Chonlakiet Khorprasert

Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries.

BACKGROUND Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year. OBJECTIVES We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18. METHODS We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually. RESULTS Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%. CONCLUSION Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand.

Directional local mean difference level set method for locating a urinary bladder lumen in brachytherapy

In this paper, we propose the directional local mean difference level set method (DLMD-LS). Our work is focused on the segmentation for a urinary bladder lumen in a T2 weighted image taken during brachytherapy. The boundary is detected as the region where the intensity means of the areas inside and outside the zero-level contour (edge) are high. The contour is controlled such that it stops evolving only at the boundary of the bright object inside the dark surrounding. Since the intensity mean is used, the DLMD-LS is more tolerant to noise than the conventional level set methods which detect the boundary as the part with large intensity gradient. Furthermore, the mean is calculated locally; therefore, the function is less affected to the different intensity distribution inside the lumen. The experiment demonstrates the superior noise tolerance and better capability to capture the blurred boundary of our proposed DLMD-LS to the directional level set method and the level set which detects the boundary according to the intensity distribution of the entire lumen.

PCN10 ESTIMATION OF THE HEALTH AND COST BURDEN OF HPV-RELATED DISEASES IN THAILAND

PCN5 SOFRAFENIB VERSUS SUNITINIB IN METASTATIC RENAL CELL CARCINOMA: INDIRECT COMPARISON ANALYSIS Leung HW, Chan AL Taipei Medical UniversityShuang Ho Hospital, Taipei, Taiwan; Chi Mei Medical Center, Tainan, Taiwan OBJECTIVES: To evaluate the clinical effectiveness of sorafenib and sunitinib in metastatic renal cell carcinoma (RCC) by using indirect comparison meta-analysis. METHODS: Systematic literature search of Medline, Embase, Cochrane controlled trials register. All randomized clinical trials of sorafenib or sunitinib versus interferon alfa for treating metastatic renal-cell carcinoma were included. Study selection, data extraction and quality assessment were performed by two reviewers with disagreements being resolved by consensus. The effects of sorafenib and sunitinib on progression-free survival were compared indirectly using indirect treatment comparison program, with interferon alfa (IFN) as a common comparator. RESULTS: Two studies were included. Median progression-free survival was prolonged with the treatment of sunitinib (11 months) compared to interferon alfa (5 months). For the comparison of sorafenib and interferon-alfa, the median progression-free survival was similar (median PFS: 5.7 months vs. 5.6 months). Indirect comparison suggests that sunitinib is not superior to sorafenib for prolongation of progress free survival (hazard ratio 0.37; 95% CI: 0.236–0.58, P = 0.0189). CONCLUSIONS: There is no signifi cant evidence to suggest that treatment with sunitinib has clinical advantages over treatment with sorafenib in patients with metastatic RCC.

Dosimetry of conformal dynamic arc radiotherapy and intensity modulated radiotherapy in unresectable cholangiocarcinoma

Background: Radiotherapy in cholangiocrcinoma has to overcome organ tolerance of the upper abdomen. Hi-technology radiotherapy may improve conformity and reduce dose to those organ. Objective: Quantitatively compare the dosimetry of conformal dynamic arc radiotherapy (CD-arcRT) and intensity modulated radiotherapy (IMRT) in unresectable cholangiocarcinoma. Material and methods: Eleven cases of unresectable cholangiocarcinoma were re-planned with IMRT and CDarcRT at King Chulalongkhorn Memorial Hospital between 20 September 2004 and 31 December 2005. Both the planning techniques were evaluated using the dose volume histogram of the planning target volume and organ at risk. The conformation number and dose to critical normal structures were used to determine the techniques. Results: IMRT technique was significantly conformed to the planning target volume than CD-arcRT in term of conformation number. For critical structure, IMRT significantly reduced the radiation dose to liver in terms of mean liver dose, V30Gy and V20Gy of the right kidney. Conclusion: The advantage of IMRT was more conformity and reduced dose to critical structure compared with CD-arcRT, but there was no difference between these techniques in terms of V20Gy of left kidney and maximum dose to the spinal cord.

Clinical Outcomes of Stereotactic Body Radiation Therapy Using Flattening Filter Free (FFF) in Early Non–Small Cell Lung Cancers and Metastatic Lung Cancers

improved OS (HR 0.379; 95% CI 0.16-0.93; PZ.033). This was not observed in patients with higher GPA scores. Conclusion: Brain radiation therapy plus EGFR-TKI, whether upfront or delayed, may improve intracranial disease control compared with TKI alone in EGFR mutant NSCLC with BM. The addition of brain irradiation to EGFR-TKI did not appear to improve survival in unselected patients, but low GPA scores may be a useful clinical predictor for early brain irradiation. Further prospective studies are needed to determine the optimal timing and appropriate patient group who need upfront brain radiation therapy. Author Disclosure: Y. Liu: None. L. Deng: None. X. Zhou: None. L. Zhou: None. Y. Xu: None. Y. Gong: None. J. Wang: None. Y. Lu: None.