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Cheung FY, Appleton ND, Rout S, Kalaiselvan R, Nicholson JA, Samad A, Chadwick M, Rajaganeshan R. Video-assisted anal fistula treatment: a high volume unit initial experience. Ann R Coll Surg Engl 2018; 100:37-41. [PMID: 29046093 PMCID: PMC5849203 DOI: 10.1308/rcsann.2017.0187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Accepted: 08/28/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Perianal fistulas are a common problem. Video-assisted anal fistula treatment is a new technique for the management of this difficult condition. We describe our initial experience with the technique to facilitate the treatment of established perianal fistulas. Methods We reviewed a prospectively maintained database relating to consecutive patients undergoing video-assisted anal fistula treatment in a single unit. Results Seventy-eight consecutive patients had their perianal fistulas treated with video-assistance from November 2014 to June 2016. Complete follow-up data were available in 74 patients, with median follow-up of 14 months (interquartile range 7-19 months). There were no complications and all patients were treated as day cases. Most patients had recurrent disease, with 57 (77%) having had previous fistula surgery. At follow-up, 60 (81%) patients reported themselves 'cured' (asymptomatic) including 5 patients with Crohn's disease and one who had undergone 10 previous surgical procedures. Logistical stepwise regression did not demonstrate any statistically significant factors that may have been considered to affect outcome (age, gender, diabetes, previous I&D, Crohn's disease, smoking, type of fistula). Conclusions Our data have shown that video-assisted anal fistula treatment is safe and effective in the management of perianal fistulas in our patients and this suggests it may be applied to all patients regardless of comorbidity, underlying pathology or type of fistula.
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Affiliation(s)
- FY Cheung
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - ND Appleton
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - S Rout
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - R Kalaiselvan
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - JA Nicholson
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - A Samad
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - M Chadwick
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
| | - R Rajaganeshan
- Department of General Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, UK
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Sze H, Chan LLK, Ng WT, Hung AWM, Lee MCH, Chang ATY, Chan OSH, Cheung FY, Yeung RMW, Lee AWM. Should all nasopharyngeal carcinoma with masticator space involvement be staged as T4? Oral Oncol 2014; 50:1188-95. [PMID: 25261296 DOI: 10.1016/j.oraloncology.2014.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 06/25/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The prognostic significance of the involvement of anatomical masticator space (MS) in nasopharyngeal carcinoma (NPC) was retrospectively reviewed. MATERIAL AND METHODS 1104 Patients with non-metastatic NPC treated with radical radiotherapy between 1998 and 2010 were re-staged according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system; tumors with medial pterygoid muscle (MP) and/or lateral pterygoid muscle (LP) involvement but did not fulfill the criteria for T3 or T4 were staged as TX. The tumor volume data, dosimetric data and survival endpoints of different T stage diseases were analyzed and compared to study the significance of MS involvement. RESULTS The overall MS involvement rate was 61.0%. The median volumes of the primary gross tumor volume were 9.6ml, 15.2ml, 19.9ml, 32.6ml and 77.3ml for T1, T2, TX, T3 and T4, respectively (p<0.001). T1, T2 and TX tumors received higher minimum dose to the gross tumor volume and planning target volume than T3 and T4. Multivariate analysis showed that age, gender, T-/N-classification and the use of chemotherapy were significant prognostic factors for various survival end-points. Patients with TX disease had similar survival rates as with T1-T2; and had a significantly better 5-year overall survival rate (86.6% vs. 76.6%; p=0.013) and a trend of higher 5-year distant failure-free survival rate (91.5% vs. 81.3%; p=0.09) than patients with T3 disease. CONCLUSION NPC with the involvement of MP and/or LP alone should be classified as T2 disease.
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Affiliation(s)
- Henry Sze
- Department of Clinical Oncology, Faculty of Medicine, The University of Hong Kong, China.
| | - Lucy L K Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - W T Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Albert W M Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Michael C H Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Amy T Y Chang
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Oscar S H Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - F Y Cheung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Rebecca M W Yeung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Anne W M Lee
- Clinical Oncology Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
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Mok FST, Chan OSH, Chang ATY, Chan LLK, Soong IS, Ng WT, Cheung FY, Yeung RMW. Treatment Outcomes of Primary Pulmonary Lymphoepithelioma-like Carcinoma: a Series of 22 Patients and Treatment Strategy Review. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1313176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Cheung FY, Leung KC, Ngan RKC. Docetaxel chemotherapy for Chinese patients with castrate-resistant prostate cancer. Hong Kong Med J 2013; 19:237-41. [DOI: 10.12809/hkmj133804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Cheung FY, Mang OWK, Law SCK. A population-based analysis of incidence, mortality, and stage-specific survival of cervical cancer patients in Hong Kong: 1997-2006. Hong Kong Med J 2011; 17:89-95. [PMID: 21471587] [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: 05/30/2023] Open
Abstract
OBJECTIVES To determine the trends in incidence and mortality of cervical cancer patients diagnosed during 1997 to 2006, and to describe stage-specific survival using population-based cancer registry data. DESIGN Retrospective, population-based study. SETTING Hong Kong. PATIENTS All patients diagnosed with cervical cancer between 1997 and 2006. Patients eligible for survival analysis were followed up till 31 December 2007. MAIN OUTCOME MEASURES Age-standardised incidence and mortality rates and average annual percent changes in these parameters were calculated using the Poisson regression model. Survival was expressed as relative survival rate using a period approach. Hazard ratios of mortality including 95% confidence intervals for certain variables were estimated using the Cox proportional hazards model. RESULTS During the 10-year period of the study, overall annual incidence and mortality rates decreased by 4.2% and 6.0%, respectively. Significant rates of reduction were observed in all age-groups except those younger than 45 years. The reduction in incidence of squamous cell carcinoma (3.6% annually) was less than that of adenocarcinoma (5.2%) and other histological types (6.8%). In all, 3807 (86.4%) of the patients were included in survival analysis. The overall 5-year relative survival rate was 71.3% (95% confidence interval, 69.5-73.1%), while the values for stages I, II, III, and IV were 90.9%, 71.0%, 41.7%, and 7.8%, respectively. Age, stage, and histology were independent prognostic factors. Survival of stage IA patients was as good as that of the general population. CONCLUSIONS As in other industrialised countries, the incidence and mortality rate of cervical cancer were decreasing. Stage-specific population-based cancer survival was available for the first time, and was useful as an indicator of cancer control. Collaboration between public and private sectors to further improve the follow-up data could provide more comprehensive surveillance information.
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Affiliation(s)
- F Y Cheung
- Hong Kong Cancer Registry, R Block, 1/F, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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Chan ATC, Leung SF, Ngan RKC, Teo PML, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TSK, Yau S, Yuen KT, Mo FKF, Lai MMP, Ma BBY, Kam MKM, Leung TWT, Johnson PJ, Choi PHK, Zee BCY. Overall Survival After Concurrent Cisplatin-Radiotherapy Compared With Radiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma. J Natl Cancer Inst 2005; 97:536-9. [PMID: 15812080 DOI: 10.1093/jnci/dji084] [Citation(s) in RCA: 349] [Impact Index Per Article: 18.4] [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: 11/13/2022] Open
Abstract
This phase III randomized study compared concurrent cisplatin-radiotherapy (CRT) versus radiotherapy (RT) alone in patients with locoregionally advanced nasopharyngeal carcinoma. A total of 350 patients were randomly assigned to receive external RT alone or concurrently with cisplatin at a dosage of 40 mg/m(2) weekly. The primary endpoint was overall survival, and the median follow-up was 5.5 years. The 5-year overall survival was 58.6% (95% confidence interval [CI] = 50.9% to 66.2%) for the RT arm and 70.3% (95% CI = 63.4% to 77.3%) for the CRT arm. In Cox regression analysis adjusted for T stage, age, and overall stage, the difference in overall survival was statistically significantly in favor of concurrent CRT (P = .049, hazard ratio [HR] = 0.71 [95% CI = 0.5 to 1.0]). Subgroup analysis demonstrated that there was no difference between overall survival in the arms for T1/T2 stage (P = .74, HR = 0.93 [95% CI = 0.59 to 1.4]), whereas there was a difference between the arms for T3/T4 stage (P = .013, HR = 0.51 [95% CI = 0.3 to 0.88]), favoring the CRT arm. The regimen of weekly concurrent CRT is a promising standard treatment strategy for locoregionally advanced nasopharyngeal carcinoma patients.
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Affiliation(s)
- Anthony T C Chan
- Department of Clinical Oncology, Sir Y. K. Pao Center for Cancer, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T. Hong Kong
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Chan AT, Ngan R, Teo P, Leung SF, Yiu HY, Yeo W, Mok T, Cheung FY, Kwan W, Zee B. Final results of a phase III randomized study of concurrent weekly cisplatin-RT versus RT alone in locoregionally advanced nasopharyngeal carcinoma (NPC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5523] [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: 11/20/2022] Open
Affiliation(s)
- A. T. Chan
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - R. Ngan
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - P. Teo
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - S. F. Leung
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - H. Y. Yiu
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - W. Yeo
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - T. Mok
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - F. Y. Cheung
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - W. Kwan
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
| | - B. Zee
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China; Queen Elizabeth Hospital, Hong Kong, Hong Kong Special Administrative Region of China
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Ngan RKC, Yiu HHY, Lau WH, Yau S, Cheung FY, Chan TM, Kwok CH, Chiu CY, Au SK, Foo W, Law CK, Tse KC. Combination gemcitabine and cisplatin chemotherapy for metastatic or recurrent nasopharyngeal carcinoma: report of a phase II study. Ann Oncol 2002; 13:1252-8. [PMID: 12181249 DOI: 10.1093/annonc/mdf200] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [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: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and toxicity of combination gemcitabine plus cisplatin (GC) chemotherapy in metastatic or recurrent nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS Forty-four patients of Chinese ethnicity with metastatic or recurrent NPC received ambulatory GC chemotherapy every 28 days (gemcitabine 1000 mg/m(2) days 1, 8 and 15; cisplatin 50 mg/m(2) days 1 and 8). There were 40 male and four female patients with a mean age of 47.4 years. More than half (54.5%) of the patients had received either prior platinum-based chemotherapy and/or radiotherapy to target lesions. RESULTS There were nine complete responses and 23 partial responses in the 44 patients, achieving an overall response rate of 73% (78% for the 41 assessable patients). The mean duration of response was 5.3 months. Improved subjective symptom-control scores were found in 78% of patients with pre-existing symptoms, while 64% of patients experienced improved general well-being scores. Toxicity was mainly hematological: grade III/IV anemia, granulocytopenia and thrombocytopenia were found in 11, 37 and 16% of cycles, respectively. With a median follow-up of 17.2 months, 62% survived 1 year while 36% were alive and progression free. CONCLUSIONS Gemcitabine plus cisplatin chemotherapy offers a satisfactory overall response rate, subjective patient improvement and safety profile for metastatic and recurrent NPC.
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Affiliation(s)
- R K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong.
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Chan ATC, Teo PML, Ngan RK, Leung TW, Lau WH, Zee B, Leung SF, Cheung FY, Yeo W, Yiu HH, Yu KH, Chiu KW, Chan DT, Mok T, Yuen KT, Mo F, Lai M, Kwan WH, Choi P, Johnson PJ. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 2002; 20:2038-44. [PMID: 11956263 DOI: 10.1200/jco.2002.08.149] [Citation(s) in RCA: 387] [Impact Index Per Article: 17.6] [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: 12/28/2022] Open
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) is highly sensitive to both radiotherapy (RT) and chemotherapy. This randomized phase III trial compared concurrent cisplatin-RT (CRT) with RT alone in patients with locoregionally advanced NPC. PATIENTS AND METHODS Patients with Ho's N2 or N3 stage or N1 stage with nodal size > or = 4 cm were randomized to receive cisplatin 40 mg/m(2) weekly up to 8 weeks concurrently with radical RT (CRT) or RT alone. The primary end point was progression-free survival (PFS). RESULTS Three hundred fifty eligible patients were randomized. Baseline patient characteristics were comparable in both arms. There were significantly more toxicities, including mucositis, myelosuppression, and weight loss in the CRT arm. There were no treatment-related deaths in the CRT arm, and one patient died during treatment in the RT-alone arm. At a median follow-up of 2.71 years, the 2-year PFS was 76% in the CRT arm and 69% in the RT-alone arm (P =.10) with a hazards ratio of 1.367 (95% confidence interval [CI], 0.93 to 2.00). The treatment effect had a significant covariate interaction with tumor stage, and a subgroup analysis demonstrated a highly significant difference in favor of the CRT arm in Ho's stage T3 (P =.0075) with a hazards ratio of 2.328 (95% CI, 1.26 to 4.28). For T3 stage, the time to first distant failure was statistically significantly different in favor of the CRT arm (P =.016). CONCLUSION Concurrent CRT is well tolerated in patients with advanced NPC in endemic areas. Although PFS was not significantly different between the concurrent CRT arm and the RT-alone arm in the overall comparison, PFS was significantly prolonged in patients with advanced tumor and node stages.
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Affiliation(s)
- A T C Chan
- Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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