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Chiang CL, Lee FAS, Chan KSK, Lee VWY, Chiu KWH, Ho RLM, Fong JKS, Wong NSM, Yip WWL, Yeung CSY, Lau VWH, Man K, Kong FMS, Chan ACY. Survival Outcome Analysis of Stereotactic Body Radiotherapy and Immunotherapy (SBRT-IO) versus SBRT-Alone in Unresectable Hepatocellular Carcinoma. Liver Cancer 2024; 13:265-276. [PMID: 38756147 PMCID: PMC11095610 DOI: 10.1159/000533425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/14/2023] [Accepted: 08/02/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction While combination of stereotactic body radiotherapy (SBRT) and immunotherapy are promising, their efficacy and safety have not been compared with SBRT-alone in patients with unresectable hepatocellular carcinoma (HCC). Methods This retrospective study included 100 patients with nonmetastatic, unresectable HCC in two hospitals. Eligible patients had tumor nodules ≤3 and Child-Pugh liver function score of A5 to B7. Seventy patients received SBRT-alone, and 30 patients underwent combined SBRT and immunotherapy (SBRT-IO). Overall survival (OS), time to progression (TTP), overall response rate (ORR), and toxicity were analyzed. We adjusted for the potential confounding factors using propensity score matching. Results The median tumor size was 7.3 cm (range, 2.6-18 cm). Twenty-five (25%) of patients had vascular invasion. Before propensity score matching, the 1-year and 3-year OS rate was 89.9% and 59.8% in the SBRT-IO group and 75.7% and 42.3% in SBRT-alone group (p = 0.039). After propensity score matching (1:2), 25 and 50 patients were selected from the SBRT-IO and SBRT-alone group. The 1-year and 3-year OS was 92.0% and 63.9% in the SBRT-IO group versus 74.0% and 43.3% in the SBRT-alone group (p = 0.034). The 1-year and 3-year TTP was better in SBRT-IO group (1-year: 68.9% vs. 58.9% and 3-year: 61.3% vs. 32.5%, p = 0.057). The ORR of 88% (complete response [CR]: 56%, partial response [PR]: 22%) in SBRT-IO arm was significantly better than 50% (CR: 20%, PR: 30%) in the SBRT-alone arm (p = 0.006). Three patients (12%) developed ≥grade 3 immune-related treatment adverse events (n = 2 hepatitis, n = 1 dermatitis) leading to permanent treatment discontinuation. Conclusion Adding immunotherapy to SBRT resulted in better survival with manageable toxicities. Prospective randomized trial is warranted.
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | | | - Kenneth Sik Kwan Chan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Venus Wan Yan Lee
- Medical Physics Unit, Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong SAR
| | - Keith Wan Hang Chiu
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR
| | - Ryan Lok Man Ho
- Radiotherapy and Oncology Department, Gleneagles Hospital, Hong Kong, Hong Kong SAR
| | - John Ka Shun Fong
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | | | | | - Cynthia Sin Yu Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong SAR
- Union Oncology Center, Union Hospital, Hong Kong, Hong Kong SAR
| | - Vince Wing Hang Lau
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Radiology, Gleneagles Hospital, Hong Kong, Hong Kong SAR
| | - Kwan Man
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Feng Ming Spring Kong
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Albert Chi Yan Chan
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
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Chiang CL, Chan KSK, Li H, Ng WT, Chow JCH, Choi HCW, Lam KO, Lee VHF, Ngan RKC, Lee AWM, Eschrich SA, Torres-Roca JF, Wong JWH. Using the genomic adjusted radiation dose (GARD) to personalize the radiation dose in nasopharyngeal cancer. Radiother Oncol 2024; 196:110287. [PMID: 38636709 DOI: 10.1016/j.radonc.2024.110287] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Locally advanced nasopharyngeal cancer (NPC) patients undergoing radiotherapy are at risk of treatment failure, particularly locoregional recurrence. To optimize the individual radiation dose, we hypothesize that the genomic adjusted radiation dose (GARD) can be used to correlate with locoregional control. METHODS A total of 92 patients with American Joint Committee on Cancer / International Union Against Cancer stage III to stage IVB recruited in a randomized phase III trial were assessed (NPC-0501) (NCT00379262). Patients were treated with concurrent chemo-radiotherapy plus (neo) adjuvant chemotherapy. The primary endpoint is locoregional failure free rate (LRFFR). RESULTS Despite the homogenous physical radiation dose prescribed (Median: 70 Gy, range 66-76 Gy), there was a wide range of GARD values (median: 50.7, range 31.1-67.8) in this cohort. In multivariable analysis, a GARD threshold (GARDT) of 45 was independently associated with LRFFR (p = 0.008). By evaluating the physical dose required to achieve the GARDT (RxRSI), three distinct clinical subgroups were identified: (1) radiosensitive tumors that RxRSI at dose < 66 Gy (N = 59, 64.1 %) (b) moderately radiosensitive tumors that RxRSI dose within the current standard of care range (66-74 Gy) (N = 20, 21.7 %), (c) radioresistant tumors that need a significant dose escalation above the current standard of care (>74 Gy) (N = 13, 14.1 %). CONCLUSION GARD is independently associated with locoregional control in radiotherapy-treated NPC patients from a Phase 3 clinical trial. GARD may be a potential framework to personalize radiotherapy dose for NPC patients.
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong, China.
| | - Kenneth Sik Kwan Chan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong, China
| | - Huaping Li
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong, China
| | | | - Horace Cheuk Wai Choi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka On Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong, China
| | - Victor Ho Fun Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong, China
| | - Roger Kai Cheong Ngan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, Hong Kong, China
| | - Anne Wing Mui Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, and University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | | | | | - Jason Wing Hon Wong
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Chan SL, Chiang CL, Chok KSH, Lee AS, Tang RSY, Lim FMY, Lee KF, Tai AYP, Lee SWM, Lo RCL, Chan AWH, Mok FPT. Hong Kong consensus recommendations on the management of pancreatic ductal adenocarcinoma. Hong Kong Med J 2024; 30:147-162. [PMID: 38590158 DOI: 10.12809/hkmj2210476] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
This project was undertaken to develop the first set of consensus statements regarding the management of pancreatic ductal adenocarcinoma (PDAC) in Hong Kong, with the goal of providing guidance to local clinicians. A multidisciplinary panel of experts discussed issues surrounding current PDAC management and reviewed evidence gathered in the local context to propose treatment recommendations. The experts used the Delphi approach to finalise management recommendations. Consensus was defined as ≥80% acceptance among all expert panel members. Thirty-nine consensus statements were established. These statements cover all aspects of PDAC management, including diagnosis, resectability criteria, treatment modalities according to resectability, personalised management based on molecular profiling, palliative care, and supportive care. This project fulfils the need for guidance regarding PDAC management in Hong Kong. To assist clinicians with treatment decisions based on varying levels of evidence and clinical experience, treatment options are listed in several consensus statements.
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Affiliation(s)
- S L Chan
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C L Chiang
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - K S H Chok
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - R S Y Tang
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - F M Y Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K F Lee
- Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China
| | - A Y P Tai
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - S W M Lee
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - R C L Lo
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A W H Chan
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - F P T Mok
- Department of Surgery and Combined Endoscopy Unit, Caritas Medical Centre, Hong Kong SAR, China
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Chiang CL, Lee WMA, Choi CWH, Ngan KCR, Ng WT, Lee HFV, Lam TC, Lam KO, Tsang KC, Wong WHJ. Radiosensitivity index as a predictive biomarker for radiotherapy de-intensification in nasopharyngeal carcinoma: abridged secondary publication. Hong Kong Med J 2024; 30 Suppl 1:27-28. [PMID: 38413209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W M A Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C W H Choi
- Division of Epidemiology and Biostatistics, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K C R Ngan
- Division of Epidemiology and Biostatistics, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W T Ng
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - H F V Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - T C Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K O Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K C Tsang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W H J Wong
- School of Biomedical Science, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Chiang CL, Lam TC, Li JCB, Chan KSK, El Helali A, Lee YYP, Law LHT, Zheng D, Lo AWI, Kam NW, Li WS, Cheung AKW, Chow JCH, Chan SPC, Lai JWY, Lee SWM, Kong FM(S, Ng WT, Kwong DLW, Lee AWM. Efficacy, safety, and correlative biomarkers of bintrafusp alfa in recurrent or metastatic nasopharyngeal cancer patients: a phase II clinical trial. Lancet Reg Health West Pac 2023; 40:100898. [PMID: 37701718 PMCID: PMC10493598 DOI: 10.1016/j.lanwpc.2023.100898] [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] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
Background The strategy of dual blockade of TGF-β and PD-L1 pathways has not been previously tested in platinum-refractory recurrent or metastatic nasopharyngeal cancer (R/M NPC) patients. This study aimed to evaluate the safety and efficacy of bintrafusp alfa in refractory R/M NPC patients. Methods In this single-arm, single-centre phase II clinical trial, 38 histologically confirmed R/M NPC patients were enrolled and administered with bintrafusp alfa every 2 weeks. Primary endpoint was objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1). Secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of response (DOR), and safety. Findings Thirty-eight patients were accrued (33 men; median age, 54 years). ORR was 23.7% (complete response, n = 2; partial response, n = 7). The median DOR was 19.2 months, median PFS was 2.3 months, median OS was 17.0 months, and 1-year OS rate was 63.2%. Unfortunately, 25 patients (65.7%) progressed within 8 weeks of treatment, 15 patients (39.5%) and 8 patients (21.1%) developed hyper-progressive disease (HPD) per RECIST v1.1 and tumor growth rate (TGR) ratio respectively. Sixteen patients (42.4%) experienced ≥ grade 3 treatment-related adverse events (TRAEs), most commonly anemia (n = 9, 23.7%) and secondary malignancies (n = 4, 10.5%). TRAEs led to permanent treatment discontinuation in 7 patients. Patients with strong suppression of plasma TGFβ1 level at week 8 were unexpectedly associated with worse ORR (9.1% vs 44.4%, P = 0.046) and development of HPD. There was no correlation between PD-L1 expression and ORR. Interpretation Bintrafusp alfa demonstrated modest activity in R/M NPC but high rates of HPD and treatment discontinuation secondary to TRAEs are concerning. Funding The project was supported by Alice Ho Miu Ling Nethersole Charity Foundation Professorship Endowed Fund and Merck KGaA.
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Affiliation(s)
- Chi Leung Chiang
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong and University of Hong Kong-Shenzhen Hospital, China
| | - Tai Chung Lam
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong and University of Hong Kong-Shenzhen Hospital, China
| | - James Chun Bong Li
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, China
| | - Kenneth Sik Kwan Chan
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, China
| | - Aya El Helali
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, China
| | | | - Laalaa Hiu Ting Law
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, China
| | - Danyang Zheng
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, China
| | | | - Ngar Woon Kam
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, China
| | - Wing Sum Li
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | | | | | | | - Jessica Wing Yu Lai
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Sarah Wai Man Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Feng-Ming (Spring) Kong
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong and University of Hong Kong-Shenzhen Hospital, China
| | - Wai Tong Ng
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong and University of Hong Kong-Shenzhen Hospital, China
| | - Dora Lai Wan Kwong
- LKS Faculty of Medicine, Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong and University of Hong Kong-Shenzhen Hospital, China
| | - Anne Wing Mui Lee
- LKS Faculty of Medicine, Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital and School of Clinical Medicine, The University of Hong Kong, China
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Chiang CL, Chiu KWH, Chan KSK, Lee FAS, Li JCB, Wan CWS, Dai WC, Lam TC, Chen W, Wong NSM, Cheung ALY, Lee VWY, Lau VWH, El Helali A, Man K, Kong FMS, Lo CM, Chan ACY. Sequential transarterial chemoembolisation and stereotactic body radiotherapy followed by immunotherapy as conversion therapy for patients with locally advanced, unresectable hepatocellular carcinoma (START-FIT): a single-arm, phase 2 trial. Lancet Gastroenterol Hepatol 2023; 8:169-178. [PMID: 36529152 DOI: 10.1016/s2468-1253(22)00339-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [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: 08/17/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The synergy between locoregional therapies and immune checkpoint inhibitors has not been investigated as conversion therapy for unresectable hepatocellular carcinoma. We aimed to investigate the activity of sequential transarterial chemoembolisation (TACE) and stereotactic body radiotherapy followed by avelumab (an anti-PD-L1 drug) for locally advanced, unresectable hepatocellular carcinoma. METHODS START-FIT was a single-arm, phase 2 trial in patients with locally advanced hepatocellular carcinoma who were not suitable for curative treatment, conducted in two hospitals in Hong Kong and one in Shenzhen, China. Eligible patients were those aged 18 years or older with an Eastern Cooperative Oncology Group performance status 0-1, Child-Pugh liver function score A5 to B7, tumour size of at least 5 cm, a maximum of three tumour lesions, and adequate hepatic, renal, and bone marrow function. Participants received TACE on day 1, followed by stereotactic body radiotherapy (27·5-40·0 Gy in five fractions) at day 28. Avelumab (10 mg/kg) was administered 14 days following stereotactic body radiotherapy and every 2 weeks thereafter. The primary endpoint was the proportion of patients deemed amenable to curative treatment, defined as those who had a sustained complete or partial treatment response for at least 2 months and if curative treatment could be performed (ie, resection, radiofrequency ablation, or transplantation), analysed by intention to treat. Safety was also analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT03817736) and has been completed. FINDINGS Between March 18, 2019, and Jan 27, 2021, 33 patients (32 [97%] men and one [3%] woman) were enrolled. The median sum of the largest diameters of lesions was 15·1 cm (IQR 8·3-14·9). 21 (64%) patients had macrovascular invasion (hepatic vein [n=13], branched portal vein [n=3], or both [n=5]). Median follow-up was 17·2 months (IQR 7·8-25·8). 18 (55%) patients were deemed amenable to curative treatment: four (12%) of 33 patients had curative treatment (resection [n=2] or radiofrequency ablation [n=2]), and 14 (42%) had a radiological complete response and opted for close surveillance. 11 (33%) of 33 patients had treatment-related adverse events that were grade 3 or worse. The most common treatment-related grade 3 or worse adverse event was transient increase in alanine aminotransferase or aspartate aminotransferase (five [15%]) after TACE. Five (15%) patients developed immune-related adverse events of grade 3 or worse (three had hepatitis, two had dermatitis). INTERPRETATION To our knowledge, this is the first prospective trial using the combination of immunotherapy and locoregional treatment as conversion therapy for locally advanced unresectable hepatocellular carcinoma, with promising results. Future randomised trials with larger cohorts of patients are warranted. FUNDING Merck.
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, Queen Mary Hospital, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Keith Wan Hang Chiu
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kenneth Sik Kwan Chan
- Department of Clinical Oncology, Queen Mary Hospital, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Francis Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong Special Administrative Region, China
| | - James Chun Bong Li
- Department of Pediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Catherine Wing Suet Wan
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Wing Chiu Dai
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Tai Chung Lam
- Department of Clinical Oncology, Queen Mary Hospital, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wenqi Chen
- Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Natalie Sean Man Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong Special Administrative Region, China
| | - Andy Lai Yin Cheung
- Medical Physics Unit, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Venus Wan Yan Lee
- Medical Physics Unit, Tuen Mun Hospital, Tuen Mun, Hong Kong Special Administrative Region, China
| | - Vince Wing Hang Lau
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Radiology, Gleneagles Hospital, Hong Kong Special Administrative Region, China
| | - Aya El Helali
- Department of Clinical Oncology, Queen Mary Hospital, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kwan Man
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Feng Ming Spring Kong
- Department of Clinical Oncology, Queen Mary Hospital, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chung Mau Lo
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Albert Chi-Yan Chan
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
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Hu Y, Zhao C, Ji R, Chen W, Shen Q, Chiang CL, Chan J, Ma L, Yang H, Wong T, Ellsworth S, Lo CM, Dawson LA, Kong FM. The role of stereotactic body radiotherapy in hepatocellular carcinoma: guidelines and evidences. Journal of the National Cancer Center 2022. [DOI: 10.1016/j.jncc.2022.05.002] [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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Chan SK, Chiu WHK, Lee HFV, Vardhanabhuti V, Cheung TT, Chan A, Chan SL, Khong PL, Ng KKC, Seto WK, Kong FMS, Chiang CL. Combined 18F-FDG and 11C-acetate positron emission tomography/computed tomography in staging and treatment decision in patients with hepatocellular carcinoma: A cost-effectiveness analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16176] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16176 Background: Dual-tracer positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose and 11C-acetate is increasingly used in the management of hepatocellular carcinoma (HCC). However, considering the high cost of dual-tracer PET/CT, there is a need to assess its value by considering both the efficacy and cost. Methods: In this retrospective cohort study, 223 dual-tracer PET/CT scans were performed in 206 patients between 2014 and 2020 for tumor staging for radiologically or histologically confirmed HCC. New lesion detection rate, changes in the Barcelona Clinic Liver Cancer (BCLC) classification, and changes in treatment allocation based on dual-tracer PET/CT were evaluated. Validation was performed on a cohort of staging patients from another institution (n = 48). A cost-benefit analysis model was built for the incurred costs and the impact of dual-tracer PET/CT findings on treatment strategy over conventional imaging was studied. Results: Of the 223 patients that underwent dual-tracer PET/CT for staging, new lesions were detected in 33 (14.8%) patients, resulting in BCLC upstaging in 26 (11.6%) and treatment modification in 16 (7.2%) cases. The external staging cohort showed similar findings where dual-tracer PET/CT resulted in 12.5% (6/48) BCLC upstaging and 10.4% (5/48) treatment modifications (concordance-index: 0.85; 95% CI: 0.82-0.88). In subgroup analysis of 200 patients performed for pre-treatment metastatic screening, dual-tracer PET/CT detected extra-hepatic metastasis in 11, 10, and 16 patients, respectively, and led to treatment modifications in all of these patients. Sixteen locoregional therapies (8%) were avoided (8 resections, 3 transplantations, and 5 TACEs), with an estimated cost saving of US$161,665 (US$808 / patient) from the use of dual-tracer PET/CT. Sensitivity analyses suggested that dual-tracer PET/CT is consistently more cost-saving than conventional imaging, irrespective of the changes in the cost of imaging, procedures, and the duration of hospital stay (range: US$112,945-210,385). The cost of PET/CT had the greatest influence on the cost savings. Conclusions: Comparing to conventional imaging, dual-tracer PET/CT improves tumor staging, alters treatment allocation and is cost-saving in patients undergoing pre-treatment metastatic screening. Our results demonstrated that the use of dual-tracer PET/CT provides additional value and improves patient care.
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Affiliation(s)
- Sik-Kwan Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wan Hang Keith Chiu
- Department of Diagnostic Radiology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | | | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Albert Chan
- Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Stephen L. Chan
- State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Wai-Kay Seto
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Feng-Ming Spring Kong
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
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Chiang CL, Lam TC, Li CBJ, Li WS, Chan SK, Lee YPY, Cheung KWA, Chow JCH, Chan PCS, Lee WMS, Lai WYJ, Helali AE, Ng WT, Kong FMS, Kwong DLW, Lee WMA. Antitumor activity of bintrafusp alfa in previously treated patients with recurrent or metastatic nasopharyngeal cancer (NPC): A single arm, prospective phase II trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18029] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18029 Background: Patients with recurrent or metastatic nasopharyngeal cancer (R/M NPC) who failed platinum-based chemotherapy have poor prognoses. We report the clinical activity and safety of bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of the transforming growth factor (TGF)-βRII receptor fused to a human IgG1 antibody blocking programmed death-ligand 1 (PD-L1), in patients with heavily pretreated R/M NPC. Tumor and plasma-based biomarkers were investigated in an exploratory analysis. Methods: Eligible patients had histologically confirmed NPC that had recurred at distant sites and were not amenable to curative treatment. All patients received at least one prior line of platinum-based chemotherapy for recurrent disease. Patients were treated with bintrafusp alfa (1200mg every 2 weeks) until disease progression. The sample size was estimated to assume a 40% objective response rate (ORR) to bintrafusp alfa compared with 20% for checkpoint inhibitors. Modified Simon two-stage optimal design was used (power, 80%; a = 0.05; P0 = 0.20; P1 = 0.40; n1 = 18; n = 33 with an additional five patients to allow for ineligibility or other reasons). The primary endpoint was ORR and secondary endpoints included survival and toxicity. Expression of PD-L1 in archived tumors, plasma clearance of Epstein-Barr virus (EBV) DNA, plasma clearance of TGF-β, and exosomal PD-L1 were assessed for a potential correlation with ORR. (NCT 04396886). Results: Out of 43 patients screened, 38 patients were enrolled. After a median follow-up of 14.9 months (range: 1.6-23.3 months), the confirmed ORR was 23.7% (95% CI: 12.4-38.8%) (complete response, n = 1; partial response, n = 8). The median treatment duration was 1.8 months (range: 0.5-14.3 months). 8 patients (21.1%) and 2 patients (5.3%) received bintrafusp alfa for > 6 months and > 12 months respectively. The 1-year overall survival (OS) rate was 57.5% (95% CI, 40.2% to 71.5%) and 1-year progression-free survival rate was 23% (95% CI, 10.1% to 39.4%). ORR was higher in patients with a decreasing trend in EBV-DNA at week 4 (40% vs. 6.3%, p = 0.02), whereas high exosomal PD-L1 levels at week 4 were predictive of worse ORR (5.3% vs. 41.7%, p = 0.012). There were no associations between clinical outcome and tissue PD-L1 expression (p = 0.952) or plasma TGF-β clearance (p = 0.28). 16 patients (42.4%) experienced ≥ grade 3 treatment-related adverse events, most commonly anemia (n = 9, 23.7%) and secondary malignancies (n = 4, 10.5%). Conclusions: Bintrafusp alfa has promising activity in heavily pretreated R/M NPC and a favorable 1-year OS rate, though the observed activity was not as high as the study initially aimed. The biomarker results warrant validation in larger cohorts. Clinical trial information: NCT04396886.
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Chung Bong James Li
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Sum Li
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Sik-Kwan Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yim Ping Yolanda Lee
- Department of Diagnostic Radiology, Gleneagles HK Hospital, Hong Kong, Hong Kong
| | | | | | | | - Wai Man, Sarah Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Hospital, Hong Kong, Hong Kong
| | - Wing Yu Jessica Lai
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Aya El Helali
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Wai-Tong Ng
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Feng-Ming Spring Kong
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Dora LW Kwong
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Mui Anne Lee
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Chiang CL, Chiu WHK, Lau WHV, Chan SK, Lee AS, Kong FMS, Chan A. Sequential trans-arterial chemoembolization and stereotactic body radiotherapy followed by immunotherapy (START-FIT) for locally advanced hepatocellular carcinoma: A single-arm, phase II trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4091 Background: Previous studies proposed therapeutic synergy between loco-regional therapies and checkpoint inhibitors in hepatocellular carcinoma (HCC). We aimed to study the safety and efficacy of sequential transarterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT) followed by Avelumab in patients with locally advanced HCC. Methods: Patients with locally advanced HCC not suitable for curative resections were eligible. All patients had HCC ≥ 5cm, tumor nodules ≤3, and child-Pugh A5-B7 liver function. Tumors with distant metastasis, main portal vein (VP4) invasion, or inferior vena cava (VV3) invasion were excluded. Patients underwent single episode of TACE followed by 5-fraction SBRT (28 days afterwards), followed by Avelumab (10mg per kg) 14 days afterwards and every 2 weeks thereafter. The primary endpoint was percentage of patients amendable to curative surgery, defined as R0 resection with sufficient remnant liver volume and function. Secondary endpoints were objective response rate (ORR) per modified Response Evaluation Criteria in Solid Tumors (mRECIST) version 1.1, survivals, and treatment-related adverse event (TRAE). The sample size assumed that around 20% patients amendable to surgery after experimental treatment compared to 5% of historical institutional results after TACE. Modified Simon two-stage optimal design was used (power, 80%; a = 0.05; P0 = 0.05; P1 = 0.20; n1 = 10; n = 29 with an additional four patients to allow for drop-out or other reasons). Results: Out of 67 patients screened, 33 patients were enrolled. The median sum of diameter of lesion(s) was 15.1cm (range: 5.3-31.1cm), and 21 (63.6%) had marcrovascular invasion (n=13, hepatic vein, n=3 branched portal vein, n=5 both). After a median follow-up of 17.2 months (range: 3.5-31.6 months), 3 (9.1%) patients had tumor downstaged with curative surgery done. The objective response rate was 62.5% (95% CI, 45.3-77.1%), of whom 15 had complete response (CR) (43.8%) and 6 had partial response (18.7%). The median overall survival (OS) and progression-free survival was 30.3 months (95% CI: 22.7-37.8 months) and 20.7 months (95% CI: 14.6-26.8 months) respectively. All three patients with surgery done were alive at 2 years (100%). For 15 patients had CR, the 2-year OS rate was 92.9% without surgery. Ten patients (30.3%) experienced ≥ grade 3 TRAEs, commonly transient increase in alanine / aspartate aminotransferase (n=4, 12.1%) and bilirubin (n=2, 6%) level after TACE. Five patients (15.2 %) developed ≥ grade 3 immune-related adverse events. Conclusions: Although merely 9% of patients were downstaged to receive curative surgery, combined locoregional treatment and immunotherapy is safe and resulted in an unexpectedly high CR rate of 43% and median OS of 30 months in patients with locally advanced unresectable HCC. Clinical trial information: NCT 03817736.
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wan Hang Keith Chiu
- Department of Diagnostic Radiology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Hang Vince Lau
- Department of Diagnostic Radiology, Gleneagles HK Hospital, Hong Kong, Hong Kong
| | - Sik-Kwan Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Feng-Ming Spring Kong
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Albert Chan
- Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong
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11
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Islam KA, Chow LKY, Kam NW, Wang Y, Chiang CL, Choi HCW, Xia YF, Lee AWM, Ng WT, Dai W. Prognostic Biomarkers for Survival in Nasopharyngeal Carcinoma: A Systematic Review of the Literature. Cancers (Basel) 2022; 14:2122. [PMID: 35565251 PMCID: PMC9103785 DOI: 10.3390/cancers14092122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
This systematic review aims to identify prognostic molecular biomarkers which demonstrate strong evidence and a low risk of bias in predicting the survival of nasopharyngeal carcinoma (NPC) patients. The literature was searched for on PubMed to identify original clinical studies and meta-analyses which reported associations between molecular biomarkers and survival, including ≥150 patients with a survival analysis, and the results were validated in at least one independent cohort, while meta-analyses must include ≥1000 patients with a survival analysis. Seventeen studies fulfilled these criteria-two studies on single nucleotide polymorphisms (SNPs), three studies on methylation biomarkers, two studies on microRNA biomarkers, one study on mutational signature, six studies on gene expression panels, and three meta-analyses on gene expressions. The comparison between the hazard ratios of high-risk and low-risk patients along with a multivariate analysis are used to indicate that these biomarkers have significant independent prognostic values for survival. The biomarkers also indicate a response to certain treatments and whether they could be used as therapeutic targets. This review highlights that patients' genetics, epigenetics, and signatures of cancer and immune cells in the tumor microenvironment (TME) play a vital role in determining their survival.
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Affiliation(s)
- Kazi Anisha Islam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
| | - Larry Ka-Yue Chow
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
| | - Ngar Woon Kam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
- Laboratory for Synthetic Chemistry and Chemical Biology, Hong Kong, China
| | - Ying Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, Guangzhou 510060, China; (Y.W.); (Y.-F.X.)
| | - Chi Leung Chiang
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
| | - Horace Cheuk-Wai Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
| | - Yun-Fei Xia
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, Guangzhou 510060, China; (Y.W.); (Y.-F.X.)
| | - Anne Wing-Mui Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
- Center of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Shenzhen 518009, China
| | - Wai Tong Ng
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
- Center of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Shenzhen 518009, China
| | - Wei Dai
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; (K.A.I.); (L.K.-Y.C.); (N.W.K.); (C.L.C.); (H.C.-W.C.); (A.W.-M.L.)
- Center of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Shenzhen 518009, China
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12
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Lee SF, Vellayappan BA, Wong LC, Chiang CL, Chan SK, Wan EYF, Wong ICK, Lambert PC, Rachet B, Ng AK, Luque-Fernandez MA. Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study. ESMO Open 2022; 7:100363. [PMID: 35026723 PMCID: PMC8760397 DOI: 10.1016/j.esmoop.2021.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/02/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework. PATIENTS AND METHODS Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death). RESULTS A total of 613 (23.6%) and 230 (8.8%) of 2600 subjects died of lymphoma and developed incident CVD, respectively. Median follow-up was 7.0 years (interquartile range 3.8-10.8 years). Older ages [hazard ratio (HR) for >75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 versus ≤60 years 1.60; 95% CI 1.12-2.30], hypertension (HR 4.92; 95% CI 2.61-9.26), diabetes (HR 1.43; 95% CI 1.09-1.87), and baseline use of aspirin (HR 5.30; 95% CI 3.93-7.16) were associated with an increased risk of incident CVD. In a subgroup of anticipated higher-risk patients (aged 61-75 years, smoked, had diabetes, and received doxorubicin), we found that they remained on average 7.9 (95% CI 7.2-8.8) years in the DLBCL state and 0.1 (95% CI 0.0-0.4) years in the CVD state, if they could be followed up for 10 years. The brief time in the CVD state is consistent with the high chance of death in patients who developed CVD. Other causes of death have overtaken DLBCL-related death after about 5 years. CONCLUSIONS In this Asian population-based cohort, we found that incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.
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Affiliation(s)
- S F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - B A Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - L C Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - C L Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - S K Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - E Y-F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong
| | - I C-K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong; Research Department of Policy and Practice, School of Pharmacy, University College London, London, UK
| | - P C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B Rachet
- Department of Non-Communicable Disease Epidemiology, ICON Group, London School of Hygiene and Tropical Medicine, London, UK
| | - A K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M A Luque-Fernandez
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), Andalusian School of Public Health, Granada, Spain.
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13
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Mak SH, Wong SMN, Chiu WHK, Chiang CL, Yip WLW, Ho HMC, Yeung SYC, Chan KHM, Lee WYV, Lee ASF. Presence of tumour capsule on contrast-enhanced CT is associated with improved outcomes of stereotactic body radiation therapy in hepatocellular carcinoma patients. Strahlenther Onkol 2022; 198:639-647. [PMID: 34988623 DOI: 10.1007/s00066-021-01879-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is a novel local therapy for the treatment of hepatocellular carcinoma (HCC). While effective, there is currently no reliable radiological marker to guide patient selection. In this study, we investigated the prognostic value of capsule appearance on contrast-enhanced computed tomography (CT) for patients undergoing SBRT. MATERIALS AND METHODS Between 2006 and 2017, 156 consecutive patients with Child-Pugh score class A/B and HCC ≥ 5 cm who underwent SBRT were retrospectively analysed. Baseline triple-phase CTs of the abdomen were reviewed for the presence of capsule appearances and correlated with objective response rate (ORR), overall survival (OS) and pattern of treatment failure. RESULTS Capsule appearance on CT was present in 83 (53.2%) patients. It was associated with improved ORR by Response Evaluation Criteria in Solid Tumours (RECIST) (60.2 vs. 24.7%, p < 0.001) and Modified Response Evaluation Criteria in Solid Tumours (mRECIST) (78.3 vs. 34.2%, p < 0.001). The presence of a capsule was also associated with superior 2‑year local control (89.1 vs. 51.4%, p < 0.001) and 2‑year OS (34.1 vs. 14.8%, p < 0.01). Hepatic out-field failure was the dominant mode of progression, which was less common in patients with intact capsule (54.2 vs. 60.3%, p = 0.01). CONCLUSION Capsule appearance on CT could potentially be a non-invasive prognostic marker for selecting HCC patients to undergo SBRT. A larger cohort is warranted to validate our findings.
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Affiliation(s)
- Siu Hin Mak
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Wan Hang Keith Chiu
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Chi Leung Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Hoi Man Connie Ho
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Ka Heng Mark Chan
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Proton Therapy Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Wan Yan Venus Lee
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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14
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Lee SF, Redondo Sánchez D, Sánchez MJ, Gelaye B, Chiang CL, Wong IOL, Cheung DST, Luque Fernandez MA. Trends in gender of authors of original research in oncology among major medical journals: a retrospective bibliometric study. BMJ Open 2021; 11:e046618. [PMID: 34663651 PMCID: PMC8524267 DOI: 10.1136/bmjopen-2020-046618] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We evaluated the temporal trend in gender ratios of first and last authors in the field of oncological research published in major general medical and oncology journals and examined the gender pattern in coauthorship. DESIGN We conducted a retrospective study in PubMed using the R package RISmed. We retrieved original research articles published in four general medical journals and six oncology specialty journals. These journals were selected based on their impact factors and popularity among oncologists. We identified the names of first and last authors from 1 January 2002 to 31 December 2019. The gender of the authors was identified and validated using the Gender API database (https://gender-api.com/). PRIMARY AND SECONDARY OUTCOME MEASURES The percentages of first and last authors by gender and the gender ratios (male to female) and temporal trends in gender ratios of first and last authors were determined. RESULTS We identified 34 624 research articles, in which 32 452 had the gender of both first and last authors identified. Among these 11 650 (33.6%) had women as the first author and 7908 (22.8%) as the last author, respectively. The proportion of female first and last authors increased from 26.6% and 16.2% in 2002, to 32.9% and 27.5% in 2019, respectively. However, the gender ratio (male to female) of first and last authors decreased by 1.5% and 2.6% per year, respectively, which were statistically significant (first author: incidence rate ratio (IRR) 0.98, 95% CI 0.97 to 1.00; last author: IRR 0.97, 95% CI 0.96 to 0.99). Male first and last authorship was the most common combination. Male-female and female-female pairs increased by 2.0% and 5.0%, respectively (IRR 1.02, 95% CI 1.01 to 1.03 and IRR 1.05, 95% CI 1.04 to 1.06, respectively). CONCLUSIONS The continued under-representation of women means that more efforts to address parity for advancement of women in academic oncology are needed.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Daniel Redondo Sánchez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María-José Sánchez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Bizu Gelaye
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Chi Leung Chiang
- Department of Clinical Oncology, University of Hong Kong, Hong Kong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | | | | | - Miguel Angel Luque Fernandez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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15
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Chiang CL, Guo Q, Ng WT, Lin S, Ma TSW, Xu Z, Xiao Y, Li J, Lu T, Choi HCW, Chen W, Chau ESC, Luk PHY, Huang SH, O'Sullivan B, Pan J, Lee AWM. Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature. Front Oncol 2021; 11:703995. [PMID: 34540670 PMCID: PMC8445029 DOI: 10.3389/fonc.2021.703995] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
This study aims to identify prognostic factors in nasopharyngeal carcinoma (NPC) to improve the current 8th edition TNM classification. A systematic review of the literature reported between 2013 and 2019 in PubMed, Embase, and Scopus was conducted. Studies were included if (1) original clinical studies, (2) ≥50 NPC patients, and (3) analyses on the association between prognostic factors and overall survival. The data elements of eligible studies were abstracted and analyzed. A level of evidence was synthesized for each suggested change to the TNM staging and prognostic factors. Of 5,595 studies screened, 108 studies (44 studies on anatomical criteria and 64 on non-anatomical factors) were selected. Proposed changes/factors with strong evidence included the upstaging paranasal sinus to T4, defining parotid lymph node as N3, upstaging N-category based on presence of lymph node necrosis, as well as the incorporation of non-TNM factors including EBV-DNA level, primary gross tumor volume (GTV), nodal GTV, neutrophil-lymphocyte ratio, lactate dehydrogenase, C-reactive protein/albumin ratio, platelet count, SUVmax of the primary tumor, and total lesion glycolysis. This systematic review provides a useful summary of suggestions and prognostic factors that potentially improve the current staging system. Further validation studies are warranted to confirm their significance.
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Affiliation(s)
- Chi Leung Chiang
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Qiaojuan Guo
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Wai Tong Ng
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Tiffany Sze Wai Ma
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Zhiyuan Xu
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Youping Xiao
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jishi Li
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tianzhu Lu
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Horace Cheuk Wai Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wenqi Chen
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Eric Sze Chun Chau
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Peter Ho Yin Luk
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Anne Wing Mui Lee
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Lam TC, Tsang KC, Choi HC, Lee VH, Lam KO, Chiang CL, So TH, Chan WW, Nyaw SF, Lim F, Lau JO, Chik J, Kong FM, Lee AW. Combination atezolizumab, bevacizumab, pemetrexed and carboplatin for metastatic EGFR mutated NSCLC after TKI failure. Lung Cancer 2021; 159:18-26. [PMID: 34303276 DOI: 10.1016/j.lungcan.2021.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Acquired resistance to TKI is an important unmet need in the management of EGFR mutated lung cancer. Recent clinical trial IMPower150 suggested that combination approach with VEGF inhibitor, check point inhibitor immunotherapy and platinum-based chemotherapy was effective in oncogene driven lung cancer. The current trial examined the efficacy of a modified regimen in an EGFR mutated cohort. METHODS An open-labelled, single arm, phase II study was conducted in patients with EGFR mutated NSCLC who had progressed on at least one EGFR TKI. For those with T790M mutation, radiological progression on osimertinib was required for enrolment. Patients were treated with combination atezolizumab (1200 mg), bevacizumab (7.5 mg/kg), pemetrexed (500 mg/m2) and carboplatin (AUC 5) given once every 3 weeks until progression. RESULTS Forty patients were enrolled. Median age was 62 (range 45-76) years. More than one half (23/40, 57.5%) had progressed on osimertinib. PD-L1 expression was < 1% in 52.5%. Median follow-up time was 17.8 months. ORR was 62.5%. Median PFS was 9.4 months (95% CI: 7.6 - 12.1). One year OS was 72.5% (95% CI: 0.56-0.83). Treatment related grade 3 or above adverse events (AE) occurred in 37.5% (15/40). Immune-related AE occurred in 32.5% (13/40) patients. Quality of life measures of function and symptoms did not change significantly throughout the course of treatments. Post-trial rechallenge with EGFR TKI containing regimen resulted in PFS of 5.8 months (95% CI 3.9-10.0 months). CONCLUSION Combination approach of atezolizumab, bevacizumab, pemetrexed and carboplatin achieved promising efficacy in metastatic EGFR mutated NSCLC after TKI failure. The results were comparable with taxane based regimen of IMPower150 while toxicity profile was improved.
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Affiliation(s)
- T C Lam
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - K C Tsang
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - H C Choi
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - V H Lee
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - C L Chiang
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - T H So
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - W W Chan
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - S F Nyaw
- Tuen Mun Hospital, Hong Kong, China
| | - F Lim
- Princess Margaret Hospital, Hong Kong, China
| | - J O Lau
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - J Chik
- Queen Elizabeth Hospital, Hong Kong, Hong Kong, China
| | - F M Kong
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - A W Lee
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
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17
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Lee SF, Choi HCW, Chan SK, Lam KO, Lee VHF, Wong IOL, Chiang CL. Cost-Effectiveness of Anti-Epidermal Growth Factor Receptor Therapy Versus Bevacizumab in KRAS Wild-Type (WT), Pan-RAS WT, and Pan-RAS WT Left-Sided Metastatic Colorectal Cancer. Front Oncol 2021; 11:651299. [PMID: 34012917 PMCID: PMC8127841 DOI: 10.3389/fonc.2021.651299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/09/2021] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives We aimed to compare the economic value of chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody (mAb) against chemotherapy with bevacizumab (Bev, an anti-vascular endothelial growth factor mAb) as first-line treatment in KRAS wild-type (WT), pan-RAS WT and pan-RAS WT left-sided metastatic colorectal cancer (mCRC) patients from the Hong Kong societal perspective. Materials and Methods We developed Markov models and 10-year horizon to estimate costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of chemotherapy plus anti-EGFR therapy against chemotherapy plus Bev in KRAS WT, pan-RAS WT, and pan-RAS WT left-sided mCRC. We considered two times of the local gross domestic product per capita (GDPpc) as the willingness-to-pay (WTP) threshold (2× GDPpc; US$97,832). Results Adding anti-EGFR mAb to chemotherapy provides additional 0.24 (95% confidence interval [CI] 0.19-0.29), 0.32 (95% CI 0.27-0.37), and 0.57 (95% CI 0.49-0.63) QALY compared to adding Bev in KRAS WT, pan-RAS WT, and left-sided pan-RAS WT mCRC populations respectively. The corresponding ICER is US$106,847 (95% CI 87,806-134,523), US$88,565 (95% CI 75,678-105,871), US$76,537 (95% CI 67,794-87,917) per QALY gained, respectively. Conclusions Anti-EGFR therapy is more cost-effective than Bev as a first-line targeted therapy in left-sided pan-RAS WT and pan-RAS WT, with ICER <US$100,000/QALY, compared to KRAS WT mCRC population.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, Hong Kong
| | - Horace C W Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | - Sik Kwan Chan
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | - Ka On Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Victor H F Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Irene O L Wong
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, Hong Kong.,Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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18
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Ho CHM, Chiang CL, Lee FAS, Chan JCH, Yeung CSY, Choi CKK, Wong FCS, Tung SY. Albumin-bilirubin versus Child-Pugh Grade as a Predictor of Survival after Individualised Hypofractionated Radiotherapy for Hepatocellular Carcinoma. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2016971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - JCH Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CKK Choi
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - SY Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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19
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Wong NSM, Chiang CL, Ho CHM, Yip WWL, Yeung CSY, Chan MKH, Lee VWY, Lee FAS, Wong FCS. Prognostic Factors and Survival in Advanced Large Hepatocellular Carcinomas Treated with Combined Transarterial Chemoembolisation and Hypofractionated Image-guided Radiotherapy. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- NSM Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - WWL Yip
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - MKH Chan
- Department of Radiation Physics, University Hospital Essen, Germany
| | - VWY Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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20
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Au KP, Chiang CL, Chan ACY, Cheung TT, Lo CM, Chok KSH. Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation. World J Clin Cases 2020; 8:2758-2768. [PMID: 32742986 PMCID: PMC7360706 DOI: 10.12998/wjcc.v8.i13.2758] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Graft hepatocellular carcinoma (HCC) recurrence after liver transplant is more frequently encountered. Graft hepatectomy is technically challenging and is associated with high morbidity. Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective for the treatment of primary HCC. However, its role in HCC recurrence in a liver graft remains unclear.
AIM To evaluate the safety and efficacy of SBRT for the treatment of graft HCC recurrence after liver transplantation.
METHODS A retrospective study was conducted. From 2012 to 2018, 6 patients with intrahepatic HCC recurrence after liver transplant were treated with SBRT at Queen Mary Hospital, the University of Hong Kong. The primary outcome was time to overall disease progression and secondary outcomes were time to local progression and best local response, as assessed with the Modified response Evaluation Criteria for Solid Tumours criteria. Patients were monitored for treatment related toxicities and graft dysfunction.
RESULTS A total of 9 treatment courses were given for 13 tumours. The median tumour size was 2.3 cm (range 0.7-3.6 cm). Two (22%) patients had inferior vena cava tumour thrombus. The best local treatment response was: 5 (55%) complete response, 1 (11%) partial response and 3 (33%) stable disease. After a median follow up duration of 15.5 mo, no local progression or mortality was yet observed. The median time to overall disease progression was 6.5 mo. There were 6 regional progression in the liver graft (67%) and 2 distant progression in the lung (22%). There was no grade 3 or above toxicity and there was no graft dysfunction after SBRT.
CONCLUSION SBRT appears to be safe in this context. Regional progression is the mode of failure.
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Affiliation(s)
- Kin Pan Au
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
| | - Chi Leung Chiang
- Department of Clinical Oncology, Queen Mary Hospital, the University of Hong Kong, Hong Kong 999077, China
| | - Albert Chi Yan Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
| | - Chung Mau Lo
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
| | - Kenneth Siu Ho Chok
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
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21
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Chiang CL, Cheung CL, Hingley JP, Sing CW, Fong KS, Lam TC, Lee VHF, Au KH, Chow JCH, Cheung YT, Ngan RKC, Choi CW, Lee AWM, Wong ICK. Excessive mortality in 1,353 five-year survivors of nasopharyngeal cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24090] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24090 Background: Survival of NPC patients has improved in past decades. Yet, survivors continue to face elevated risks of life-threatening late effects. Their impact on late mortality remains poorly quantified. Methods: 1353 five-year NPC survivors diagnosed between 1997 and 2013 at Queen Mary Hospital were reviewed. Their demographics and treatment data were taken from electronic medical records. Survival probability, standardized mortality ratios (SMRs) and absolute excessive risk were calculated for overall and cause-specific deaths. Results: At median follow-up time of 12.4 years, 412 (30.5%) five-year survivors had died at the time of analysis. 66.2% of deaths attributed to non-recurrence death. Estimated 10-, 15-, and 20-year survival probability were 81.4%, 67.6%, and 57.3% respectively. Compared to Hong Kong general population, absolute excessive risk of death from any causes was 17 deaths per 1000 person-years; overall SMR was 3.52 (95% CI: 3.19 to 3.87, p<0.001). Increases in cause-specific mortality were seen for death due to pulmonary (SMR: 6.75; 95% CI: 5.67 to 7.98) and secondary malignancy (SMR: 1.41; 95% CI: 1.06 to 1.83). Conclusions: Five-year NPC survivors still face excessive mortality long after diagnosis, and majority of death was from non-recurrence death. Further analyses are needed to determine predictive factors of excessive mortality. [Table: see text]
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - James Philip Hingley
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chor Wing Sing
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ka Shun Fong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Victor Ho-Fun Lee
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Yin Ting Cheung
- School of Pharmacy, Chinese University of Hong Kong, Hong Kong, China
| | | | - Cheuk-Wai Choi
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anne WM Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
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22
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Yu H, Dai W, Chiang CL, Du S, Zeng ZC, Shi GM, Zhang W, Chan A, Hu C, Kong FM. Deep learning to develop transcriptomic model for survival prediction in TCGA patients with hepatocellular carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14057] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14057 Background: This study aimed to investigate the prognostic value of transcriptome and clinical data of Hepatocellular carcinoma (HCC) patients for overall survival (OS) by deep learning method. Methods: A total of 371 HCC patients with 20530 level three RNA-sequencing data were from The Cancer Genome Atlas (TCGA). Cox-nnet model, a deep learning model through an artificial neural network extension of the Cox regression model, was used for OS prediction. The patients were randomly split into train-set and test-set (7:3). In train-set, the significant genes associated with OS under univariate Cox regression were considered for modeling. Clinical parameters, including age, gender, pathologic stage, child pugh classification, creatinine level etc. were also considered. The Cox-nnet model was developed by cross-validation. Its discrimination was determined by the concordance index (CI) in the independent test-set and compared with multivariable Cox regression. The clustering method Uniform Manifold Approximation and Projection (UMAP) was used for revealing biological information from the hidden layer in the model. Results: In the train-set (n = 259), 1505 genes and two clinical variables (child pugh score and creatinine level) were significantly associated with OS (adjusted P-value < 0.05). To avoid overfitting, only 40 most significant genes were included in the Cox-nnet model. In the test-set (n = 112), the CI of Cox-nnet (0.76, se = 0.04) is better than the CI of multivariable Cox regression (0.71, se = 0.05). The difference between good or poor survival subgroups classified by Cox-nnet was remarkably significant ( P-value = 1e-4, median OS: 80.7 vs. 25.1 months). In the Cox-nnet model with all significant variables, the weights in the hidden layer were clustered by UMAP into 3 positive clusters and 2 negative clusters, which are enriched in GO/KEGG. The “cell cycle” and “complement and coagulation cascades” are the most important signal pathways in positive and negative clusters, respectively. Conclusions: Combining transcriptomic and clinical data, and with deep learning algorithm, we built and validated a robust model for survival prediction in HCC patients. Our study would be useful to explore the clinical implications in survival prediction and corresponding genetic mechanisms. Clinical trial information: 5U24CA143799, 5U24CA143835, 5U24CA143840, 5U24CA143843, 5U24CA143845, 5U24CA143848, 5U24CA1438.
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Affiliation(s)
- Hao Yu
- Shenzhen Polytechnic, Shenzhen, China
| | - Wei Dai
- Department of Clinical Oncology, University of Hong Kong, Hongkong, China, Hongkong, China
| | - Chi Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Zhao-Chong Zeng
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Guo-Ming Shi
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China, Shanghai, China
| | - Albert Chan
- Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Feng-Ming Kong
- Department of Clinical Oncology, University of Hong Kong, Hongkong, China, Hongkong, China
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23
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Chiang CL, Lee SF, Lee VW, Yeung CS, Cheung SK, Poon MC, Foo DC, Lo SH, Lam KO, Lee FA, Wong FC, Chan MK. Toxicity outcome of endorectal brachytherapy boost in medically inoperable patients. Strahlenther Onkol 2020; 196:993-997. [PMID: 32313964 DOI: 10.1007/s00066-020-01612-0] [Citation(s) in RCA: 3] [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: 12/05/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
AIM This communication reviews results and toxicity of image-guided high-dose-rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (ERT) in medically inoperable patients with rectal cancer. MATERIALS AND METHODS A total of 18 patients with rectal cancer and clinical stage T2-4N0‑2 treated with HDREBT boost after ERT were retrospectively reviewed. RESULTS Following treatment with a median total dose (EQD2, α/β = 10) of 66 Gy (range 48-92 Gy), the incidence of early and late rectal grade 3 toxicity was 11% and 19%, respectively. There was no correlation between the occurrence of acute and late toxicity. CONCLUSION With proper technique, a combined approach using EBRT and HDREBT was associated with acceptable toxicity in medically inoperable rectal cancer patients.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China.
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus Wy Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Cynthia Sy Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Steven Kt Cheung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | | | - Dominic Cc Foo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - S H Lo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Francis As Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank Cs Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Mark Kh Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
- Clinic for Radiation Oncology, University Hospital Essen, Essen, Germany
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24
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So TH, Chan SK, Chan WL, Choi H, Chiang CL, Lee V, Lam TC, Wong I, Law S, Kwong D, Ming Spring Kong F, Jin JY, Lam KO. Lymphopenia and Radiation Dose to Circulating Lymphocytes With Neoadjuvant Chemoradiation in Esophageal Squamous Cell Carcinoma. Adv Radiat Oncol 2020; 5:880-888. [PMID: 33089018 PMCID: PMC7560564 DOI: 10.1016/j.adro.2020.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 01/19/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose We hypothesized that radiation-induced lymphopenia could be predicted by the effective dose to the circulating immune cells (EDIC) in advanced esophageal squamous cell carcinoma treated with trimodality therapy according to the Dutch ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial regimen. To test this hypothesis, we examined the effect of EDIC on the degree of lymphocyte drop (lymphocyte nadir). Methods and Materials Patients with advanced nonmetastatic esophageal squamous cell carcinoma treated in a single tertiary cancer center from 2012 to 2018 were eligible for this study. All patients had to have a radiation therapy plan available for EDIC computation and received neoadjuvant chemoradiation according to the Dutch CROSS trial regimen before radical esophagectomy. The EDIC was calculated as a function of integral doses to the lung, heart, and total body with a verified mathematical model. The association between EDIC and lymphocyte nadir was studied, and the relationships of overall survival (OS) with lymphocyte nadir and EDIC were assessed using multivariable Cox regression model. Results This analysis included 92 eligible consecutive patients (77 men and 15 women). The mean EDIC was 2.8 Gy (range, 0.6-4.4). EDIC was significantly correlated with lymphocyte nadir (Spearman coefficient = –0.505; P < .01), and lymphocyte nadir was a significant independent factor for shorter OS (hazard ratio = 0.63; P < .001). Lymphocyte nadir was also the most significant factor in determining OS among other clinical parameters. Exploratory analysis showed significant OS differences between EDIC groups (<2, 2-4, and >4 Gy). The 2–year OS rates were 66.7%, 42.7%, and 16.7% for EDIC <2, 2 to 4, and >4 Gy, respectively. Conclusions There was a significant correlation between radiation dose to circulating immune cells and lymphocyte nadir, which in turn affected OS in patients with advanced nonmetastatic esophageal squamous cell carcinoma treated by trimodality therapy.
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Affiliation(s)
- Tsz Him So
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Sik Kwan Chan
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Wing Lok Chan
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Horace Choi
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Chi Leung Chiang
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Victor Lee
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Tai Chung Lam
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | - Ian Wong
- Department of Surgery, the University of Hong Kong, Hong Kong
| | - Simon Law
- Department of Surgery, the University of Hong Kong, Hong Kong
| | - Dora Kwong
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
| | | | - Jian Yue Jin
- Department of Radiation Oncology, University Hospitals/Seidman Cancer Center and Case Comprehensive Cancer Center, Mentor, Ohio
| | - Ka On Lam
- Department of Clinical Oncology, the University of Hong Kong, Hong Kong
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25
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Yeung CSY, Chiang CL, Wong NSM, Ha SK, Tsang KS, Ho CHM, Wang B, Lee VWY, Chan MKH, Lee FAS. Palliative Liver Radiotherapy (RT) for Symptomatic Hepatocellular Carcinoma (HCC). Sci Rep 2020; 10:1254. [PMID: 31988376 PMCID: PMC6985173 DOI: 10.1038/s41598-020-58108-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 03/14/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
This study aims at evaluating the symptom response, response duration, and toxicity of single dose palliative liver radiotherapy (RT) for symptomatic HCC patients. We reviewed unresectable HCC patients treated with palliative RT in our institution. Eligible patients were unsuitable or refractory to trans-arterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT), with an index symptom of pain or abdominal discomfort. The primary outcome was the percentage of patients with clinical improvement of index symptom at 1 month. Secondary outcomes were response duration, toxicities, alpha-feto protein (AFP) response, and radiological response. Fifty-two patients were included in the study. The index symptom was pain in 34 patients (65.4%), and abdominal discomfort (34.6%) in 18 patients. At 1 month, 51.9% of patients had improvement of symptoms. Median time to symptom progression was 89 days (range: 12–392 days). Treatment was well tolerated with only 2 patients (3.8%) developing grade 3 GI toxicities. AFP response, radiological response rate, and disease control rate at 3 months were 48.6%, 15.1%, and 54.5% respectively. Half of the patients had improvement of index symptoms after receiving palliative liver RT with median response duration of 3 months. The treatment was well tolerated with minimal toxicities.
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Affiliation(s)
- Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China. .,Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China. .,Department of Clinical Oncology, HKU-Shenzhen Hospital, ShenZhen, China.
| | - Natalie S M Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - S K Ha
- Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China
| | - K S Tsang
- Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - B Wang
- Department of Clinical Oncology, HKU-Shenzhen Hospital, ShenZhen, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - Mark K H Chan
- Department of Radiation Physics, Imperial College London NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
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Chiang CL, So TH, Lam TC, Choi HCW. Cost-effectiveness analysis of Abiraterone Acetate versus Docetaxel in the management of metastatic castration-sensitive prostate cancer: Hong Kong's perspective. Prostate Cancer Prostatic Dis 2019; 23:108-115. [PMID: 31273290 DOI: 10.1038/s41391-019-0161-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several randomized control trials (RCTs) have showed that adding either abiraterone acetate (AA) or docetaxel (D) to androgen-deprivation therapy (ADT) improves survival of metastatic castration-sensitive prostate cancer patients (mCSPC). Yet, the cost-effectiveness of these treatment options has not been fully compared under Hong Kong's setting. This cost-effectiveness analysis (CEA) serves as the first study in Hong Kong to compare the economic value of these two combinations ADT + AA vs. ADT + D. METHODS A deterministic Markov model is used to project cost-effectiveness of each treatment until death. Survival curves for progression/death were extracted and digitized from the five RCTs (CHAARTED, LATITUDE, two STAMPEDE (2016/2017), and GETUG-AFU15). Clinically significant adverse events (AEs) were modeled; utility values were obtained from the literature. Primary outcomes were the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). We used the societal perspective from Hong Kong and considered three times of local gross domestic product per capita (GDPpc) as the willingness-to-pay (WTP) threshold (i.e., US$138,649). We estimated the break-even cost of AA in case ADT + AA is not a cost-effective strategy under this WTP threshold. While considering the standard AA dosage (1000 mg) as the main analysis, we also examined the potential impact of the low-dose AA (250 mg) strategy. RESULTS Integrating simulations with probabilistic sensitivity analysis, ADT + D returns 0.79 (median; 95% credible interval 0.56-0.97) QALY with an ICER of US$14,397/QALY ($7824-22,632) compared to ADT-alone. A head-to-head comparison indicates that ADT + AA further gains 0.79 (0.45-1.17) QALY but with an ICER of $361,439/QALY ($260,615-599,683) when compared to ADT + D. Considering three times of GDPpc as WTP threshold, ADT + D is more cost-effective in all simulations; while ADT + AA is more cost-effective than ADT + D only if the cost of AA is reduced by at least 63%. The low-dose AA (250 mg) strategy is potentially cost-effective when it generates equivalent efficacy as the standard dosage (1000 mg). CONCLUSIONS ADT + D is therefore shown to be a more cost-effective strategy than ADT + AA in metastatic castration-sensitive prostate cancer patients in developed economies. Addition of AA substantially improved QALY compared to D but at a significant cost.
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Affiliation(s)
- Chi Leung Chiang
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Hong Kong, China
| | - Tsz Him So
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Hong Kong, China
| | - Tai Chung Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Hong Kong, China
| | - Horace C W Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
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Chiang CL, Choi HC, Lam KO, Chan BY, Lee SF, Yeung SY, Lau KS, Chan SY, Choy TS, Yuen KK. Real-world treatment patterns and outcomes in refractory metastatic colorectal cancer. Asia Pac J Clin Oncol 2019; 15 Suppl 2:5-13. [PMID: 30887726 DOI: 10.1111/ajco.13114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/03/2023]
Abstract
AIM To investigate treatment patterns and outcomes of metastatic colorectal cancer (mCRC) patients beyond second progression (PD2) since regorafenib and TAS-102 became available in Hong Kong. METHODS The clinical records of consecutive mCRC patients who were treated beyond PD2 at Department of Clinical Oncology, Queen Mary Hospital between June 2013 and February 2018, were retrospectively reviewed. RESULTS Of 176 PD2 patients (76.7% Eastern Cooperative Oncology Group performance status 0/1 and a median follow-up time of 6.6 [range, 0.4-37.2] months), 104 (59%) underwent palliative care only and 72 (41%) received active third-line (3L) treatment: regorafenib (n = 22), TAS-102 (n = 6), chemotherapy + antiepidermal growth factor receptor (n = 12), chemotherapy + antivascular endothelial growth factor (n = 28) or clinical trials (n = 4). Patients on active 3L treatment had significantly longer OS than those on palliative care only: 11.7 versus 5.5 months (adjusted hazard ratio = 0.41, 95% confidence interval: 0.28-0.61, P < 0.001). For those on active treatment, OS was significantly associated with the time from diagnosis of metastasis to PD2 (P < 0.001) and post-3L treatments (P = 0.009). When analyzing treatment eligibility according to trial criteria, half of the eligible patients (54/109) did not receive active treatment, but both eligible and ineligible patients achieved better OS when receiving active 3L treatment versus palliative care only (P < 0.001 and P = 0.002). No unexpected toxicity was reported. CONCLUSION Active 3L and beyond treatment significantly prolonged OS versus palliative care, even in selected "trial ineligible" patients. Given a high rate of palliation only care in eligible patients, improved patient access to medicine and counseling may be needed to maximize outcomes.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - H C Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - B Y Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - K S Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - S Y Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - T S Choy
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - K K Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
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Chiang CL, Chan MKH, Yeung CSY, Ho CHM, Lee FAS, Lee VWY, Wong FCS, Blanck O. Combined stereotactic body radiotherapy and trans-arterial chemoembolization as initial treatment in BCLC stage B-C hepatocellular carcinoma. Strahlenther Onkol 2018; 195:254-264. [PMID: 30413833 DOI: 10.1007/s00066-018-1391-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 03/23/2018] [Accepted: 10/17/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE We retrospectively evaluated the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with trans-arterial chemoembolization (TACE) as initial therapy in Barcelona Clinic Liver Cancer (BCLC) system stage B-C hepatocellular carcinoma (HCC). PATIENTS AND METHODS Seventy-two patients received a single dose of TACE followed by SBRT 4 weeks later. All patients had tumor sizes ≥5 cm, at least 700 ml of disease-free liver, Child-Pugh (CP) score ≤ B7 and tumor nodules ≤5. SBRT dose, ranging from 6 × 5-8 Gy or 5-10 × 4 Gy, was individualized according to normal tissue constraints. No subsequent scheduled treatment was delivered unless disease progression was observed. Local control (LC), overall survival (OS), progression-free survival (PFS), response rate (RR), and toxicity were evaluated. RESULTS The patients' characteristics were: median age 60 years (range 28-87 years); CP score A/B (n = 68/4); BCLC stage B/C (n = 51/21); solitary/multifocal (n = 37/35); portal vein invasion (n = 18). The median tumor size and GTV were 11.2 cm (range 5.0-23.6 cm) and 751 cm3 (range 41-4009 cm3), respectively. The median equivalent dose in 2 Gy per fraction (EQD2, α/β = 10) was 37.3 Gy2 (range, 28-72 Gy2). The median follow-up time was 16.8 months (range, 3-96 months). The objective RR was 68% and the 1‑year LC rate was 93.6% (95% CI, 87.6-100%). The median OS was 19.8 months (95% CI, 11.6-30.6 months). SBRT-related grade 3 or higher adverse gastrointestinal events and treatment-related death occurred in three (2.8%) and one patient (1.4%) respectively. No patient developed classical radiation-induced liver injury. CONCLUSION Our experience suggests that combined TACE and SBRT can be a safe and effective initial therapy for BCLC stage B-C HCC with appropriate patient selection. Further prospective trials are warranted.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Mark K H Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China. .,Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany.
| | - Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Oliver Blanck
- Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
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Lee SF, Chiang CL, Lee FAS, Wong YW, Poon CM, Wong FCS, Tung SY. Outcome of neoadjuvant chemoradiation in MRI staged locally advanced rectal cancer: Retrospective analysis of 123 Chinese patients. J Formos Med Assoc 2018; 117:825-832. [DOI: 10.1016/j.jfma.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022] Open
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Chiang CL, Yeung CSY, Wong MYP, Lee VWY, Lee VHF, Lee FAS, Wong FCS. Stereotactic Body Radiotherapy for Pancreatic Cancer. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716861] [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: 11/05/2022] Open
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Chiang CL, Lee FAS, Wong YW, Poon CM, Choi CKK, Wong FCS, Sze WK, Tung SY. Short-course Preoperative Radiotherapy with Delayed Surgery for Locally Advanced Rectal Cancer. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716844] [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: 11/05/2022] Open
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Yeo W, Lam KO, Law AL, Chiang CL, Lee CC, Au KH. Authors' reply. Hong Kong Med J 2017; 23:315-316. [PMID: 28572525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- W Yeo
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - A Ly Law
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - C L Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - C Cy Lee
- Department of Clinical Oncology, United Christian Hospital, Kwun Tong, Hong Kong
| | - K H Au
- Department of Clinical Oncology, United Christian Hospital, Kwun Tong, Hong Kong
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Chan M, Chiang CL, Lee V, Cheung S, Leung R, Wong M, Lee F, Blanck O. Target localization of 3D versus 4D cone beam computed tomography in lipiodol-guided stereotactic radiotherapy of hepatocellular carcinomas. PLoS One 2017; 12:e0174929. [PMID: 28384187 PMCID: PMC5383048 DOI: 10.1371/journal.pone.0174929] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/18/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Aim of this study was to comparatively evaluate the accuracy of respiration-correlated (4D) and uncorrelated (3D) cone beam computed tomography (CBCT) in localizing lipiodolized hepatocellular carcinomas during stereotactic body radiotherapy (SBRT). METHODS 4D-CBCT scans of eighteen HCCs were acquired during free-breathing SBRT following trans-arterial chemo-embolization (TACE) with lipiodol. Approximately 1320 x-ray projections per 4D-CBCT were collected and phase-sorted into ten bins. A 4D registration workflow was followed to register the reconstructed time-weighted average CBCT with the planning mid-ventilation (MidV) CT by an initial bone registration of the vertebrae and then tissue registration of the lipiodol. For comparison, projections of each 4D-CBCT were combined to synthesize 3D-CBCT without phase-sorting. Using the lipiodolized tumor, uncertainties of the treatment setup estimated from the absolute and relative lipiodol position to bone were analyzed separately for 4D- and 3D-CBCT. RESULTS Qualitatively, 3D-CBCT showed better lipiodol contrast than 4D-CBCT primarily because of a tenfold increase of projections used for reconstruction. Motion artifact was observed to subside in 4D-CBCT compared to 3D-CBCT. Group mean, systematic and random errors estimated from 4D- and 3D-CBCT agreed to within 1 mm in the cranio-caudal (CC) and 0.5 mm in the anterior-posterior (AP) and left-right (LR) directions. Systematic and random errors are largest in the CC direction, amounting to 4.7 mm and 3.7 mm from 3D-CBCT and 5.6 mm and 3.8 mm from 4D-CBCT, respectively. Safety margin calculated from 3D-CBCT and 4D-CBCT differed by 2.1, 0.1 and 0.0 mm in the CC, AP, and LR directions. CONCLUSIONS 3D-CBCT is an adequate alternative to 4D-CBCT when lipoid is used for localizing HCC during free-breathing SBRT. Similar margins are anticipated with 3D- and 4D-CBCT.
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Affiliation(s)
- Mark Chan
- Department of Radiation Oncology, University Medical Center Schleswig–Holstein, Kiel, Germany
- * E-mail:
| | - Chi Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong (S.A.R)
- Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, China
| | - Venus Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong (S.A.R)
| | - Steven Cheung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Ronnie Leung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Matthew Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Frankle Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig–Holstein, Kiel, Germany
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Yeo W, Lam KO, Law AL, Lee CC, Chiang CL, Au KH, Mo FK, So TH, Lam KC, Ng WT, Li L. Adjuvant S-1 chemotherapy after curative resection of gastric cancer in Chinese patients: assessment of treatment tolerability and associated risk factors. Hong Kong Med J 2016; 23:54-62. [PMID: 27966431 DOI: 10.12809/hkmj164885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/05/2022] Open
Abstract
INTRODUCTION The use of adjuvant chemotherapy with S-1 (tegafur, gimeracil, and oteracil potassium) has been shown to improve the outcome of patients with gastric cancer. There are limited data on the tolerability of S-1 in Chinese patients. In this multicentre retrospective study, we assessed the toxicity profile in local patients. METHODS Patients with stage II-IIIC gastric adenocarcinoma who had undergone curative resection and who had received S-1 adjuvant chemotherapy were included in the study. Patient demographics, tumour characteristics, chemotherapy records, as well as biochemical, haematological, and other toxicity profiles were extracted from medical charts. Potential factors associated with grade 2-4 toxicities were identified. RESULTS Adjuvant S-1 was administered to 30 patients. Overall, 19 (63%) patients completed eight cycles. The most common grade 3-4 adverse events included neutropaenia (10%), anaemia (6.7%), septic episode (16.7%), diarrhoea (6.7%), hyperbilirubinaemia (6.7%), and syncope (6.7%). Dose reductions were made in 22 (73.3%) patients and 12 (40.0%) patients had dose delays. Univariate analyses showed that patients who underwent total gastrectomy were more likely to experience adverse haematological events (P=0.034). Patients with nodal involvement were more likely to report adverse non-haematological events (P=0.031). Patients with a history of regular alcohol intake were more likely to have earlier treatment withdrawal (P=0.044). Lower body weight (P=0.007) and lower body surface area (P=0.017) were associated with dose interruptions. CONCLUSIONS The tolerability of adjuvant S-1 in our patient population was similar to that in other Asian patient populations. The awareness of S-1-related toxicities and increasing knowledge of potential associated factors may enable optimisation of S-1 therapy.
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Affiliation(s)
- W Yeo
- Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - A Ly Law
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - C Cy Lee
- Department of Clinical Oncology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - K H Au
- Department of Clinical Oncology, United Christian Hospital, Kwun Tong, Hong Kong
| | - F Kf Mo
- Comprehensive Clinical Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - T H So
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - K C Lam
- Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
| | - W T Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - L Li
- Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
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Lee SF, Chiang CL, Lee AS, Wong FCS, Tung SY. Severe ileitis associated with capecitabine: Two case reports and review of the literature. Mol Clin Oncol 2015; 3:1398-1400. [PMID: 26807255 DOI: 10.3892/mco.2015.635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022] Open
Abstract
Capecitabine is a commonly used anticancer drug, which has been associated with adverse events, including skin and gastrointestinal symptoms, such as vomiting and diarrhea. We herein present treated two rare cases of capecitabine-associated ileitis. In one of the patients, ileitis occurred during combination chemotherapy for metastatic colon cancer, despite previous good tolerance to this drug; the other patient developed ileitis following adjuvant single-agent treatment. The first case is unlike previously reported cases, in which patients had no past exposure to capecitabine. Ileitis may be severe but reversible with early diagnosis and proper supportive treatment, and patients may resume chemotherapy following capecitabine discontinuation.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Chi Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Frank Chi Shing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Stewart Yuk Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
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Lee AS, Zee BC, Cheung FY, Kwong P, Cheng ACK, Lai M, Kwok C, Chong M, Jolivet J, Chiang CL, Leung KC, Siu S, Lee C, Tung SY. Randomized phase II study of the x-linked inhibitor of apoptosis (XIAP) antisense AEG35156 in combination with sorafenib in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4105 Background: XIAP inhibits caspases which are proteases responsible for apoptotic cell death. It is highly expressed in HCC. AEG35156 is a second generation antisense oligonucleotide targeting XIAP mRNA, thus lowers the apoptotic threshold of cancer cells. It also accumulates in the liver. This study is designed to assess the added benefit of combining AEG35156 with sorafenib. Methods: Patients with histologically or clinically diagnosed (AASLD criteria) HCC who had failed or were unsuitable for resection or ablative therapies were randomized (2:1) to receive either weekly injection of AEG35156 300mg in combination with sorefanib 400mg BID or sorefanib alone. The primary end point was progression-free survival (PFS). Other endpoints were overall survival (OS), response rates and safety. Results: 51 patients were recruited. 48 patents were evaluable. There were 31 patients in the combination arm and 17 in the control arm. The median age was 60. 88% of patients were male. 81% of patients were hepatitis B carrier. 90% of patients belong to Child-Pugh class A. The median follow-up was 16.2 months. The PFS for the combination arm was 4.0 months (95% CI: 1.2-4.1) and 2.6 months for control arm. The OS for the combination arm was 6.5 months (95% CI: 3.9-11.5) and 5.4 months for the control arm. There were 3 partial responders (Choi’s criteria) in the combination arm (10%, 95% CI: 3-27%) and none (0%) in the control arm. Patients who had the study treatment interrupted (PFS 4.0, 95% CI: 2.4-5.4) or had dose modification (PFS 4.45, 95% CI: 1.0-6.5) according to protocol did significantly better than those who had no dose reduction (PFS 1.2, 95% CI: 1.2-4.0) and those in the control arm (PFS 2.6, 95% CI: 1.2-5.4). This also applies to OS. Regarding toxicities, there were one AEG35156 related serious adverse event (SAE) of hypersensitivity and two sorafenib related gastrointestinal SAE. Conclusions: AEG35156 in combination with Sorafenib was well tolerated in patients with advanced HCC. Dose reduced AEG35156 in combination with sorafenib have shown more activity than sorafenib alone and warrants further investigation.
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Affiliation(s)
| | | | | | | | | | - Maria Lai
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chloe Kwok
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Marc Chong
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jacques Jolivet
- Aegera Therapeutics (Pharmascience Inc.), Montreal, QC, Canada
| | | | - K C Leung
- Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Steven Siu
- Queen Mary Hospital, North Point, Hong Kong
| | - Conrad Lee
- Princess Margaret Hospital, Kowloon, Hong Kong
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Wong GKC, Chiang CL, To KF, Ng HK, Ching SC, Poon WS. Klebsiella meningitis mimicking clinical deterioration from hemorrhage of a complex posterior fossa arteriovenous malformation. Am J Forensic Med Pathol 2006; 27:271-3. [PMID: 16936510 DOI: 10.1097/01.paf.0000221090.03770.ac] [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] [Indexed: 11/25/2022]
Abstract
We report a case of a 33-year-old male with a history of complex posterior fossa arteriovenous malformation (AVM) with partial resection done in China; at follow-up in our unit, he presented with a 1-day history of acute deterioration of consciousness level after minor head injury. The clinical and radiologic features were compatible with spontaneous hemorrhage from the AVM, and the patient died 1 day after admission. However, postmortem examination revealed the direct cause of death was due to Klebsiella meningitis. The clinical catch is highlighted, and the importance of early and prompt detection of this condition is emphasized.
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Affiliation(s)
- George K C Wong
- Division of Neurosurgery, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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Hwang TL, Chiang CL, Wang PN. Parenteral nutrition support after bone marrow transplantation: comparison of total and partial parenteral nutrition during the early posttransplantation period. Nutrition 2001; 17:773-5. [PMID: 11527677 DOI: 10.1016/s0899-9007(01)00628-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
OBJECTIVE Bone marrow transplantation (BMT) usually is indicated if the patient's malignant disease involves the marrow or if hazard to the normal marrow is the limiting factor in the aggressive treatment of disease. The success of BMT depends on a complete team with all the resources needed to ensure optimal results. Aggressive nutrition support after BMT is very important. Adequate parenteral nutrition, total (TPN) or partial, followed by enteral nutrition according to the patient's gastrointestinal function is the important principle. METHODS Between 1996 and 2000, 60 patients, 46 male and 14 female, received BMT in Chang Gung Memorial Hospital. Their ages ranged from 6 to 54 y. Standard TPN was used in 40 patients after BMT, and partial parenteral nutrition was used in the remaining 20 patients. TPN was enriched with branched-chain amino acids (BCAA) when the patient's liver functions were impaired, and cyclic TPN was shifted when the patient's liver functions persistently deteriorated. RESULTS Most patients improved their nutrition status and increased their body weights, especially those receiving TPN. The patients receiving partial parenteral nutrition decreased their visceral proteins significantly during the course of parenteral nutrition. The BCAA-TPN can maintain a patient's visceral protein better than standard TPN. Only two patients expired because of graft rejection and sepsis; their body weights and nutrition status showed deterioration despite aggressive nutrition support. CONCLUSIONS We conclude that the nutrition support for patients with BMT is related to the success of marrow transplantation. Parenteral nutrition support, especially with TPN, is important because of frequent gastrointestinal dysfunction during the posttransplantational period, and it is better at maintaining the nutrition status and body weights of patients after BMT. An oral diet can be resumed after the patient's gastrointestinal function has improved and it can be tolerated.
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Affiliation(s)
- T L Hwang
- Department of Nutritional Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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39
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Abstract
Stable anisotropic gold nanoparticles were prepared by the reduction of tetrachloroauric acid with hydrazine in mixed reverse micelles formed with anionic surfactant Aerosol-OT and nonionic surfactant sorbitan monooleate (Span80) in isooctane. It was found that the Span80 serves not only as a structure modifier but also as a stabilizer for Au particles, to prevent their further growth and precipitation. The control of particle size, shape, and degree of dispersion was achieved by varying the process variables, such as molar ratio of reduction agent to metal salt, size of water droplets (omega(o)), concentration of metal salt, and sequence of addition of metal salt into the mixed reverse micelles. When the HAuCl(4) was injected directly into the mixed reversed micelles containing hydrazine, nonspherical gold nanoparticles, such as rods and cubes, were obtained at the molar ratio of hydrazine to HAuCl(4) of less than 1.0. The nonspherical Au particles were preferably formed at larger omega(o) value and lower gold salt loading. By the analyses of high-resolution electron microscope, electron diffraction pattern, and energy-dispersive X-ray analysis (EDX), the resultant particles have been found to be pure gold of face-centered cubic structure. Copyright 2000 Academic Press.
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Affiliation(s)
- CL Chiang
- Department of Chemical Engineering, Southern Taiwan University of Technology, 710 Yung-Kang City, Tainan Hsien, Taiwan, Republic of China
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Liu DW, Tsao YP, Hsieh CH, Hsieh JT, Kung JT, Chiang CL, Huang SJ, Chen SL. Induction of CD8 T cells by vaccination with recombinant adenovirus expressing human papillomavirus type 16 E5 gene reduces tumor growth. J Virol 2000; 74:9083-9. [PMID: 10982354 PMCID: PMC102106 DOI: 10.1128/jvi.74.19.9083-9089.2000] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 05/02/2000] [Accepted: 07/14/2000] [Indexed: 11/20/2022] Open
Abstract
The potential of the E5 protein as a tumor vaccine candidate has not been explored yet. In this study, we evaluate the human papillomavirus type 16 (HPV-16) E5 protein delivered by an adenovirus vector as a tumor vaccine for cervical lesions. The results demonstrate that a single intramuscular injection of a recombinant adenovirus carrying the HPV-16 E5 gene into syngeneic animals can reduce the growth of tumors which contain E5 gene expression. Moreover, the E5 vaccine-induced tumor protection occurs through CD8 T cells but not through CD4 T cells in in vitro assays. In addition, our studies using knockout mice with distinct T-cell deficiencies confirm that cytotoxic T-lymphocyte-induced tumor protection is CD8 dependent but CD4 independent. Hence, HPV-16 E5 can be regarded as a tumor rejection antigen.
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Affiliation(s)
- D W Liu
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
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41
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Lin SC, Chung TC, Ueng TH, Lin YH, Hsu SH, Chiang CL, Lin CC. The hepatoprotective effects of Solanum alatum Moench. on acetaminophen-induced hepatotoxicity in mice. Am J Chin Med 2000; 28:105-14. [PMID: 10794122 DOI: 10.1142/s0192415x00000131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Solanum alatum Moench. has been shown to have a protective effect against carbon tetrachloride (CCl4)-induced liver injury. Solanum alatum treatment (100 mg/kg, p.o.) decreased the elevation of serum alanine aminotransferase (ALT; GPT) and aspartate aminotransferase (AST; GOT) induced by acetaminophen (paracetamol) (600 mg/kg, i.p.) administration. It also decreased the extent of visible necrosis in liver tissue. In addition, Solanum alatum treatment restored hepatic glutathione (GSH) depletion induced by acetaminophen (600 mg/kg, i.p.) administration. Microsomal enzyme levels such as P-450, reductase, and aniline hydroxylation enzyme were also restored to normal levels after Solanum alatum administration. The hepatoprotective mechanism may function through direct binding with acetaminophen toxic metabolites, decreasing the attraction of acetaminophen metabolites for other cellular GSH or thiol protein. Additionally, Solanum alatum treatment increased the concentration of hepatic GSH and maintained a high level activity of GSTase, which led to acceleration of the excretion of toxic acetaminophen metabolites.
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Affiliation(s)
- S C Lin
- Department of Pharmacology, Taipei Medical College, Taiwan
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42
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Lin SC, Chung CY, Chiang CL, Hsu SH. The influence of propolis ethanol extract on liver microsomal enzymes and glutathione after chronic alcohol administration. Am J Chin Med 1999; 27:83-93. [PMID: 10354820 DOI: 10.1142/s0192415x99000112] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Propolis designates a series of gums, resins and balms of viscous consistency, which are gathered by honeybees from certain parts, mainly the buds and barks of plants, especially those found on coniferous trees. Bees bring propolis back to the hive, where it is modified and mixed with other substances including the bees' own wax and salivary secretions. In this study, the influences of propolis ethanol extract on chronic alcohol induced liver microsomal enzyme changes were investigated. Three grams of alcohol was added to rats' daily diet for four weeks to induce chronic alcohol liver injuries, and two different doses of propolis ethanol extract were p.o. administrated three times per day on the 28th, 29th, and 30th day. During the period of propolis administration, the ethanol diet was continued. After sacrifice, the rat livers were excised for assay of microsomal enzymes activity, glutathione (GSH) concentration, glutathione-S-transferase (GSTase) and gamma-glutamylcysteine synthetase (gamma-GCSase) activity. It was found that 30 mg/kg of propolis ethanol extract significantly prevented the elevations of total cytochrome P-450 enzymes, NADPH-dependent cytochrome C reductase, aniline hydroxylation, 7-ethoxyresorufin hydroxylation (7-ERH), 7-penthoxyresorufin hydroxylation (7-PRH), and lipid peroxidation induced by chronic ethanol administration. Additionally, propolis ethanol extract (100 mg/kg) also induced GSTase and gamma-GCSase activities and decreased glutathione levels in the liver.
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Affiliation(s)
- S C Lin
- Department of Pharmacology, Taipei Medical College, Taiwan
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Abstract
This is the second of two reports on a study of the durations related to marriage. Divorce and death of one's spouse, the main causes of dissolution of marriage, are two of the most important events in a person's life. In the United States in 1994, 30.7 million, or 16.2%, of the adult population were either divorced or widowed. Among the widowed, the female to male ratio was 5 to 1! In this paper duration of separation due to divorce and duration of widowhood are the main variables under study. Algebraic formulas are derived and computer programs are written for estimating these durations for husbands and wives, and for living couples of any age. Relations with the duration of marriage, the expectation of life, and the family life cycle are also presented.
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Affiliation(s)
- C L Chiang
- School of Public Health, University of California, Berkeley, California, 94720, USA
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Abstract
In the functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994), reinforcer duration varied across conditions (e.g., brief attention vs. 30 s of escape); this may result in unequal exposure to the establishing operations for aberrant behavior. In this study, we compared the effects of unequal and equal reinforcer duration during a functional analysis. The results showed that reinforcer duration affects the rate of aberrant behavior and may potentially alter functional analysis interpretation.
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Affiliation(s)
- W W Fisher
- Neurobehavioral Unit, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA
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Tsai SW, Wei HJ, Chiang CL. Action of lipolytical enzymes in biphasic organic-aqueous systems: dynamics of the irreversible Michaelis-Menten reaction. Biotechnol Bioeng 1993; 41:603-11. [PMID: 18609595 DOI: 10.1002/bit.260410602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Through simple model analysis, the mass action kinetic model for lipolytic enzymes in biphasic aqueous-organic systems can be simplified using the quasi-steady state assumption (or the quasi-equilibrium state assumption) for the adsorbed enzyme E* or the enzyme-substrate complex E*S. Some parameter combinations leading to the above assumptions are derived confirmed by full numerical integration of the whole enzymatic process. The results may be classified into three categories: (1) the quasi-equilibrium state assumption for E*, (2) the quasi-steady state assumption for E*, and (3) the quasi-steady state assumption for E*S. Further simplification for both E* and E*S is also discussed.
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Affiliation(s)
- S W Tsai
- Department of Chemical Engineering, National Cheng Kung University, Tainan, Taiwan, Republic of China
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Lin WC, Shen EY, Wong TT, Chiang CL, Wu CC, Chou KS. Early diagnosis of a vein of Galen aneurysm: report of a case. J Formos Med Assoc 1992; 91:1115-8. [PMID: 1363216] [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: 03/25/2023] Open
Abstract
Congenital vascular malformation with an aneurysm of the vein of Galen is rarely seen, particularly in the prenatal period. With the advancement of diagnostic techniques such as ultrasonography, we were able to detect a case prenatally and to diagnose it postnatally.
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Affiliation(s)
- W C Lin
- Department of Pediatrics, St. Mary Hospital, Lotung, Taiwan, R.O.C
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Abstract
The two-state recurrent stochastic model with time-independent transition rates is generalized to a model with time-dependent transition rates. The rates can be any general function of external time, that is, any general function of the calendar time in which the process unfolds. Formulas for the state transition probabilities, the proportion of individuals in a particular state at time t, the distribution function, and the expectation of the number of individuals in a particular state at time t are derived.
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Affiliation(s)
- S S Kenley
- Syntex Research, Palo Alto, California 94303
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48
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Affiliation(s)
- C L Chiang
- School of Public Health, University of California, Berkeley 94720
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49
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Abstract
In this paper, Lotka's intrinsic rate of current population growth is evaluated. A new method of computing the net reproduction rate and a new rate of population growth are proposed. The proposed rate is the rate of growth of the female population per woman per year. The rate is positive, equal to zero, or negative as a population is increasing, remaining stationary, or decreasing. The rate for the 1987 U.S. white female population was R = -0.0037. This means that the white population was decreasing in 1987 and was losing 3.7 females for every 1000 women per year.
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Affiliation(s)
- C L Chiang
- School of Public Health, University of California, Berkeley
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50
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Abstract
The concept of pore size distribution is incorporated into the Clark model of enzyme immobilization in the present study. This refined model predicted that in the case of small harmonic pore radius with the same surface area and porosity of the support, more enzyme could be loaded in a support with nonuniform pores than that with uniform pores. In comparing the enzyme loading efficiency of the support with two different pore size distributions, the one with Gaussian distribution had the greater amount of enzyme immobilized than the other one with Rajagopalan's distribution. Furthermore, more enzyme could be loaded in a support with wider Gaussian pore size distribution than that with narrower distribution. The immobilized enzyme profile in the solid support with pore size distribution displayed a stepwise pattern which differed appreciably from the sigmoidal profile predicted for the support with uniform pore size. This stepwise enzyme distribution profile became sigmoidal with decreasing h(T) or increasing k. The new model could be used for designing protocols for an enzyme immobilization process.
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Affiliation(s)
- C L Chiang
- Institute of Biomedical Engineering, National Yang-Ming Medical College, Taipei, Taiwan, Republic of China
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