Wei-Chung Hsu

Impact of magnetic resonance imaging versus CT on nasopharyngeal carcinoma: Primary tumor target delineation for radiotherapy

Our aim was to assess the capacity of CT versus MRI for delineating to the primary tumor extent of nasopharyngeal carcinoma (NPC) in treated patients.

Comparison of surgery or radiotherapy on complications and quality of life in patients with the stage IB and IIA uterine cervical cancer.

OBJECTIVES To compare the long-term complications and quality of life of patients with stage IB and stage IIA uterine cervical carcinoma treated by surgery or radiotherapy. METHODS From August 2003 to May 2004, 202 patients with uterine cervical carcinoma were treated with surgery or radiotherapy at two institutions and were enrolled in this study upon follow-up at least 2 years post treatment. All patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and complications Questionnaire. RESULTS Constipation (p<0.001), flushing (p<0.001), dysuria (p<0.001), urinary incontinence (p<0.01), dysparia (p<0.05) and vaginal dryness (p<0.05) were statistically higher in the surgery treated group, while diarrhea (p<0.001), bloody stools (p<0.001) and abdominal pain (p<0.01) were higher in the radiotherapy group. Using factor analysis and introducing personal conditioned variables, pelvic neural dysfunction was significantly higher in surgery group and intestinal dysfunction was higher in radiotherapy group. There was no difference in sexual dysfunction between these two modalities. Comparison of EORTC QLQ-C30 showed that the majority of issues had minimal differences between these two treatment modalities, except social functioning (p<0.05; higher in radiotherapy group), constipation (p<0.001; higher in surgery group) and diarrhea (p<0.01; higher in radiotherapy group). CONCLUSIONS In early stage uterine cervical cancer patients, surgery or radiotherapy resulted in different complications, whereas long-term quality of life showed few differences between these two different modalities. These data were helpful for physicians in regards to the changes of patients, and moreover, for rehabilitation and supportive care of the patients after treatment.

Mini-Nutritional Assessment Predicts Functional Status and Quality of Life of Patients With Hepatocellular Carcinoma in Taiwan

This study aimed to determine the possibility of using the Mini-Nutritional Assessment (MNA) to evaluate the quality of life and functional status in patients with hepatocellular carcinoma (HCC). The study recruited 300 outpatients with HCC from a teaching hospital in Central Taiwan to serve as subjects. All subjects were interviewed with a structured questionnaire for rating the nutritional status with the MNA (long-form and short-form), and for evaluating quality of life and functional status with Global Quality of Life (GQL) and Global Functional Status (GFS), respectively, of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version-3. Cancer staging and liver cirrhosis indicators, blood biochemical indicators, and self-rated health status and mobility were used as reference standards. Results showed that based on the strength of the correlation and association with the reference standards, both the long-form and short-form of the MNA performed better than GQL and GFS in predicting quality of life and functional status of patients with HCC. These results suggest that the MNA is suitable for identifying the risk of deteriorating quality of life or functional status, in addition to identifying the risk of malnutrition, in patients with HCC.

Radiation treatment with volumetric modulated arc therapy of hepatocellular carcinoma patients. Early clinical outcome and toxicity profile from a retrospective analysis of 138 patients

BackgroundTo report early outcome and toxicity for inoperable patients with hepatocellular carcinoma (HCC) treated with volumetric modulated arc therapy (VMAT).MethodsOne hundred and thirty eight patients were retrospectively analysed. Dose prescription ranged from 45 to 66Gy with conventional fractionation regime. Based on AJCC staging, 88.4% presented stage III or IV. Two-thirds (69.6%) were Child-Pugh stage A, the remaining were stage B. According to Barcelona Clinic Liver Cancer staging, 72.5% of patients were classified as stage C.ResultsMedian age was 66 years, median tumor volume was 516cm3 (28 to 3620cm3). The most patients (83%) were treated with 60Gy. Median follow-up time was 9 months. One-year overall survival rate was 45% (100% for AJCC stage I, 83% for stage II, 45% for stage III and 28% for stage IV), median survival was 10.3 months (95% C.I. 7.2-13.3). Local control was achieved in 94% (of 109 assessable patients), stable disease in 29%, partial response in 53%, complete response in 11%, and progression in 6%. Radiation-induced liver disease was observed in 34 patients (25%). Gastrointestinal grade 3 toxicity was modest with a total of 17 (12.3%) cases for all endpoints.ConclusionsClinical results could suggest to introduce VMAT as an appropriate technique for the patients with HCC.

Usefulness of the Mini Nutritional Assessment in Predicting the Nutritional Status of Patients With Liver Cancer in Taiwan

Liver cancer patients are confronted with the additional risk of malnutrition because the disease is often associated with hepatitis, liver cirrhosis, and metabolic disturbances. Nutritional intervention can improve treatment outcome, but early detection is important. This study aimed to determine whether the Mini Nutritional Assessment (MNA) could effectively rate the nutritional status of patients with liver cancer in Taiwan. A total of 300 patients were evaluated for nutritional status with two modified versions of the MNA in short and long forms. MNA-Taiwan Version 1 adopted population-specific anthropometric cutpoints, whereas Version 2 replaced mid-arm and calf circumferences in place of body mass index. Predicted statuses were compared to results predicted by the Council on Nutrition Appetite Questionnaire (CNAQ) and analyzed for correlations with biochemical or cancer status parameters. Results showed that both versions of the MNA were effective in predicting nutritional status, and predictions by the short forms agreed well with those by the long forms. The nutritional scores correlated well with hemoglobin, serum albumin, C-reactive protein, r-glutamyl transpeptidase, TNM (tumor, node, metastasis) staging, and severity of cirrhosis. These results suggest that the MNA can be an effective tool for assessing the nutritional status of patients with liver cancer.

Preliminary Results of Three-Dimensional Conformal Radiotherapy and Thalidomide for Advanced Hepatocellular Carcinoma

Purpose : The purpose of this study was to evaluate the response and therapeutic results of advanced hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiotherapy (3D-CRT) and thalidomide. Materials and Methods : From October 1999 to September 2002, thirty-three advanced HCC patients who had been treated with 3D-CRT and thalidomide were reviewed. The mean age was 61.36 years old (range: 36-80 years old). Three-dimensional CRT was delivered at 1.5 Gy per fraction using 6 or 10 MV photons, twice a day and 5 days a week for a total dose of 45- 75 Gy. The mean treatment volume was 369.59 ml (range: 32.54-2094.82 ml). The dosage of thalidomide was 200 mg/day in 25 patients, 300 mg/day in 5 patients, and 400 mg/day in 3 patients. Results : Sixty-four percent [21/33; 1 complete response (CR), 20 partial response (PR)] of patients responded in 淯T field?and 12.1% (4/33; 4 PR) of patients responded in 烋on-irradiated lesion? When therapeutic outcome was determined by the different tumor patterns, the responses of 淯T field?for the recurrent tumor, huge mass, HCC with metastatic lesions and multiple lesions were 80.0% (8/10; 1 CR, 7 PR), 71.4% (5/7; 5 PR), 61.5% (8/13; 8 PR), and 0% (0/3; 2 SD and 1 PD), respectively (p = 0.234). Furthermore, the responses of 烋on-irradiated lesion?for the recurrent tumor, huge mass, HCC with metastatic lesions and multiple lesions were 10.0% (1/10; 1 PR), 14.3% (1/7; 1 PR), 15.4% (2/13; 2 PR), and 0% (0/3; all 3 PD), respectively (p = 0.778). The mean and median survival times were 327 and 242 days, respectively. The adverse effects of 3D-CRT and thalidomide include constipation (26/33, 78.8%), drowsiness and sedation (15/33, 45.5%), skin rash (11/33, 33.3%), lower extremity edema (20/33, 60.6%), peripheral neuropathy (2/33, 6.1%), dizziness (1/33, 3.0%), orthostatic hypotension (1/33, 3.0%), leukopenia (5/33, 15.2%), transient elevation in liver function tests (9/33, 27.3%), and epigastralgia (8/33, 24.2%). Conclusions : Our experience concluded that 3D-CRT combined with thalidomide might be a safe and effective treatment modality for unresectable HCC patients. The preliminary data showed quite promising result. It is valuable to study the potential role of 3D-CRT combined with thalidomide in the treatment strategy for HCC at various stages.

Radiotherapy of Conjunctival Lymphoma with A Specially Designed Lens Block

Purpose:To evaluate and discuss the therapeutic results and technique of conjunctival lymphoma. Materials and Methods: This retrospective study was to review the 10 patients with conjunctival lymphoma treated at National Taiwan University Hospital from 1988 to 1996. There were 8 men and 2 women. The range of age was 32 - 75 years old, mean: 59.1 years old. Most of the patients presented with conjunctival mass, reddish eyes and forelgn body sensation. The conjunctival lesions in all patients were treated with a single anterior field which covered the entire conjunctiva, using 3 MeV to 10 MeV electron beam. Total dose of 30 Gy to 50 Gy was delivered in 15 to 25 fractions over 23 to 33 days. In all cases, a specially designed lead shield was used to protect the lens. The follow-up time ranged from 24 months to 124 months. Results: All patients were doing well with no sign of active localized or distant disease till the closing date of the study. Moreover, the complications, including decreased visual acuity, cataract and photophobia, were minimal. Conclusion: Lymphoma clinically localized to conjunctiva as the initial presentation can be cured by radiation therapy with a dosage of 30 Gy to 40 Gy. The complications of radiation therapy can be minimized with sophisticated treatment technique and well protection of the highly radiosensitive lens.

Lymphoma with Intraspinal Extramedullary Involvement as Initial Presentation

Purpose: To review the treatment results of lymphoma with initial presentation of spinal cord or cauda equina compression. Materials and Methods: Lymphoma with cord or cauda equina compression as initial presentation were seen in 9 patients in our hospital between 1977 to 1996. Among them, six patients presented with stage IE primary spinal epidurl involvement, whereas the others has stage ⅡE, ⅢE and ⅣE disease (1 patient each). Except for one Hodgkins lymphoma and one lymphosarcoma, all of the other patients were non-Hodgkins lymphoma with unfavorable histologic grading, mostly were the intermediate grade classification according to the Warking Formulation. After decompression surgery, the subsequent treatments of these patients were radiotherapy (2 patients), chemotherapy (1 patient), and combination of both treatment modalities (6 patients). Results: A prodromal phase of local back pain occurred in all patients, with duration from 1 to 10 months, followed by a second phase of rapidly progressive signs of cord compression. After treatment, 5 patients achieved complete remission: among with, one died of chemotherapy complication, one died of intercurrent disease, one had distant metastasis, and only 2 patients remained disease free. The other 4 patients who got partial remission were all dead of this disease. Conclusion: Lymphoma with spinal epidural or intradural involvement at initial presentation is an aggressive disease. An intensive treatment combination with irradiation, chemotherapy, and surgery, is suggested in order to achieve good local control and longterm survival.

Treatment Results of Malignant Lymphoma of Nasopharynx at National Taiwan University Hospital

Purpose: To evaluate the therapeutic results of nasopharyngeal malignant lymphoma treated at NTUH over the past fifteen years (1979-1993). Materials & Methods: Forty patients with malignant lymphoma of nasopharynx visited our hospital in the past fifteen years and their data were analyzed. The age of the patients ranged from 13 to 81 years old. There were 20 male patients and 20 female patients. Stage I and LI patients were 18 and 22, respectively. According to histopathologic classification, patients with low grade, intermediate grade and high grade malignant lymphoma were 10, 26 and 4, respectively. Seven patients received radical radiotherapy and 15 patients received chemotherapy. The remaining 10 patients were treated by combined chemotherapy and irradiation. Eight patients did not receive any treatment. Results: The actuarial five-year survival rates for nasopharyngeal malignant lymphoma patients with Stage I, II were 65.7% and 27.3%, respectively. When classified by the Rappaport classification, the actuarial five-year survival rates for patients of nodular type and diffuse type were 72.7% and 33.5%, respectively. The actuarial five-year survival rates for patients of Low grade, intermediate grade and high grade nasopharyngeal malignant lymphoma were 80.0%, 39.0%, and 50.0%, respectively. The actuarial five- year survival rates for patients treated with radiotherapy, chemotherapy and combined treatment modalities were 100.0%, 58.7%, and 30.0%, respectively. Conclusion: Lymphoma clinically localized to nasopharynx can be cured by radiotherapy. When classified by histopathology, patients with low grade or nodular type can be successfully treated using local radiotherapy alone. Chemotherapy used as primary treatment (with or without adjuvant radiotherapy) may be benefit for intermediate grade or diffuse type patients.