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Ho F, Tey J, Tseng M, Ng I, Tan TH, Lim K, Leong YH, Tham IW. Radiation oncology training in Singapore - A non-Australasian RANZCR training site. J Med Imaging Radiat Oncol 2021; 65:460-463. [PMID: 34146383 DOI: 10.1111/1754-9485.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
The Radiation Oncology Department at The National Cancer Institute, Singapore (NCIS) and the Royal Australian and New Zealand College of Radiology (RANZCR) has had a well-established relationship that began as a partnership to grow a pool of local radiation oncologists to meet a nation's demand for radiotherapy services. This journey has surpassed its initial aims and now has produced a generation of radiation oncologists leading a national cancer institute. We recount the history and progress of this partnership here, as well as the unique success of its product; the only RANZCR-accredited radiation oncology training site outside of Australia and New Zealand since 2002. We outline the mutual benefits through many years of collaboration and deliberate efforts to grow the partnership. We also outline the distinctive specialist training path that our trainees take to meet both the local accreditation body as well as the RANZCR requirements.
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Affiliation(s)
- Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Michelle Tseng
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Ivy Ng
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Teng Hwee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Keith Lim
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Yiat Horng Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore City, Singapore
| | - Ivan Wk Tham
- Radiation Oncology Centre, Mount Elizabeth Novena Hospital, Singapore City, Singapore
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Huang CC, Fang FM, Chen HC, Hsu HC, Huang TL, Su YL, Chang YC. Therapeutic outcome of nasopharyngeal carcinoma with cranial nerve palsy: a single institution experience of 104 patients. Onco Targets Ther 2017; 10:2069-2075. [PMID: 28435298 PMCID: PMC5391821 DOI: 10.2147/ott.s129653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Cranial nerve (CN) palsy is the main symptom in patients with locally advanced nasopharyngeal carcinoma (NPC). This study aimed to evaluate the therapeutic outcome of NPC with CN palsy and to analyze the prognostic factors. PATIENTS AND METHODS A total of 104 NPC patients with CN palsy curatively treated by conventional (n=44) or conformal (n=60) radiotherapy (RT) were enrolled. Upper CN palsy was present in 81 patients, lower CN palsy in four patients, and both upper and lower CN palsy in 19 patients. Forty-one patients had CN palsy for >2 months before diagnosis. RESULTS Complete recovery of CN palsy was observed in 74 patients. The actuarial 5-year locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 58.2%, 62.2%, and 38.4%, respectively. No significant difference was observed in CN recovery, LRC, DMFS, or OS for patients treated by conventional versus conformal technique. However, significant reduction of grade 3 or greater toxicities was found in those treated by the conformal technique (odds ratio =0.28). CONCLUSION Patients with CN palsy presenting >2 months before diagnosis were hard to recover from palsy. The LRC, OS, and recovery from CN palsy did not significantly change with the treatment evolution. Patients with complete recovery from CN palsy had longer OS.
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Affiliation(s)
- Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Hui-Chun Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | | | - Yu-Li Su
- Department of Hematology and Oncology
| | - Ya-Chun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
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Kamio Y, Sakai N, Takahashi G, Baba S, Namba H. Nasopharyngeal carcinoma presenting with rapidly progressive severe visual disturbance: a case report. J Med Case Rep 2014; 8:361. [PMID: 25373786 PMCID: PMC4227451 DOI: 10.1186/1752-1947-8-361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/08/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Nasopharyngeal carcinoma is one of the most difficult tumors to diagnose correctly at the initial phase because of the occasional lack of nasal symptoms. The perineural spread of the trigeminal nerve is one of the most common and important routes in the intracranial paracavernous extension of nasopharyngeal carcinoma, but visual loss is very rare. CASE PRESENTATION We report the case of a 54-year-old Japanese man with nasopharyngeal carcinoma, who presented with rapid and severe disturbance of left monocular visual acuity and eye movement with a 10-month history of ipsilateral otitis media and facial pain. Magnetic resonance imaging revealed a lesion in the left fossa of Rosenmüller, pterygopalatine fossa, sphenoid and ethmoid sinus, and the left cavernous sinus extending to the orbital apex through the superior orbital fissure. The histopathological diagnosis was nonkeratinizing undifferentiated nasopharyngeal carcinoma. Epstein-Barr virus was detected by in situ hybridization. Although focal radiotherapy induced remarkable tumor shrinkage and relieved ocular motor disturbance and facial pain, his visual acuity did not improve. CONCLUSION The awareness of cranial nerves in addition to intracranial and orbital apex involvement, as in this case, is important for appropriate diagnosis and treatment planning of nasopharyngeal carcinoma.
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Affiliation(s)
| | - Naoto Sakai
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan.
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Zong J, Lin S, Chen Y, Wang B, Xiao Y, Lin J, Li R, Pan J. Does MRI-detected cranial nerve involvement affect the prognosis of locally advanced nasopharyngeal carcinoma treated with intensity modulated radiotherapy? PLoS One 2014; 9:e100571. [PMID: 24963626 PMCID: PMC4070924 DOI: 10.1371/journal.pone.0100571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/26/2014] [Indexed: 11/18/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is one of the common cancers in South China. It can easily invade into cranial nerves, especially in patients with local advanced disease. Despite the fact that the magnetic resonance imaging (MRI) findings are not always consistent with the symptoms of CN palsy, MRI is recommended for the detection of CN involvement (CNI). However, the prognostic impact of MRI-detected CNI in NPC patients is still controversial. To investigate the prognostic value of MRI detected CNI, we performed a retrospective analysis on the clinical data of 375 patients with NPC who were initially diagnosed by MRI. All patients had T3-4 disease and received radical intensity modulated radiation therapy (IMRT) as their primary treatment. The incidence of MRI-detected CNI was 60.8%. A higher incidence of MRI-detected CNI was observed in T4 disease compared with T3 disease (96.8% vs. 42.8%, P<0.001), and a higher incidence was also found in patients with Stage IV disease compared with those with Stage III disease (91.5% vs. 42.3%; P<0.001). The local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) of patients with T3 disease, with or without MRI-detected CNI, was superior to that of patients with T4 disease (P<0.05). No significant differences in LRFS, DMFS or OS were observed between T3 patients with or without MRI-detected CNI. The survival of Stage III patients with or without MRI-detected CNI was significantly superior to that of Stage IV patients (P<0.01), but there was no significant difference between Stage III patients with or without MRI-detected CNI for all endpoints. Therefore, when treated with IMRT, MRI-detected CNI in patients with NPC does not appear to affect the prognosis. In patients with clinical T3 disease, the presence of MRI-detected CNI is not sufficient evidence for defining T4 disease.
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Affiliation(s)
- Jingfeng Zong
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Shaojun Lin
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Yunbin Chen
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Bingyi Wang
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Youping Xiao
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Jin Lin
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Rui Li
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
| | - Jianji Pan
- Provincial Clinical College, Fujian Medical University, Fuzhou City, Fujian Province, People's Republic of China
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou City, Fujian Province, People's Republic of China
- * E-mail:
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Tao CJ, Liu X, Tang LL, Mao YP, Chen L, Li WF, Yu XL, Liu LZ, Zhang R, Lin AH, Ma J, Sun Y. Prognostic scoring system for locoregional control among the patients with nasopharyngeal carcinoma treated by intensity-modulated radiotherapy. CHINESE JOURNAL OF CANCER 2013; 32:494-501. [PMID: 23981849 PMCID: PMC3845563 DOI: 10.5732/cjc.013.10121] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma (NPC) has decreased with the extensive use of intensity-modulated radiotherapy (IMRT). We aimed to develop a prognostic scoring system (PSS) that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT. The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed. Age, pathologic classification, primary tumor extension, primary gross tumor volume (GTV-p), T and N categories, and baseline lactate dehydrogenase (LDH) level were analyzed. Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS. Independent prognostic factors for locoregional relapse included N2–3 stage, GTV-p ≥26.8 mL, and involvement of one or more structures within cluster 3. We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups: low risk (score 0), intermediate risk (score >0 and ≤1), high risk (score >1 and ≤2), and extremely high risk (score >2). The 5-year locoregional control rates for these groups were 97.4%, 93.6%, 85.2%, and 78.6%, respectively (P < 0.001). We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.
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Affiliation(s)
- Chang-Juan Tao
- State Key Laboratory of Oncology in South China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China. ,sunying@ sysucc.org.cn
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