose intensity-modulated radiotherapy: evaluated by fat-saturated dynamic contrast-enhanced magnetic resonance imaging. Magn Reson Imaging 2013; 31:1278-84. [PMID: 23664679 DOI: 10.1016/j.mri.2013.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 07/22/2012] [Revised: 12/13/2012] [Accepted: 03/14/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate parotid perfusion in early-to-intermediate stage after parotid-sparing radiation dose using fat-saturated DCE-MRI, and to verify whether the perfusion alteration was related to radiation dose and the PSV. METHODS AND MATERIALS Thirty-two parotid glands from 16 consecutive patients with pathologically proven nasopharyngeal carcinoma treated by IMRT were examined. The parotid glands received a radiation dose of 28.9±3.9Gy with a PSV of 43.1%±13.9%. Perfusion parameters were calculated using time-shifted Brix model from fat-saturated DCE-MRI data before (pre-RT) and in early-to-intermediate stage after (post-RT) IMRT. Paired t-test was used to evaluate perfusion changes, while Pearson's correlation test was used to examine perfusion dependency on radiation dose and PSV. For multiple comparisons Bonferroni correction was applied. RESULTS Successful fat saturation was achieved in 29 of 32 parotid glands. Compared with pre-RT, the post-RT parotid glands showed significantly higher A, peak enhancement, and wash-in slope, plus a lower Kel, suggesting a mixed effect of increased vascular permeability and acinar loss. Linear regression showed that peak enhancement was positively associated with radiation dose in post-RT parotid glands. Kel and slope were negatively associated with PSV, while time-to-peak was positively associated with PSV significantly. CONCLUSIONS Our results suggest that time-shifted Brix model is feasible for quantifying parotid perfusion using DCE-MRI. The perfusion alterations in early-to-intermediate stage after IMRT might be related to a mixed effect of increased vascular permeability and acinar loss with dose and PSV dependencies.
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Affiliation(s)
- Cheng-Chieh Cheng
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, Republic of China; Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
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Chen YH, Chang SD, Ma HI, Chou YC, Chao HL, Jen YM, Ju DT. Multisession CyberKnife radiosurgery for post-surgical residual and recurrent pituitary adenoma: preliminary result from one center. J Radiosurg SBRT 2013; 2:105-117. [PMID: 29296349 PMCID: PMC5658882] [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] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 07/26/2012] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy of CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) for patients with pituitary adenoma. METHODS We conducted a retrospective review of all patients treated by image-guided radiosurgery at our institution between August 2007 and June 2009. Twentytwo patients with pituitary adenoma were identified. The median follow-up period from date of treatment was 30.8 + 7.7months. The median patient age was 56 years. The mean tumor volume was 4.1 + 2.8 mL (range, 0.8-16.0 mL), and the prescribed dose was 25 Gy (5 Gy x 5). RESULTS Tumors were treated with a mean coverage of 95.1 ± 1.3%(range 90.2-99.1%), a mean conformality index of 1.4 ± 0.4 (range, 1.2-1.8), and a mean treatment isodose line of 76.4 ± 3.0%(range70-83%). The primary endpoints were radiographic and endocrinological tumor control. The local radiographic control rate in this series was 100% (22/22). Radiographic evidence of tumor necrosis developed in 3 patients (13.7%). CONCLUSION CyberKnife multisession radiosurgery of 25 Gy (5 Gy x 5) provided excellent local control with acceptable adverse effect in patients with pituitary adenoma post-transsphenoidal resection. This preliminary study provides data that supports the belief that the optic nerve and chiasm tolerate the above dosing regimens in perichiasmatic pituitary adenomas, and this dosing regimen may achieve satisfactory radiographic and endocrinological tumor control for post-transsphenoidal resection.
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Affiliation(s)
- Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Lu YC, Fan HC, Gao HW, Chen CM, Jen YM, Cheng SN, Chen SJ. Effective radiotherapy cured cauda equina syndrome caused by remitted intracranial germinoma depositing. Pediatr Neonatol 2012; 53:315-9. [PMID: 23084725 DOI: 10.1016/j.pedneo.2012.07.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/08/2011] [Accepted: 08/14/2011] [Indexed: 10/27/2022] Open
Abstract
Cauda equina syndrome (CES) in children is very rare and can permanently disable. A remitted intracranial germinoma depositing on the spinal cord, leading to CES, has never been reported. We discuss the case of a 10-year-old girl who presented with sudden ataxia, low back pain, sensory deficits of the left lower extremity, and difficulty urinating and defecating 7 months after totally remitted intracranial germinoma postintracranial surgery and cranial irradiation. Magnetic resonance imaging (MRI) of the brain and spine showed multiple intradural extramedullary homogeneous masses from the cervical to lumbar levels, compressing the conus medullaris and cauda equina. After emergent craniospinal irradiation, the patient's neurologic symptoms dramatically subsided. A remitted intracranial germinoma depositing on her spinal cord could be the cause of CES. Early identification and a proper craniospinal irradiation may halt the progression of symptoms.
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Affiliation(s)
- Ying-Chun Lu
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan
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Huang WY, Lin CC, Jen YM, Lin KT, Yang MH, Chen CM, Chang YN, Sung FC, Kao CH. Association between adult otitis media and nasopharyngeal cancer: a nationwide population-based cohort study. Radiother Oncol 2012; 104:338-42. [PMID: 22981611 DOI: 10.1016/j.radonc.2012.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine whether the diagnosis of otitis media (OM) in adults is associated with an increased risk for the subsequent development of nasopharyngeal cancer (NPC) using a nationwide population-based retrospective study. METHODS AND MATERIALS We selected 13,513 adult patients that had been previously diagnosed with OM between 2000 and 2005 from the Taiwan Longitudinal Health Insurance Database 2000 as the study cohort, and randomly extracted the data of 135,130 participants matched by sex, age, and baseline year for the comparison cohort. The follow-up period was terminated upon developing NPC, withdrawal from the national health insurance system, or the end of 2009. Cumulative incidences and hazard ratios (HRs) of NPC development were determined. RESULTS The subsequent NPC incidence rates in the OM and comparison cohorts were 6.41 and 0.58 per 10000 person-years, respectively (adjusted HR, 11.04; 95% CI, 7.68-5.87; P<0.0001). The NPC risk for males was significantly higher than that for females (adjusted HR=3.24; 95% CI, 2.16-4.85). In both female and male patients, the diagnosis of OM was associated with a significantly increased risk for NPC (adjusted HR, 11.91 vs. 10.78, respectively). Among the OM cohort, 62 participants were subsequently diagnosed with NPC, with 71% of them occurring within 1 year following the diagnosis of OM. However, even after 5-year follow-up, the OM cohort still displayed a higher risk for NPC (adjusted HR=2.50). Stratified by the frequency of OM episodes, more than one episode per year had a significantly greater risk of developing NPC, compared with the comparison cohort (HR=29.22; 95% CI, 20.19-42.27). CONCLUSION We found that adult OM is a warning sign for the development of NPC in Taiwan, with approximately an 11-fold higher risk for adult OM patients. We recommend that OM patients undergo follow-up examinations for at least 5 years. To extrapolate our findings, further studies are warranted in other areas in which NPC is endemic.
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Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Huang WY, Jen YM, Lee MS, Chang LP, Chen CM, Ko KH, Lin KT, Lin JC, Chao HL, Lin CS, Su YF, Fan CY, Chang YW. Stereotactic body radiation therapy in recurrent hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2012; 84:355-61. [PMID: 22342300 DOI: 10.1016/j.ijrobp.2011.11.058] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients of recurrent hepatocellular carcinoma (HCC). METHODS AND MATERIALS This was a matched-pair study. From January 2008 to December 2009, 36 patients with 42 lesions of unresectable recurrent HCC were treated with SBRT. The median prescribed dose was 37 Gy (range, 25 to 48 Gy) in 4-5 fractions over 4-5 consecutive working days. Another 138 patients in the historical control group given other or no treatments were selected for matched analyses. RESULTS The median follow-up time was 14 months for all patients and 20 months for those alive. The 1- and 2-year in-field failure-free rates were 87.6% and 75.1%, respectively. Out-field intrahepatic recurrence was the main cause of failure. The 2-year overall survival (OS) rate was 64.0%, and median time to progression was 8.0 months. In the multivariable analysis of all 174 patients, SBRT (yes vs. no), tumor size (≤4 cm vs. >4 cm), recurrent stage (stage IIIB/IV vs. I) and Child-Pugh classification (A vs. B/C) were independent prognostic factors for OS. Matched-pair analysis revealed that patients undergoing SBRT had better OS (2-year OS of 72.6% vs. 42.1%, respectively, p = 0.013). Acute toxicities were mild and tolerable. CONCLUSION SBRT is a safe and efficacious modality and appears to be well-tolerated at the dose fractionation we have used, and its use correlates with improved survival in this cohort of patients with recurrent unresectable HCC. Out-field recurrence is the major cause of failure. Further studies of combinations of SBRT and systemic therapies may be reasonable.
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Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Lin CS, Jen YM, Kao WY, Ho CL, Dai MS, Shih CL, Cheng JC, Chang PY, Huang WY, Su YF. Improved outcomes in buccal squamous cell carcinoma. Head Neck 2012; 35:65-71. [DOI: 10.1002/hed.22916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2011] [Indexed: 11/12/2022] Open
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Lin DS, Jen YM, Lee JC, Liu SC, Lin YS. Recurrence of nasopharyngeal carcinoma in the parotid region after parotid-gland-sparing radiotherapy. J Formos Med Assoc 2011; 110:655-60. [PMID: 21982471 DOI: 10.1016/j.jfma.2011.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 06/24/2010] [Accepted: 08/27/2010] [Indexed: 10/17/2022] Open
Abstract
This study reported our experience of the clinical characteristics of periparotid recurrence of nasopharyngeal carcinoma (NPC) after parotid-gland-sparing radiotherapy. We retrospectively reviewed the charts of 296 patients with NPC who underwent parotid-gland-sparing radiotherapy at the Tri-Service General Hospital from 1998 to 2008. Eighty-three patients underwent three-dimensional conformal radiotherapy, and 205 patients underwent intensity-modulated radiotherapy; parotid glands were spared bilaterally in all patients. None of these patients had undergone previous radiotherapy or surgical treatment of the head and neck. Disease recurred in a spared parotid gland in three patients (1.04%). Two of these patients had undergone three-dimensional conformal radiotherapy and the third underwent intensity-modulated radiotherapy. All three patients had undergone parotidectomy. Adjuvant radiotherapy or concurrent chemoradiation was administered. One patient died of metastatic disease 26 months after diagnosis of recurrence; the others were well with no evidence of disease at 63 and 6 months after initial recurrence. Periparotid recurrence is an uncommon pattern of locoregional failure after parotid-gland-sparing radiotherapy for NPC. Early diagnosis and aggressive therapy for patients with periparotid recurrence may improve outcomes.
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Affiliation(s)
- Deng-Shan Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Shueng PW, Shen BJ, Wu LJ, Liao LJ, Hsiao CH, Lin YC, Cheng PW, Lo WC, Jen YM, Hsieh CH. Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma. Radiat Oncol 2011; 6:95. [PMID: 21838917 PMCID: PMC3163198 DOI: 10.1186/1748-717x-6-95] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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] [Received: 03/05/2011] [Accepted: 08/13/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC). METHODS Between August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction. RESULTS After completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively. CONCLUSION HT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings.
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Affiliation(s)
- Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
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Yang CH, Wang SJ, Lin ATL, Jen YM, Lin CA. Evaluation of prostate volume by transabdominal ultrasonography with modified ellipsoid formula at different stages of benign prostatic hyperplasia. Ultrasound Med Biol 2011; 37:331-337. [PMID: 21208737 DOI: 10.1016/j.ultrasmedbio.2010.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 09/16/2010] [Accepted: 10/29/2010] [Indexed: 05/30/2023]
Abstract
The aim of the study was to propose an eccentricity parameter (EP)-based correction to the ellipsoid formula to improve the evaluation of the prostate volume defined by transabdominal ultrasonography (TAUS) at different stages of benign prostatic hyperplasia (BPH). All 202 adult male volunteers underwent the prostate volume evaluations with TAUS and computerized tomography (CT). Based on the EP index, three clearly different stages of BPH were also deduced by analytical analysis. By applying the correction formula, the mean prostate volume differences of TAUS with CT were improved from 28.1%, -25.4% and -0.6% to 7.6%, -3.5% and -0.6% for EP < 0.055, 0.055 < EP < 0.14 and EP > 0.14, respectively. Hence, for EP > 0.14, representing the advanced stage of BPH, TAUS with the ellipsoid formula can be regarded as an effective tool for computing volume, whereas for EP < 0.14, the correction formula is recommended to improve the volume estimation based on TAUS.
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Affiliation(s)
- Cheng-Hsiu Yang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Huang WY, Jen YM, Chen CM, Su YF, Lin CS, Lin YS, Chang YN, Chao HL, Lin KT, Chang LP. Intensity modulated radiotherapy with concurrent chemotherapy for larynx preservation of advanced resectable hypopharyngeal cancer. Radiat Oncol 2010; 5:37. [PMID: 20470428 PMCID: PMC2890614 DOI: 10.1186/1748-717x-5-37] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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] [Received: 02/19/2010] [Accepted: 05/15/2010] [Indexed: 11/17/2022] Open
Abstract
Background To analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT) plus concurrent chemotherapy, and compare the results with patients treated with primary surgery. Methods Between January 2003 and November 2007, 14 patients were treated with primary surgery and 33 patients were treated with concurrent chemoradiotherapy (CCRT) using IMRT technique. Survival rate, larynx preservation rate were calculated with the Kaplan-Meier method. Multivariate analysis was conducted for significant prognostic factors with Cox-regression method. Results The median follow-up was 19.4 months for all patients, and 25.8 months for those alive. The 5-year overall survival rate was 33% and 44% for primary surgery and definitive CCRT, respectively (p = 0.788). The 5-year functional larynx-preservation survival after IMRT was 40%. Acute toxicities were common, but usually tolerable. The rates of treatment-related mucositis (≥ grade 2) and pharyngitis (≥ grade 3) were higher in the CCRT group. For multivariate analysis, treatment response and cricoid cartilage invasion strongly correlated with survival. Conclusions IMRT plus concurrent chemotherapy may preserve the larynx without compromising survival. Further studies on new effective therapeutic agents are essential.
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Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chiou JF, Tai CJ, Wang YH, Liu TZ, Jen YM, Shiau CY. Sorafenib induces preferential apoptotic killing of a drug- and radio-resistant Hep G2 cells through a mitochondria-dependent oxidative stress mechanism. Cancer Biol Ther 2009; 8:1904-13. [PMID: 19770576 DOI: 10.4161/cbt.8.20.9436] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sorafenib (Nexavar, BAY43-9006), a bi-arylurea, is a newly established anti-cancer drug and its functional attribute of cytotoxicity is based on the multi-kinase inhibitory action. Here, we report yet another novel pathway in which sorafenib can induce apoptotic cell death preferentially and efficaciously on an experimentally proven drug- and radio-resistant human Hep G2 cells via a mitochondria-dependent oxidative stress mechanism. A real time confocal imaging assay revealed that sorafenib could rapidly provoke the production of ROS plethorically, mainly concentrating in the mitochondria, albeit substantial amounts of ROS could also be detected in cytosol and nucleus. The rapid production of ROS could simultaneously induce intracellular glutathione (iGSH) depletion. A nearly 90% of iGSH was found to be depleted in 1h period after the cells received the drug treatment. Besides mitochondria, iGSH depletion could also be detected in other cellular compartment including cytoplasm and nucleus. Interestingly, we also demonstrated that sorafenib could trigger mitochondrial Ca(2+) overload. All these events compoundedly serve as the final arbitrator to initiate lethal apoptotic process through the release of cytochrome c and caspase 3/7 activation. Collectively, we provide first evidence here that sorafenib can provoke an alternative pathway for apoptosis induction of Hep G2 cells through a mitochondria-dependent oxidative stress mechanism which is independent of original kinase inhibitory attribute of the drug action. Most importantly, we also demonstrate that sorafenib can effectively eradicate a highly drug- and radio-resistant HCC cells. Thus, our data can provide the basis for a potential applicability of sorafenib in a combined treatment modality.
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Affiliation(s)
- Jeng-Fong Chiou
- Graduate Institute of Medical Sciences, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Lee MS, Jen YM, Liu DW, Su YC, Hung SK, Hwang JM, Lee CC, Li SC, Tsai WT, Chen FL, Lin HY. Should Tonsillar Carcinoma With Nasopharynx Invasion Alone be Classified as a T4b Disease? Tzu Chi Med J 2009. [DOI: 10.1016/s1016-3190(09)60040-9] [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: 11/29/2022] Open
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Liu SC, Jen YM, Jiang SS, Chang JL, Hsiung CA, Wang CH, Juang JL. G(alpha)12-mediated pathway promotes invasiveness of nasopharyngeal carcinoma by modulating actin cytoskeleton reorganization. Cancer Res 2009; 69:6122-30. [PMID: 19602597 DOI: 10.1158/0008-5472.can-08-3435] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The molecular mechanisms behind the aggressiveness of nasopharyngeal carcinoma (NPC), a highly invasive and metastatic head and neck malignancy, have not been made clear. In this study investigating these mechanisms, guanine nucleotide-binding protein alpha(12) subunit (G(alpha)(12)) signaling was found by microarray analysis to be increased in primary NPC cells and NPC-derived cell lines. Using small interfering RNA to knock down G(alpha)(12) in NPC cells resulted in a reduction in cell migration and invasion as well as a reversal in fibroblastoid morphology. Using microarray analysis, we also found a reduction in expression of key actin dynamics regulators and several epithelial-to-mesenchymal transition-related genes in G(alpha)(12)-depleted NPC cells. Knocking down one of those genes, IQ motif containing GTPase activating protein 1, reduced the migration and formation of adherens junctions and reversed the fibroblastoid morphology of NPC cells, as knocking down G(alpha)(12) was found to do. Immunohistochemical analysis found NPC tumors to have significantly greater levels of G(alpha)(12) protein than the normal basal epithelial cells. Quantitative real-time PCR analysis revealed a significant correlation between G(alpha)(12) mRNA levels and NPC lymph node metastasis. Together, our findings support a model in which activation of G(alpha)(12) signaling promotes tumorigenesis and progression of NPC by modulating actin cytoskeleton reorganization and expression of epithelial-to-mesenchymal transition-related genes. =
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Affiliation(s)
- Shu-Chen Liu
- Department of Radiation Oncology, Graduate Institute of Life Sciences, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
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Lin HY, Ku CH, Liu DW, Chao HL, Lin CS, Jen YM. Hyperbaric oxygen therapy for late radiation-associated tissue necroses: is it safe in patients with locoregionally recurrent and then successfully salvaged head-and-neck cancers? Int J Radiat Oncol Biol Phys 2009; 74:1077-82. [PMID: 19327913 DOI: 10.1016/j.ijrobp.2008.08.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 08/28/2008] [Accepted: 08/29/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To test, in a retrospective matched-pair study, whether necrosis-rescuing hyperbaric oxygen therapy (HBOT) increases the risk of cancer re-recurrence in patients with locoregionally recurrent and then successfully salvaged head-and-neck cancers. METHODS AND MATERIALS Between January 1995 and July 2004, we retrospectively identified 22 patients with locoregionally recurrent and then successfully salvaged head-and-neck cancers. We defined two groups: the HBOT group, 11 patients with HBOT for rescuing late radiation-associated tissue necroses; and the non-HBOT group, the other 11 matched-pair patients without HBOT. Between the two groups, the following four factors were matched for case pairing: primary cancer subsite, initial cancer stage, age, and gender. RESULTS Three findings indicate that HBOT increases the risk of cancer re-recurrence. First, we observed more cancer re-recurrences in the HBOT group than in the non-HBOT group: 9 of 11 vs. 4 of 11, with 5-year disease-free survival rates after salvage of 32.7% vs. 70.0% (hazard ratio 3.2; 95% confidence interval 1.03-10.7; p = 0.048). Second, re-recurrences developed rapidly after HBOT in 6 patients. Third, 3 patients had unusual cancer re-recurrences after HBOT. Remarkably, of 9 patients with cancer re-recurrences in the HBOT group, 4 patients had cancer disease-free intervals of 9 months or less before HBOT. CONCLUSIONS Necrosis-rescuing HBOT should be given with caution in patients with locoregionally recurrent and then successfully salvaged head-and-neck cancers; if it cannot be omitted entirely, deferring HBOT 9 months or longer after cancer re-treatment may be prudent.
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Affiliation(s)
- Hon-Yi Lin
- Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Dalin Branch, Taiwan, Republic of China
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Lin SC, Jen YM, Chang YC, Lin CC. Assessment of xerostomia and its impact on quality of life in head and neck cancer patients undergoing radiotherapy, and validation of the Taiwanese version of the xerostomia questionnaire. J Pain Symptom Manage 2008; 36:141-8. [PMID: 18395402 DOI: 10.1016/j.jpainsymman.2007.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 09/23/2007] [Accepted: 09/25/2007] [Indexed: 11/23/2022]
Abstract
The purposes of this study were to (a) explore the impact of xerostomia and saliva flow on quality of life and (b) validate the Taiwanese version of the Xerostomia Questionnaire (XQ) for patients undergoing radiotherapy (RT) for head and neck cancer in Taiwan. This was a prospective longitudinal study. Instruments consisted of the Xerostomia Questionnaire-Taiwan version (XQ-T) and the Medical Outcomes Study Short Form-36 Taiwan Version. Salivary output was measured by collecting unstimulated whole saliva. The questionnaires and measurements of salivary output were completed before RT was initiated and at two, four, six, and eight weeks after RT had started. Changes in xerostomia scores, quality of life, saliva flow, and predictors of quality of life over time were examined by using general estimating equations. The XQ-T is the first xerostomia measurement instrument developed for use with Taiwanese cancer patients and demonstrated excellent reliability and validity. Saliva flow was significantly correlated with XQ-T scores at two, four, six, and eight weeks after RT had started, but not before RT had begun. Saliva flow and quality-of-life scores significantly diminished and xerostomia scores significantly increased over the eight-week period. Saliva flow and XQ-T scores significantly predicted quality of life, after adjusting for the maturation effect. The results of this study show that the XQ-T is the first xerostomia measurement instrument to be developed for Taiwanese cancer patients and demonstrates excellent reliability and validity.
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Affiliation(s)
- Shu-Chen Lin
- Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
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Juan CJ, Chen CY, Jen YM, Liu HS, Liu YJ, Hsueh CJ, Wang CY, Chou YC, Chai YT, Huang GS, Chung HW. Perfusion characteristics of late radiation injury of parotid glands: quantitative evaluation with dynamic contrast-enhanced MRI. Eur Radiol 2008; 19:94-102. [PMID: 18661135 DOI: 10.1007/s00330-008-1104-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 05/28/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
We aimed to quantitatively investigate the alteration of parotid perfusion after irradiation using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on a two-compartment tracer kinetic model. This study enrolled 19 patients (53.2 +/- 14.9 years) treated by head and neck radiotherapy and 19 age-relevant and sex-matched subjects as a control group. Perfusion parameters (K ( el ), k (21) and A) of parotid glands were analyzed based on the Brix model from T1-weighted DCE-MRI. Suitability of the Brix model was evaluated via Monte Carlo simulation for the goodness-of-fit. Analysis of nonlinear goodness-of-fit showed that the Brix model is appropriate in evaluating the parotid perfusion (R(2) = 0.938 +/- 0.050). The irradiated parotid glands showed significantly lower K ( el ) (P < 0.0005) and k (21) (P < 0.05) and consequently significantly higher value of peak enhancement (P < 0.0005) and time-to-peak (P < 0.0005) compared with non-irradiated ones, suggestive of gradual and prolonged accumulation and delayed wash-out of contrast agent due to increased extracellular extravascular space and decreased vascular permeability in the irradiated glands. Linear regression analysis showed dose-dependent perfusion changes of the irradiated parotid glands. We conclude that quantitative DCE-MRI is a potential tool in investigating parotid gland perfusion changes after radiotherapy.
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Affiliation(s)
- Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
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Lin HY, Jen YM, Liu DW, Hwang JM, Lee MS, Hung SK, Chao HL, Lin CS, Shum WY. The Role of Primary Surgery in Resectable Stage III/IV Tonsillar Carcinoma. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60008-7] [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: 11/16/2022] Open
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Abstract
Primary malignant fibrous histiocytoma of thyroid is extremely rare. Only three cases have been reported. We report two cases of this rare disease. Case 1 was a 70-year-old woman who had Graves' disease and a growing 3.5-cm thyroid nodule with constrictive symptoms. Fine-needle aspiration cytology showed suspicious atypical cells. She had a total thyroidectomy; frozen section showed sarcoma. Final pathology showed malignant fibrous histiocytoma. Case 2 was a 67-year-old woman who had a 5-cm thyroid nodule that rapidly grew, causing tracheal deviation. A diagnostic lobectomy and pathology showed malignant fibrous histiocytoma. She then had a completion total thyroidectomy. Neither patient had metastatic lesions found by whole body gallium scans, computerized tomographic scans, and neck sonography. Both patients had postoperative radiotherapy and were alive and without recurrence at 6 months follow-up.
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Affiliation(s)
- Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Affiliation(s)
- Hon-Yi Lin
- Tri-Service General Hospital, Taipei 114, Taiwan.
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Chen HC, Jen YM, Wang CH, Lee JC, Lin YS. Etiology of vocal cord paralysis. ORL J Otorhinolaryngol Relat Spec 2007; 69:167-71. [PMID: 17264533 DOI: 10.1159/000099226] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [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: 03/06/2006] [Accepted: 08/25/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Vocal cord paralysis (VCP) is a sign of a certain underlying disease, a diagnosis which can be attributed to various causes. This study intends to analyze the contemporary etiology of VCP in a tertiary medical center. MATERIALS AND METHODS A retrospective review of medical records from June 2000 to December 2004 of hospitalized patients with VCP was done to determine the etiology. RESULTS Two hundred and ninety-one patients with a determined etiology were identified, consisting of 176 males and 115 females. Unilateral VCP was present in 259 patients, while 32 presented with bilateral VCP. The causes were surgical in 40.2%, neoplastic in 29.9%, idiopathic in 10.7%, traumatic in 8%, central in 3.8%, radiation-induced in 3.4%, inflammatory in 2%, cardiovascular in 1.7% and other causes in 0.3% of the cases. Thyroidectomy represented the most common surgery for VCP and was the cause in 57 patients. Lung cancer was responsible for 34 cases and was the most common neoplastic etiology. In males, neoplasm was the most common cause occurring in 63 of 176 males, whereas surgery was most frequent in 59 of 115 females. CONCLUSION Surgical trauma, mainly thyroidectomy, is the most common cause of VCP in hospitalized patients. The possibility of a neoplasm must be ruled out before VCP is labeled idiopathic. A benign thyroid tumor could also cause VCP. Besides, radiation-induced cranial nerve paralysis in head and neck cancer may play a significant role.
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Affiliation(s)
- Hsin-Chien Chen
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Lin CS, Jen YM, Chiu SY, Hwang JM, Chao HL, Lin HY, Shum WY. Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy. Jpn J Clin Oncol 2006; 36:212-7. [PMID: 16613896 DOI: 10.1093/jjco/hyl006] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [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: 12/11/2022] Open
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) often have unresectable tumors. Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients' survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE. The purpose of this study was to analyze the recanalization rate of thrombosed portal vein and treatment toxicities after stereotactic radiotherapy (SRT) or three-dimensional conformal radiotherapy (3DCRT). METHODS From March 2002 to November 2004, 43 patients were enrolled in this prospective study. Twenty-two patients were in the SRT group and 21 in the 3DCRT group. For SRT, 3 Gy per fraction, 3 fractions per week, was given to a total dose of 45 Gy. For 3DCRT, a daily dose of 1.8 Gy, 5 fractions per week, was given to a total dose of 45 Gy. RESULTS Of the 43 patients, 16 completed the planned radiotherapy. Eventually, 14 patients received evaluation for portal vein recanalization, 8 in the SRT and 6 in the 3DCRT group, respectively. For all patients, the crude response rate was 26%. For 14 evaluable patients, the crude response rate was 79%. It was 75% in the SRT group and 83% in the 3DCRT group (P = 0.71). The median survival time was 6.0 and 6.7 months for the SRT and 3DCRT group, respectively (P = 0.911). CONCLUSIONS Image-based radiotherapy, either SRT or 3DCRT, can recanalize the PVTT in unresectable HCC patients. Responders also had better 1 year and 2 year survivals. A more strict patient selection criterion may maximize the potential benefits of radiotherapy for hepatoma patients with PVTT.
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Affiliation(s)
- Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, 325 Section 2 Cheng-Kong Rd., Nei-Hu 11490, Taipei, Taiwan, ROC.
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Jen YM, Lin YC, Wang YB, Wu DM. Dramatic and prolonged decrease of whole salivary secretion in nasopharyngeal carcinoma patients treated with radiotherapy. ACTA ACUST UNITED AC 2006; 101:322-7. [PMID: 16504865 DOI: 10.1016/j.tripleo.2005.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 06/25/2004] [Revised: 01/08/2005] [Accepted: 01/12/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study evaluates: (1) the change in whole salivary secretion rates of nasopharyngeal carcinoma patients before, during, and after radiotherapy, especially during the first week of irradiation; (2) the recovery capability of salivary glands up to 2 years postirradiation; and (3) the possible prognostic factors affecting salivary gland functions. STUDY DESIGN Fifty patients who completed conventional radiotherapy using either once-per-day or hyperfractionated technique were included. Both unstimulated and stimulated whole salivary flow rates and ratios (flow rate compared with baseline) were measured before, during, 1, 3, and 6 months, and 1 and 2 years after radiotherapy. Multivariate analysis of potential prognostic factors affecting the salivary secretion ratio was made. RESULTS Salivary glands were very radiosensitive and responded to radiation very early. After 720 cGy at the fourth day of the 8-week treatment, the unstimulated and stimulated salivary flow rates had decreased by 40%-50%. The nadir was reached in many patients after 3600 cGy (4 weeks). A second phase of decrease in salivary secretion was noted after completion of radiotherapy. CONCLUSIONS Different mechanisms may be responsible for salivary response after low and high dose of radiation. This study shows no recovery of salivary secretion during the follow-up period, and the best strategy for managing radiation-induced salivary gland damage may be reduction of radiation dose to the glands.
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Affiliation(s)
- Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan.
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Lin CS, Jen YM, Cheng MF, Lin YS, Su WF, Hwang JM, Chang LP, Chao HL, Liu DW, Lin HY, Shum WY. Squamous cell carcinoma of the buccal mucosa: An aggressive cancer requiring multimodality treatment. Head Neck 2006; 28:150-7. [PMID: 16200628 DOI: 10.1002/hed.20303] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [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: 11/10/2022] Open
Abstract
BACKGROUND In our clinical practice, we have observed a high incidence of locoregional failure in squamous cell carcinoma (SCC) of the buccal mucosa. We analyze our treatment results of this cancer and compare these results with those in the literature. We intend to define the pattern and incidence of failure of buccal cancer and provide information for the design of a better multimodality treatment. METHODS During the period from 1983 through 2003, 121 previously untreated patients with M0 stage SCC of the buccal mucosa were treated with a curative intent at our hospital. Twenty-seven patients received surgery alone, 36 had radiotherapy alone, and 58 underwent surgery plus postoperative radiotherapy. RESULTS The 5-year locoregional control, overall survival, and cause-specific survival rates for all patients were 36.3%, 34.3%, and 36.9%, respectively. The locoregional recurrence rate was 57% for all patients, with 80% occurring in the primary site alone. Patients with T1-2N0 disease who received surgery alone still had a high local recurrence incidence of 41%. For patients with locally advanced disease, surgery plus postoperative radiotherapy achieved better overall survival and locoregional control rates than surgery alone or radiotherapy alone. T classification was the only prognostic factor affecting locoregional control and survival in the surgery alone group, whereas N classification and skin invasion predicted a poorer survival for the surgery plus postoperative radiotherapy group. CONCLUSIONS SCC of the buccal mucosa is an aggressive cancer with a high locoregional failure rate even in patients with T1-2N0 disease. Possible reasons include inadequate treatment and an intrinsically aggressive nature. Postoperative radiotherapy has resulted in a better locoregional control rate for patients with T3-4 or N+ disease and should also be considered for patients with T1-2N0 disease for whom adjuvant therapy after radical surgery currently is not recommended by most guidelines.
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Affiliation(s)
- Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, 325 Section 2 Cheng-Kong Rd., Nei-Hu, Taipei, Taiwan, Republic of China
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Lin YS, Jen YM, Wang BB, Lee JC, Kang BH. Epidemiology of oral cavity cancer in taiwan with emphasis on the role of betel nut chewing. ORL J Otorhinolaryngol Relat Spec 2005; 67:230-6. [PMID: 16254455 DOI: 10.1159/000089214] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [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: 03/03/2004] [Accepted: 04/28/2005] [Indexed: 11/19/2022]
Abstract
This article reports the epidemiological characteristics and the possible contributing etiology of oral cavity cancer in Taiwan. Data on oral cavity cancer from the period between 1986 and 1997 were compiled from the Taiwan Cancer Registry Annual Report. The amount of average annual consumption per person of cigarettes, alcohol and betel nut were extracted from the Annual Report of Taiwan Tobacco and Wine Monopoly Bureau and the Agriculture Counsel of Taiwan. The incidence of oral cavity cancer increased annually. Both the total and male incidence have increased substantially since 1993. Regarding the peak incidence, most cases were seen in the sixth to eighth decades of life. Multiple regression models indicated that 86.2% variation in the incidence of oral cavity cancer was explained by the annual average betel nut consumption per person. These results imply that those who chew betel nut belong to a high-risk group and require special consideration and attention regarding health education and health promotion.
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Affiliation(s)
- Yaoh-Shiang Lin
- Department of Otolaryngology--Head & Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC.
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Abstract
Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We present the first reported case of adult hepatoblastoma in Taiwan. A 52-year-old female suffered from sudden onset of abdominal pain and general weakness for days. Internal bleeding with hemorrhagic shock was suspected and two massive lesions in both lobes of the liver with hemoperitoneum were noted from imaging studies. Surgical resection of the larger left lobe tumor and radio-frequency ablation of the right smaller one were performed. The histopathology diagnosis was of a hepatoblastoma.
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Affiliation(s)
- Hung-Yen Ke
- Division of General Surgery, Tri-Service General Hospital, 325, Sec. 2, Chen-Kung Road, Neihu 114, Taipei, Taiwan, China.
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Jen YM, Shih R, Lin YS, Su WF, Ku CH, Chang CS, Shueng PW, Hwang JM, Liu DW, Chao HL, Lin HY, Chang LP, Shum WY, Lin CS. Parotid gland-sparing 3-dimensional conformal radiotherapy results in less severe dry mouth in nasopharyngeal cancer patients: a dosimetric and clinical comparison with conventional radiotherapy. Radiother Oncol 2005; 75:204-9. [PMID: 15908027 DOI: 10.1016/j.radonc.2005.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 04/19/2004] [Revised: 01/28/2005] [Accepted: 03/01/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE This study examined the efficacy of parotid gland sparing of three-dimensional conformal radiotherapy (3DCRT) compared with conventional radiotherapy for NPC patients. Both the dose given to the parotids and clinical assessment of dry mouth were conducted. MATERIALS AND METHODS Dry mouth was assessed for 108 patients treated with conventional technique and 72 treated with 3DCRT. Dose analysis was performed in 48 patients of the 3DCRT group. A dose of 70 Gy was given to the midplane in conventional radiotherapy and to 90% isodose volume in 3DCRT. Prognostic factors affecting the severity of dry mouth were analyzed using Generalized Estimating Equation (GEE). RESULTS In the 3DCRT group about 50% of the patients' parotid glands received less than 25 Gy. Parallel analysis of dry mouth shows a significant decrease in the incidence of severe xerostomia after 3DCRT. The proportion of patients without dry mouth was also significantly higher in the 3DCRT group than the conventional group at 1-3 years after completion of radiotherapy. Although 3DCRT delivered a higher dose to the tumor, it spared the parotid gland significantly better than the conventional treatment. Late toxicities were mostly similar between the 2 groups while local control in T4 patients and survival were improved for 3DCRT. CONCLUSION Dosimetrically and clinically 3DCRT is better than conventional technique regarding parotid gland protection.
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Affiliation(s)
- Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, Taiwan, ROC.
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Chin SC, Jen YM, Chen CY, Som PM. Necrotic nasopharyngeal mucosa: an ominous MR sign of a carotid artery pseudoaneurysm. AJNR Am J Neuroradiol 2005; 26:414-6. [PMID: 15709147 PMCID: PMC7974087] [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: 05/01/2023]
Abstract
Massive hemoptysis is not commonly seen in patients who have nasopharyngeal carcinoma. It most often is the result of both radiation therapy and skull base infection. We present a practical imaging approach by using MR imaging and conventional angiography that may facilitate the prevention of such life-threatening bleeding and help provide effective control of infection. With the aid of these studies, clinicians may be able to manage this condition with more confidence.
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Affiliation(s)
- Shy-Chyi Chin
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Hsu WL, Shueng PW, Jen YM, Wu CJ, Hwang JM, Chang LP, Chen CM, Lin LC, Teh BS. Long-term treatment results of invasive cervical cancer patients undergoing inadvertent hysterectomy followed by salvage radiotherapy. Int J Radiat Oncol Biol Phys 2004; 59:521-7. [PMID: 15145172 DOI: 10.1016/j.ijrobp.2003.11.023] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Accepted: 11/04/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the long-term results of salvage radiotherapy for patients of invasive cervical cancer after inadequate surgery. METHODS AND MATERIALS Between October 1975 and January 1994, 90 patients were treated with radiotherapy for invasive cervical carcinoma after simple hysterectomy. The inadequate surgery was performed for a variety of reasons. All patients had postoperative external beam irradiation or intravaginal brachytherapy, or both. The end points of this study were local control, survival, and treatment-related toxicity. RESULTS The patients' age varied between 33 and 76 with a median of 53 years. The most common histopathology was squamous cell carcinoma, which accounted for 91% of the patients. The most frequent reason for inadvertent hysterectomy was understaged disease with preoperative diagnosis as carcinoma in situ for 51 patients (57%). Malignancy was not suspected before surgery in 28 patients (31%). After surgery, 72 patients (80%) were restaged as Ib, 12 patients (13.3%) as IIa, and 6 patients (6.7%) as IIb. Median follow-up time was 83 months. Seventy-three patients had follow-up times of 5 years or more. The overall 5-year and 10-year survival rates of 90 patients were 85.5% and 74.1%, respectively. Disease-specific 5-year and 10-year survival rates were 85.5% and 80.5%, respectively. All 16 patients with either locoregional or distant failure eventually died of disease. Fourteen patients (15.5%) had late morbidities. Radiation proctitis developed in 6 patients, intestinal obstruction in 4 patients, and hemorrhagic cystitis in 3. There was only 1 patient (1%) with terminal ileum stenosis and severe intestinal obstruction requiring surgical intervention. CONCLUSIONS Most cases of inadequately treated invasive cervical cancer were the result of suboptimal preoperative workups. Patients who had early tumors and no gross residual tumor after inadequate hysterectomy can have excellent prognoses when given postoperative radiotherapy. The severe long-term complication related to salvage radiotherapy is rare.
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Affiliation(s)
- Wen-Lin Hsu
- Department of Radiation Oncology, Buddhist Tzu-Chi Medical Center, Hualien, Taiwan
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Chen HC, Lin CJ, Jen YM, Juan CJ, Hsueh CJ, Lee JC, Su WF. Ruptured internal carotid pseudoaneurysm in a nasopharyngeal carcinoma patient with skull base osteoradionecrosis. Otolaryngol Head Neck Surg 2004; 130:388-90. [PMID: 15054390 DOI: 10.1016/j.otohns.2003.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chang YW, Lin YS, Jen YM, Dai MS. A puzzling cause for bilateral vocal cord palsies in a patient with relapsed metastatic nasopharyngeal carcinoma. Support Care Cancer 2003; 12:129-31. [PMID: 14615929 DOI: 10.1007/s00520-003-0544-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Accepted: 09/03/2003] [Indexed: 10/26/2022]
Abstract
Unilateral vocal cord paralysis (VCP) is a frequent complication of a variety of cancers. It is easy to diagnose and not fatal. Bilateral VCP is rare and it is fatal if not appropriately managed. We encountered a patient with nasopharyngeal carcinoma who developed bilateral VCP with hoarseness and respiratory distress 2 years after initial diagnosis. A tracheostomy was performed to restore airway patency.
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Affiliation(s)
- Yaw-Wen Chang
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Neihu, 114 Taipei, Taiwan
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