Chao-Yueh Fan

Stereotactic ablative radiotherapy for unresectable hepatocellular carcinoma patients who failed or were unsuitable for transarterial chemoembolization.

Background The role of stereotactic ablative radiotherapy (SABR) in patients with hepatocellular carcinoma (HCC) who are refractory to or unsuitable for transarterial chemoembolization remains unclear. We examined the efficacy and safety of Cyberknife SABR and its effect on survival in this group of HCC patients. Materials and methods From June 2008 to June 2011, 53 patients with 68 tumors of unresectable HCC were treated using Cyberknife SABR. The tumors measured 1.1–13 cm (median, 4.3 cm). The median prescribed dose was 40 Gy in four to five fractions over 4–5 consecutive working days. Results The median follow-up period was 13.1 months for all patients and 18.1 months for the living patients. Objective responses were observed in 48 of 67 tumors (71.6%), including 22 tumors (32.8%) with complete responses. The 1- and 2-year in-field failure-free rate was 73.3 and 66.8%, respectively. Out-field intrahepatic recurrence was the main cause of treatment failure (28/52 patients). The median survival time was 20.0 months, and the 1- and 2-year overall survival rate was 70.1 and 45.4%, respectively. Multivariable analysis showed that Eastern Cooperative Oncology Group performance status (⩽1 vs. >1) and tumor response (responder vs. nonresponder) were independent prognostic factors for overall survival. Radiation-induced liver disease, including classic and nonclassic types, developed in five patients (9.4%). Other acute toxicities were generally mild and tolerable. Conclusion Our findings supported the feasibility of SABR as a salvage treatment for HCC when transarterial chemoembolization was ineffective or technically unsuitable. Additional efforts to improve the response rate and reduce out-field recurrence are required.

Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy

AbstractThe aim of the article is to analyze breast cancer patient clinical outcomes after long-term follow-up using intensity-modulated radiotherapy (IMRT) or conventional tangential radiotherapy (cRT).We retrospectively reviewed patients with stage 0–III breast cancer who received breast conserving therapy between April 2004 and December 2007. Of the 234 patients, 103 (44%) were treated with IMRT and 131 (56%) were treated with cRT. A total prescription dose of 45 to 50 Gy (1.8–2 Gy per fraction) was delivered to the whole breast. A 14 Gy boost dose was delivered in 7 fractions. The median follow-up was 8.2 years.Five of 131 (3.8%) cRT-treated patients and 2 of 103 (1.9%) IMRT-treated patients had loco-regional failure. The 8-year loco-regional failure-free survival rates were 96.7% and 97.6% (P = 0.393) in the cRT and IMRT groups, respectively, whereas the 8-year disease-free survival (DFS) rates were 91.2% and 93.1%, respectively (P = 0.243). Patients treated with IMRT developed ≥ grade 2 acute dermatitis less frequently than patients treated with cRT (40.8% vs 56.5%; P = 0.017). There were no differences in late toxicity.IMRT reduces ≥ grade 2 acute skin toxicity. Local control, DFS, and overall survival were equivalent with IMRT and cRT. IMRT can be considered a standard technique for breast cancer treatment.

Stereotactic ablative radiotherapy with CyberKnife in the treatment of locally advanced prostate cancer: preliminary results.

Aims and Background Recent clinical reports of stereotactic ablative radiotherapy (SABR) in the treatment of low-risk prostate cancer have been encouraging. Our study evaluates the efficacy and safety of SABR using the CyberKnife system for treating intermediate- to very-high-risk prostate cancer. Methods and Study Design Between May 2010 and June 2013, 31 patients (15 intermediate risk, 14 high risk, and 2 very high risk) without pelvic lymph node metastasis were enrolled retrospectively. The treatment consisted of 37.5 Gy in 5 fractions over 1-2 weeks using CyberKnife SABR. Twenty-five patients (81%) received androgen deprivation therapy (ADT). Biochemical failure was defined using the nadir + 2 criterion. Toxicity was assessed with the Common Terminology Criteria of Adverse Events (version 4). Results The median follow-up was 36 months (range 7-58 months). The median pretreatment prostate-pecific antigen (PSA) was 13.5 ng/mL (range 4.5-124.0 ng/mL). The median PSA decreased to 0.09 ng/mL (range <0.04-5.38 ng/mL) and 0.12 ng/mL (range <0.04-2.63 ng/mL) at 6 months and 12 months after SABR, respectively. The 3-year biochemical relapse-free survival was 90.2% for all patients, 100% for the intermediate-risk patients, and 82% for the high- and very-high-risk patients (p = 0.186). No patient experienced ≥ grade 3 toxicity. There were 7 acute and 5 late grade 2 genitourinary toxicities and 1 acute and no late grade 2 gastrointestinal toxicity. Conclusions Our preliminary results support that CyberKnife SABR with ADT is safe and feasible in patients with intermediate- to high-risk prostate cancer. A further large-scale clinical trial with longer follow-up is warranted.

Risk of hypothyroidism among patients with nasopharyngeal carcinoma treated with radiation therapy: A Population-Based Cohort Study

BACKGROUND AND PURPOSE This study aimed to assess the incidence and risk of hypothyroidism among patients with nasopharyngeal carcinoma (NPC) after radiation therapy (RT). MATERIAL AND METHODS We identified 14,893 NPC patients and 16,105 other head and neck cancer (HNC) patients treated with RT without thyroidectomy from the National Health Insurance Research Database in Taiwan between 2000 and 2011. Each NPC patient was randomly frequency-matched with four individuals without NPC by age, sex, and index year. Competing-risk regression models were used to estimate hazard ratios (HRs) of hypothyroidism requiring thyroxin associated with NPC after RT. RESULTS The risk of developing hypothyroidism was significantly higher in the NPC cohort than in the matched cohort (adjusted HR=14.35, 95% CI=11.85-17.37) and the HNC cohort (adjusted HR=2.06, 95% CI=1.69-2.52). Independent risk factors for hypothyroidism among NPC patients included younger age, female sex, higher urbanization level, autoimmune disease, and receipt of chemotherapy. CONCLUSION The risk of hypothyroidism requiring thyroxin was significantly higher in NPC patients after RT than in the general Taiwanese population and HNC patients. Regular clinical and serum thyroid function tests are essential among NPC survivors after RT.

Risk of depressive disorder among patients with head and neck cancer: A nationwide population‐based study

The purpose of this study was to assess the incidence and risk of depressive disorder among patients with head and neck cancer.

Stereotactic ablative radiotherapy for patients with unresectable or medically inoperable cholangiocarcinoma

Purpose The role of stereotactic ablative radiotherapy (SABR) in patients with unresectable or medically inoperable cholangiocarcinoma remains unclear. We examined the efficacy and safety of SABR in this group of patients. Methods From January 2008 to December 2014, 15 patients with 17 lesions were included in this study. The lesions included 14 intrahepatic, 1 hilar, and 2 distal bile duct tumors. Three patients were classified as medically inoperable because of old age or multiple comorbidities. Tumors measured 0.8-13 cm (median, 3.6 cm). The median prescribed dose was 45 Gy delivered in 5 fractions over 5 consecutive days. Results The median follow-up period for surviving patients was 29.9 months. Objective responses were observed for 10 of 17 tumors (58.8%), including 3 complete responses (17.6%). The median survival duration was 12.6 months, and the 1- and 2-year overall survival rates were 50.3% and 14.4%, respectively. The 1- and 2-year in-field failure-free rates were 61.5% and 30.8%, respectively. For patients with biologically effective doses (BEDs) exceeding 75 Gy10, the 1- and 2-year overall survival rates were 58.3% and 33.3%, respectively, compared to 20.0% and 0%, respectively for those with BEDs lower than 75 Gy10. Radiation-induced liver disease did not develop in any patient. Acute toxicities were generally mild and tolerable. Conclusions Stereotactic ablative radiotherapy could be an alternative treatment for unresectable or medically inoperable cholangiocarcinoma. Further dose escalation may be considered to optimize local control.

Stereotactic ablative radiotherapy with CyberKnife for advanced thymic carcinoma: a case report.

Thymic carcinoma is a rare but lethal mediastinal cancer. The optimal treatment for advanced thymic carcinoma is not yet established. This report is the first known of stereotactic ablative radiotherapy (sabr) with CyberKnife (Accuray, Sunnyvale, CA, U.S.A.) as definitive therapy for thymic carcinoma. The patient, a 70-year-old woman with thymic carcinoma, invasion into neighboring organs, and pleural metastases-underwent CyberKnife sabr at 40 Gy in 5 fractions for two lesions, one in the thymus and one in the right paraspinal pleura. After 61 months of observation, a partial response was observed in the irradiated fields. However, disease progression in the non-irradiated pleura was noted. The patient underwent salvage CyberKnife sabr for the four initially nonirradiated pleural lesions. Computed tomography images obtained 10 months after the salvage therapy revealed a partial response. The patient is living, with progression-free irradiated lesions and no radiation-related toxicity. CyberKnife sabr is feasible for patients who are unable to undergo either surgery or conventionally fractionated radiation therapy.

Association between nasopharyngeal carcinoma and risk of optic neuropathy: A population-based cohort study

The purpose of this study was to assess the predictive factors of optic neuropathy among patients with nasopharyngeal carcinoma (NPC).

Lower Urinary Tract Infection and Subsequent Risk of Prostate Cancer: A Nationwide Population-Based Cohort Study

Purpose We investigated whether lower urinary tract infection (LUTI), including cystitis or urethritis, is associated with an increased risk of developing prostate cancer (PCa), in a nationwide population-based cohort study. Methods We identified 14,273 men newly diagnosed with LUTI (9347 with cystitis, and 4926 with urethritis) between 1998 and 2011, from the Taiwan Longitudinal Health Insurance Database 2000. Each patient was randomly frequency-matched with 4 men without LUTI, based on age and index year of diagnosis. Cox’s proportional hazard regression analysis was performed to estimate the effect of LUTI on the PCa risk. Results The risk of developing PCa was significantly higher in the cystitis cohort (adjusted HR = 1.46, 95% CI = 1.20–1.78) and in the urethritis cohort (adjusted HR = 1.72, 95% CI = 1.26–2.34) than in the group without LUTI. Further analyses indicated that patients with more than 5 medical visits for LUTI per year had a significantly greater risk of developing PCa. Conclusion We found that cystitis or urethritis may play an etiological role in the development of PCa in Taiwanese men, particularly in those with repeated medical visits for cystitis or urethritis. Further studies are warranted on the association between LUTI and PCa in other countries, particularly where the prevalence of PCa is high.

Advanced Thymic Carcinoma: Clinical Experience and Prognostic Factors of 18 Patients

Purpose: Thymic carcinoma is an uncommon but lethal malignancy. We analyze the outcomes and prognostic factors of patients with advanced thymic carcinoma treated at a single institution.Materials and Methods: The records of 18 patients with histologically confirmed thymic carcinoma treated between April 1996 and April 2012 at Tri-Service General Hospital were retrospectively reviewed. Surgical resection was performed in 9 patients, including 3 patients who received preoperative therapy and postoperative chemoradiotherapy followed by chemotherapy, 5 who received postoperative chemoradiotherapy followed by chemotherapy and 1 who received postoperative radiotherapy alone. Eight patients had tumor which were unresectable or medically inoperable and underwent chemoradiotherapy followed by chemotherapy or radiotherapy alone. One patient died 2 months after diagnosis without any cancer treatment. Radiotherapy was delivered with three-dimensional conformal radiation therapy, intensity-modulated radiation therapy or stereotactic ablative radiotherapy using Cyberknife (Accuray, Inc., Sunnyvale, CA). The median dose of radiotherapy was 63 Gy. Most (93.3%) of the chemotherapy regimen contained cisplatin.Results: The distribution of Masaoka stage at presentation was III in 7 patients, IVA in 4 patients and IVB in 7 patients. The 5-year overall survival (OS) rate and 3-year progression-free survival (PFS) rate were 46.5% and 32.1%, respectively. The 5-year in-field tumor control rate of 17 patients who underwent radiotherapy was80.9%. Univariate statistical analysis revealed that radiotherapy ≧ 65 Gy was the only statistically significant predictor of outcome. A total radiation dose of ≧ 65 Gy results in improved 3-year OS (100% vs. 13.1%, p= 0.004) and 3-year PFS (47.6% vs. 16%, p=0.044) in patients with thymic carcinoma. The survival benefit of receiving radiotherapy ≧ 65 Gy was apparent in the unresected group of patients with thymic carcinoma.Conclusions: Aggressive multidisciplinary treatments including surgery, radiotherapy, and chemotherapy, are helpful in treating advanced thymic carcinoma. Radiotherapy with dose above 65 Gy may improve the OS and PFS of patients with advanced thymic carcinoma, especially in the unresected group.