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Gupta A, McQuaid D, Dunlop A, Barnes H, Mohajer J, Smith G, Nartey J, Morrison K, Herbert T, Alexander S, McNair H, Newbold K, Nutting C, Bhide S, Harrington KJ, Wong KH. Measurement and Incorporation of Laryngeal Motion Using cine-MRI on an MR-Linear Accelerator to Generate Radiation Therapy Plans for Early-stage Squamous Cell Cancers of the Glottis. Adv Radiat Oncol 2024; 9:101490. [PMID: 38681895 PMCID: PMC11046225 DOI: 10.1016/j.adro.2024.101490] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Swallow-related motion of the larynx is most significant in the cranio-caudal directions and of` short duration. Conventional target definition for radical radiation therapy includes coverage of the whole larynx. This study longitudinally examined respiration- and swallow-related laryngeal motions using cine-magnetic resonance imaging. We further analyzed the dosimetry to organs at risk by comparing 3D-conformal radiation therapy (3D-CRT), volumetric modulated arc therapy (VMAT), and intensity modulated radiation therapy (IMRT) techniques. Methods Fifteen patients with T1-2 N0 glottic squamous cell carcinomas were prospectively recruited for up to 3 cine-MRI scans on the Elekta Unity MR-Linear accelerator, at the beginning, middle, and end of a course of radical radiation therapy. Swallow frequency and motion of the hyoid bone, cricoid and thyroid cartilages, and vocal cords were recorded during swallow and rest. Adapted treatment volumes consisted of gross tumor volume + 0.5-1 cm to a clinical target volume with an additional internal target volume (ITV) for personalized resting-motion. Swallow-related motion was deemed infrequent and was not accounted for in the ITV. We compared radiation therapy plans for 3D-CRT (whole larynx), VMAT (whole larynx), and VMAT and IMRT (ITV for resting motion). Results Resting- and swallow-related motions were most prominent in the cranio-caudal plane. There were no significant changes in the magnitude of motion over the course of radiation therapy. There was a trend of a progressive reduction in the frequency of swallow. Treatment of partial larynx volumes with intensity modulated methods significantly reduced the dose to carotid arteries, compared with treatment of whole larynx volumes. Robustness analysis demonstrated that when accounting for intrafraction swallow, the total dose delivered to the ITV/planning target volume was maintained at above 95%. Conclusions Swallow-related motions are infrequent and accounting for resting motion in an ITV is sufficient. VMAT/IMRT techniques that treat more conformal targets can significantly spare critical organs at risk such as the carotid arteries and thyroid gland, potentially reducing the risk of carotid artery stenosis-related complications and other long-term complications.
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Affiliation(s)
- Amit Gupta
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Dualta McQuaid
- The Joint Department of Physics, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Helen Barnes
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Jonathan Mohajer
- The Joint Department of Physics, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Gillian Smith
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Jayde Nartey
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Kian Morrison
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Trina Herbert
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Sophie Alexander
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Chris Nutting
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Kevin Joseph Harrington
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Kee Howe Wong
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Ansley W, Kamyab A, Noden L, Odutoye B, Williamson P, Wong KH, Dent P, Sharma A, Weller A, Pitiyage G, Ofo E. Does the extent of neck surgery based on preoperative calcitonin level influence survival in medullary thyroid carcinoma: a retrospective tertiary centre experience. Ann R Coll Surg Engl 2024. [PMID: 38661438 DOI: 10.1308/rcsann.2024.0033] [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: 04/26/2024] Open
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) is a rare thyroid cancer arising from the calcitonin-secreting parafollicular cells. Previous studies suggested a preoperative calcitonin level >200ng/l is an indication for prophylactic lateral neck dissection (LND) to remove micrometastases and improve survival outcomes. METHODS This retrospective single-centre study assessed the efficacy of preoperative calcitonin levels as a marker for determining need for prophylactic LND in MTC. Data were obtained on demographics, preoperative calcitonin levels, size and laterality of index tumour, type of neck dissection (central neck dissection (CND), LND), nodes removed, levels with involved nodes, number of nodes histologically involved, mortality, adjuvant therapy and locoregional recurrence. RESULTS A total of 33 patients were identified from St George's University Hospitals NHS Foundation Trust between 1 January 2001 and 19 August 2021; 8 were excluded for data quality issues. Of the 18 classified with a high preoperative calcitonin level (>200ng/l), 10 (56%) had a LND and 8 (44%) had a CND. In the low-calcitonin group, three (43%) patients had a CND only and four (57%) had a LND. There was no difference in absolute or disease-free survival between the low and high groups (p=0.960, p=0.817), or between those who had a CND and LND in the high-calcitonin group (p=0.607, hazard ratio (HR) 0.55; p=0.129, HR 8.78). CONCLUSION There was no statistically significant difference in outcomes between high and low calcitonin groups. A selective approach to performing LND in MTC patients based on clinical and imaging findings suggesting disease presence in the lateral neck should be explored further.
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Affiliation(s)
- W Ansley
- St George's University Hospitals NHS Foundation Trust, UK
- St George's University of London, UK
| | - A Kamyab
- St George's University Hospitals NHS Foundation Trust, UK
- St George's University of London, UK
| | | | - B Odutoye
- St George's University Hospitals NHS Foundation Trust, UK
| | - P Williamson
- St George's University Hospitals NHS Foundation Trust, UK
| | - K H Wong
- Royal Marsden NHS Foundation Trust, UK
| | - P Dent
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Sharma
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Weller
- St George's University Hospitals NHS Foundation Trust, UK
| | - G Pitiyage
- St George's University Hospitals NHS Foundation Trust, UK
| | - E Ofo
- St George's University Hospitals NHS Foundation Trust, UK
- St George's University of London, UK
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Bao KKH, Cheung KM, Chow JCH, Leung CWL, Wong KH. The real-world impact of the COVID-19 pandemic on patients with cancer: a multidisciplinary cross-sectional survey. Hong Kong Med J 2023; 29:132-141. [PMID: 37055192 DOI: 10.12809/hkmj219326] [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: 04/15/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to cancer care worldwide. We conducted a multidisciplinary survey of the real-world impact of the pandemic, as perceived by patients with cancer. METHODS A total of 424 patients with cancer were surveyed using a 64-item questionnaire constructed by a multidisciplinary panel. The questionnaire examined patient perspectives regarding COVID-19-related effects (eg, social distancing measures) on cancer care delivery, resources, and healthcare-seeking behaviour, along with the physical and psychosocial aspects of patient well-being and pandemic-related psychological repercussions. RESULTS Overall, 82.8% of respondents believed that patients with cancer are more susceptible to COVID-19; 65.6% expected that COVID-19 would delay anti-cancer drug development. Although only 30.9% of respondents felt that hospital attendance was safe, 73.1% expressed unaltered willingness to attend scheduled appointments; 70.3% of respondents preferred to receive chemotherapy as planned, and 46.5% were willing to accept changes in efficacy or side-effect profile to allow an outpatient regimen. A survey of oncologists revealed significant underestimation of patient motivation to avoid treatment interruptions. Most surveyed patients felt that there was an insufficient amount of information available concerning the impact of COVID-19 on cancer care, and most patients reported social distancing-related declines in physical, psychological, and dietary wellness. Sex, age, education level, socio-economic status, and psychological risk were significantly associated with patient perceptions and preferences. CONCLUSION This multidisciplinary survey concerning the effects of the COVID-19 pandemic revealed key patient care priorities and unmet needs. These findings should be considered when delivering cancer care during and after the pandemic.
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Affiliation(s)
- K K H Bao
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K M Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - J C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - C W L Leung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K H Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
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Lorimer C, Cheng L, Chandler R, Garcez K, Gill V, Graham K, Grant W, Sardo Infirri S, Wadsley J, Wall L, Webber N, Wong KH, Newbold K. Dabrafenib and Trametinib Therapy for Advanced Anaplastic Thyroid Cancer - Real-World Outcomes From UK Centres. Clin Oncol (R Coll Radiol) 2023; 35:e60-e66. [PMID: 36379836 DOI: 10.1016/j.clon.2022.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/18/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
AIMS Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer with a median survival of 4 months. Recent advances in molecular profiling have shown that up to half of ATCs harbour the BRAF-V600E mutation. The aim of this study was to provide real-world data and experience on the use of combination therapy dabrafenib and trametinib in patients with BRAF-V600E-mutated advanced ATC. MATERIALS AND METHODS We retrospectively evaluated patients with confirmed BRAF-V600E-mutated ATC, defined as patients with locally advanced or metastatic ATC with no locoregional, radical treatment options. Outcomes measured were overall survival, progression-free survival, response rate, discontinuation rate, dose reduction rate and toxicity data. RESULTS Seventeen patients were evaluated and the mean age was 68 years. Ten patients died by the time of censoring. The median duration of follow-up was 12 months (3-43 months). The estimated median overall survival was 6.9 months (95% confidence interval 2.46 months - upper confidence interval not reached) and the median progression-free survival was 4.7 months (95% confidence interval 1.4-7.8 months). Dose interruptions and/or reductions were common, but none of the patients had to permanently discontinue treatment because of toxicities. Severe toxicities (grades 3 and 4) were uncommon. CONCLUSIONS This study supports the indication of dabrafenib and trametinib in BRAF-V600E-mutated ATC as an effective and well-tolerated treatment in an historically difficult to treat cancer.
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Affiliation(s)
- C Lorimer
- The Royal Marsden Hospital, London, UK
| | - L Cheng
- The Royal Marsden Hospital, London, UK.
| | - R Chandler
- Northern Centre for Cancer Care, Newcastle Upon Tyne, UK
| | - K Garcez
- The Christie NHS Foundation Trust, Manchester, UK
| | - V Gill
- St James's Institute of Oncology, St James's Hospital, Leeds, UK
| | - K Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - W Grant
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | | | - J Wadsley
- Weston Park Cancer Centre, Sheffield, UK
| | - L Wall
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - N Webber
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - K H Wong
- The Royal Marsden Hospital, London, UK
| | - K Newbold
- The Royal Marsden Hospital, London, UK
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Chuk EYH, Chow JCH, Cheung KM, Tse SSW, Ho RCY, Wong HY, Yeung ANY, Wong KH. Absolute Lymphocyte Count in Cervical Cancer Patients Prior to Definitive Chemoradiotherapy: a Prognostic Indicator? Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217467] [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: 12/25/2022] Open
Affiliation(s)
- EYH Chuk
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - JCH Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - KM Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - SSW Tse
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - RCY Ho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - HY Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - ANY Yeung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
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Chan ALC, Wong KH, Tam KY, Man YY, Tang PY. Underestimation of Ductal Carcinoma In Situ and Invasive Ductal Carcinoma in Specimens Obtained with Stereotactic-Guided Vacuum-Assisted Biopsy. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217345] [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: 12/24/2022] Open
Affiliation(s)
- ALC Chan
- Department of Radiology, North District Hospital and Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - KH Wong
- Department of Radiology, North District Hospital and Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - KY Tam
- Department of Radiology, North District Hospital and Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - YY Man
- Department of Radiology, North District Hospital and Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - PY Tang
- Department of Radiology, North District Hospital and Alice Ho Miu Ling Nethersole Hospital, Hong Kong
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Chung HS, Chow JCH, Lam MHC, Ngan RKC, Wong KH. Clinicopathological Features, Prognostic Factors, and Treatment Outcomes in Non-metastatic Breast Cancer in Young Asian Women in Hong Kong. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217419] [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)
- HS Chung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - JCH Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - MHC Lam
- Department of Oncology, United Christian Hospital, Hong Kong
| | - RKC Ngan
- Department of Clinical Oncology, Gleneagles Hospital Hong Kong, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
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Tsui T, Cheung KM, Chow JCH, Wong KH. Risk Factors for Early Mortality in Head and Neck Cancer Patients Undergoing Definitive Chemoradiation. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217471] [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)
- T Tsui
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - KM Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - JCH Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
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Tsang THF, Wong KH, Allen K, Chan KKL, Chan MCM, Chao DVK, Cheung AN, Fan CYM, Hui EP, Ip DKM, Lam KO, Law CK, Law WL, Loong HHF, Wong KH, Wong MCS, Yeung RMW, Ying ACH, Ho RKW. Update on the Recommendations on Breast Cancer Screening by the Cancer Expert Working Group on Cancer Prevention and Screening. Hong Kong Med J 2022; 28:161-168. [PMID: 35400644 DOI: 10.12809/hkmj219622] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer (BC) is the most common cancer among women in Hong Kong. The Food and Health Bureau commissioned The University of Hong Kong (HKU) to conduct the Hong Kong Breast Cancer Study (HKBCS) with the aim of identifying relevant risk factors for BC in Hong Kong and developing a locally validated BC risk assessment tool for Hong Kong Chinese women. After consideration of the most recent international and local scientific evidence including findings of the HKBCS, the Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) has reviewed and updated its BC screening recommendations. Existing recommendations were preserved for women at high risk and slightly changed for women at moderate risk. The following major updates have been made concerning recommendations for other women in the general population: Women aged 44 to 69 with certain combinations of personalised risk factors (including presence of history of BC among first-degree relative, a prior diagnosis of benign breast disease, nulliparity and late age of first live birth, early age of menarche, high body mass index and physical inactivity) putting them at increased risk of BC are recommended to consider mammography screening every 2 years. They should discuss with their doctors on the potential benefits and harms before undergoing mammography screening. A risk assessment tool for local women (eg, one developed by HKU) is recommended to be used for estimating the risk of developing BC with regard to the personalised risk factors described above.
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Affiliation(s)
- T H F Tsang
- Hong Kong College of Community Medicine, Hong Kong
| | - K H Wong
- Centre for Health Protection, Department of Health, Hong Kong
| | - K Allen
- World Cancer Research Fund International, United Kingdom
| | - K K L Chan
- The Hong Kong College of Obstetricians and Gynaecologists, Hong Kong
| | | | - D V K Chao
- The Hong Kong College of Family Physicians, Hong Kong
| | - A N Cheung
- The Hong Kong College of Pathologists, Hong Kong
| | - C Y M Fan
- Professional Development and Quality Assurance Service, Department of Health, Hong Kong
| | - E P Hui
- Hong Kong College of Physicians, Hong Kong
| | - D K M Ip
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - C K Law
- Hong Kong College of Radiologists, Hong Kong
| | - W L Law
- The College of Surgeons of Hong Kong, Hong Kong
| | - H H F Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - K H Wong
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - M C S Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - R M W Yeung
- Hospital Authority (Clinical Oncology), Hong Kong
| | - A C H Ying
- The Hong Kong Anti-Cancer Society, Hong Kong
| | - R K W Ho
- Centre for Health Protection, Department of Health, Hong Kong
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Chiu CL, Wong KH, Lai MH, Lai YM. Anti-N-methyl-D-aspartate Receptor Encephalitis Magnetic Resonance Imaging and Clinical Features: A Case Series. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2117278] [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)
- CL Chiu
- Department of Radiology, North District Hospital, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - KH Wong
- Department of Radiology, North District Hospital, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - MH Lai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong
| | - YM Lai
- Department of Radiology, North District Hospital, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
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Gupta A, Dunlop A, Mitchell A, McQuaid D, Nill S, Barnes H, Newbold K, Nutting C, Bhide S, Oelfke U, Harrington KJ, Wong KH. Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach. Clin Transl Radiat Oncol 2022; 32:48-51. [PMID: 34849412 PMCID: PMC8608651 DOI: 10.1016/j.ctro.2021.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The Elekta Unity MR-Linac (MRL) has enabled adaptive radiotherapy (ART) for patients with head and neck cancers (HNC). Adapt-To-Shape-Lite (ATS-Lite) is a novel Adapt-to-Shape strategy that provides ART without requiring daily clinician presence to perform online target and organ at risk (OAR) delineation. In this study we compared the performance of our clinically-delivered ATS-Lite strategy against three Adapt-To-Position (ATP) variants: Adapt Segments (ATP-AS), Optimise Weights (ATP-OW), and Optimise Shapes (ATP-OS). METHODS Two patients with HNC received radical-dose radiotherapy on the MRL. For each fraction, an ATS-Lite plan was generated online and delivered and additional plans were generated offline for each ATP variant. To assess the clinical acceptability of a plan for every fraction, twenty clinical goals for targets and OARs were assessed for all four plans. RESULTS 53 fractions were analysed. ATS-Lite passed 99.9% of mandatory dose constraints. ATP-AS and ATP-OW each failed 7.6% of mandatory dose constraints. The Planning Target Volumes for 54 Gy (D95% and D98%) were the most frequently failing dose constraint targets for ATP. ATS-Lite median fraction times for Patient 1 and 2 were 40 mins 9 s (range 28 mins 16 s - 47 mins 20 s) and 32 mins 14 s (range 25 mins 33 s - 44 mins 27 s), respectively. CONCLUSIONS Our early data show that the novel ATS-Lite strategy produced plans that fulfilled 99.9% of clinical dose constraints in a time frame that is tolerable for patients and comparable to ATP workflows. Therefore, ATS-Lite, which bridges the gap between ATP and full ATS, will be further utilised and developed within our institute and it is a workflow that should be considered for treating patients with HNC on the MRL.
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Affiliation(s)
- Amit Gupta
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Adam Mitchell
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Dualta McQuaid
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Simeon Nill
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Helen Barnes
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Chris Nutting
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Uwe Oelfke
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Kevin Joseph Harrington
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Kee Howe Wong
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
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12
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Johnson D, Li L, Lee KC, Lam KO, Wong KH, Ho WM, Ma B. Total Neoadjuvant Therapy for High Risk Rectal Cancer in Western and Asian Populations – Current Evidence and Clinical Applications. Clin Colorectal Cancer 2021; 21:45-54. [DOI: 10.1016/j.clcc.2021.12.004] [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] [Received: 09/24/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
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13
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Gupta A, Wong KH, Newbold K, Bhide S, Nutting C, Harrington KJ. Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy. Front Oncol 2021; 11:753908. [PMID: 34616688 PMCID: PMC8488425 DOI: 10.3389/fonc.2021.753908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.
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Affiliation(s)
- Amit Gupta
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Kee Howe Wong
- Head and Neck Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kate Newbold
- Head and Neck Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shreerang Bhide
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Chris Nutting
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Kevin Joseph Harrington
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
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14
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Chow JCH, Lee A, Bao KKH, Cheung KM, Chan JCH, Tam AHP, Sung WWY, Tsui TYM, Chuk EYH, Chung DHS, Wong KH, Prayongrat A, Lertbutsayanukul C, Kannarunimit D, Chakkabat C, Kitpanit S. Cranial neuropathies in advanced nasopharyngeal carcinoma: Neurological recovery after modern radiotherapy and systemic chemotherapy. Radiother Oncol 2021; 163:221-228. [PMID: 34506830 DOI: 10.1016/j.radonc.2021.08.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/08/2022]
Abstract
OBJECTIVES Cranial neuropathy is a common presenting symptom of advanced T4 nasopharyngeal carcinoma (NPC). Data on neurological outcomes after modern intensity-modulated radiotherapy (IMRT) and chemotherapy are scarce. MATERIALS AND METHODS Case records of consecutive T4 NPC patients who received definitive IMRT in two tertiary oncology centers in 2004-2019 were reviewed. Patterns of cranial neuropathies at disease presentation were recorded. Time to neurological recovery and the rate of subsequent re-palsy were estimated by the Kaplan-Meier method. Clinical predictors were analyzed using multivariable Cox regression. RESULTS During the study period, 257 T4 NPC patients presented with 504 individual cranial neuropathies. The median time from neuropathy onset to NPC diagnosis was two months (IQR, 1-4 months). Cranial nerves (CN) VI (56.4%), V2 (47.9%), and V3 (29.2%) were most frequently involved. At a median follow-up of 6.4 years, the crude partial and full recovery rates of neuropathies were 111 (22%) and 289 (57.3%), respectively. CN III, IV, and VI had the highest 5-year full recovery rate (72.7%), followed by CN V1-3 (60.3%), XII (48.6%), and II (18.2%) (p < 0.001). Positive smoking history, optic nerve involvement, and longer duration of neuropathy were independent negative predictors for neurological recovery. After full recovery, re-palsy was observed in 6.9% (20/289) of the nerves, 60% of which co-occurred with local NPC recurrences. CONCLUSION Durable recovery of most cranial neuropathies in advanced T4 NPC was observed in the era of modern IMRT and effective systemic chemotherapy. Both patient and disease factors affected the chance of neurological recovery. Re-palsy of recovered nerves should prompt careful evaluation for local recurrence.
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Affiliation(s)
- James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Kelvin K H Bao
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K M Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Jeffrey C H Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anthony H P Tam
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Winnie W Y Sung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Therese Y M Tsui
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Elizabeth Y H Chuk
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Daniel H S Chung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K H Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anussara Prayongrat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chawalit Lertbutsayanukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Danita Kannarunimit
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chakkapong Chakkabat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sarin Kitpanit
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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15
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Nenclares P, Gunn L, Soliman H, Bover M, Trinh A, Leslie I, Wong KH, Melcher A, Newbold K, Nutting CM, Ap Dafydd D, Bhide SA, Harrington K. On-treatment immune prognostic score for patients with relapsed and/or metastatic head and neck squamous cell carcinoma treated with immunotherapy. J Immunother Cancer 2021; 9:e002718. [PMID: 34103355 PMCID: PMC8190047 DOI: 10.1136/jitc-2021-002718] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Accepted: 05/06/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous studies have suggested that inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH) and fibrinogen) are prognostic biomarkers in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors (ICIs). We aimed to develop a model that predicts response and survival in patients with relapsed and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy. METHODS Analysis of 100 consecutive patients with unresectable R/M HNSCC who were treated with ICI. Baseline and on-treatment (day 28) NLR, fibrinogen and LDH were calculated and correlated with response, progression-free survival (PFS) and overall survival (OS) using univariate and multivariate analyses. The optimal cut-off values were derived using maximally selected log-rank statistics. RESULTS Low baseline NLR and fibrinogen levels were associated with response. There was a statistically significant correlation between on-treatment NLR and fibrinogen and best overall response. On-treatment high NLR and raised fibrinogen were significantly associated with poorer outcome. In multivariate analysis, on-treatment NLR (≥4) and on-treatment fibrinogen (≥4 ng/mL) showed a significant negative correlation with OS and PFS. Using these cut-off points, we generated an on-treatment score for OS and PFS (0-2 points). The derived scoring system shows appropriate discrimination and suitability for OS (HR 2.4, 95% CI 1.7 to 3.4, p<0.0001, Harrell's C 0.67) and PFS (HR 1.8, 95% CI 1.4 to 2.3, p<0.0001, Harrell's C 0.68). In the absence of an external validation cohort, results of fivefold cross-validation of the score and evaluation of median OS and PFS on the Kaplan-Meier survival distribution between trained and test data exhibited appropriate accuracy and concordance of the model. CONCLUSIONS NLR and fibrinogen levels are simple, inexpensive and readily available biomarkers that could be incorporated into an on-treatment scoring system and used to help predict survival and response to ICI in patients with R/M HNSCC.
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Affiliation(s)
- Pablo Nenclares
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Lucinda Gunn
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Heba Soliman
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Mateo Bover
- Head and Neck Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amy Trinh
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Kee Howe Wong
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Alan Melcher
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kate Newbold
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Chris M Nutting
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Derfel Ap Dafydd
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Shreerang A Bhide
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kevin Harrington
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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16
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Vasiliadou I, Breik O, Baker H, Leslie I, Sim VR, Hegarty G, Michaelidou A, Nathan K, Hartley A, Good J, Sanghera P, Fong C, Urbano TG, Lei M, Petkar I, Ferreira MR, Nutting C, Wong KH, Newbold K, Harrington K, Bhide S, Kong A. Safety and Treatment Outcomes of Nivolumab for the Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Retrospective Multicenter Cohort Study. Cancers (Basel) 2021; 13:cancers13061413. [PMID: 33808781 PMCID: PMC8003537 DOI: 10.3390/cancers13061413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/08/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Abstract
Nivolumab is an anti-PD-1 monoclonal antibody currently used as immunotherapy for patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) with evidence of disease progression after platinum-based chemotherapy. This study evaluates real-world safety and treatment outcomes of non-trial nivolumab use. A retrospective multicenter cohort study of patients with recurrent/metastatic HNSCC treated with nivolumab between January 2017 and March 2020 was performed. Overall, 123 patients were included. The median age was 64 years, the majority of patients were male (80.5%) and had a smoking history (69.9%). Primary outcomes included overall response rate (ORR) of 19.3%, median progression-free survival (PFS) of 3.9 months, 1-year PFS rate of 16.8%, a median overall survival (OS) of 6.5 months and 1-year OS rate of 28.6%. These results are comparable to the CHECKMATE-141 study. Of 27 patients who had PD-L1 status tested, positive PD-L1 status did not significantly affect PFS (p = 0.86) or OS (p = 0.84). Nivolumab was well tolerated with only 15.1% experiencing immune-related toxicities (IRT) and only 6.7% of patients stopping due to toxicity. The occurrence of IRT appeared to significantly affect PFS (p = 0.01) but not OS (p = 0.07). Nivolumab in recurrent/metastatic HNSCC is well tolerated and may be more efficacious in patients who develop IRT.
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Affiliation(s)
- Ifigenia Vasiliadou
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Omar Breik
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women’s Hospital, QLD 4029 Brisbane, Australia
| | - Holly Baker
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Van Ren Sim
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Gemma Hegarty
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Andriana Michaelidou
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Kannon Nathan
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Andrew Hartley
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - James Good
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Paul Sanghera
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Charles Fong
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Teresa Guerrero Urbano
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Mary Lei
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Imran Petkar
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Miguel Reis Ferreira
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Chris Nutting
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kee Howe Wong
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kate Newbold
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kevin Harrington
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
| | - Shree Bhide
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Anthony Kong
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Comprehensive Cancer Centre, King’s College London, Guy’s Campus, London SE1 1UL, UK
- Correspondence:
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17
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Gunn L, Gilbert J, Nenclares P, Soliman H, Newbold K, Bhide S, Wong KH, Harrington K, Nutting C. Taste dysfunction following radiotherapy to the head and neck: A systematic review. Radiother Oncol 2021; 157:130-140. [PMID: 33545253 DOI: 10.1016/j.radonc.2021.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/07/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND An intact sense of taste provides pleasure, supports sustenance and alerts the body to toxins. Head and neck cancer (HNC) patients who receive radiotherapy (RT) are high-risk for developing radiation-induced taste dysfunction. Advances in RT offer opportunities for taste-preserving strategies by reducing dose to the gustatory organs-at-risk. METHODS PubMed, Medline and EMBASE were searched for publications reporting on taste, RT and HNC. Randomised trials, cohort studies and cross-sectional studies were included. RESULTS 31 studies were included in this review. Meta-analysed prevalence of acute taste dysfunction following RT was approximately 96% (95% CI 64 to 100%) by objective measures and 79% (95% CI 65 to 88%) by subjective measures, with the majority of patients showing at least partial recovery. Long-term dysfunction was seen in ~25% of patients. Taste dysfunction was associated with sequalae including weight loss and reduced quality-of-life (QoL). Taste dysfunction was more common when the oral cavity, and specifically the anterior two-thirds of the tongue, was irradiated, suggesting a dose constraint for taste preservation might be feasible. Proton beam therapy and customised bite blocks reduced dose to the gustatory field and subsequent loss of taste. CONCLUSIONS Taste dysfunction following RT is common and negatively affects patients' nutritional status and QoL. Decisions about treatment strategies, including choice of RT modality, dose distribution across the gustatory field and the use of adjuncts like bite blocks may be beneficial. However, evidence is limited. There is a pressing need for randomised studies or large prospective cohort studies with sufficient adjustment for confounders.
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Affiliation(s)
- Lucinda Gunn
- Head and Neck Unit, The Royal Marsden London, London, UK.
| | | | | | - Heba Soliman
- Head and Neck Unit, The Royal Marsden London, London, UK
| | - Kate Newbold
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Shree Bhide
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kee Howe Wong
- Head and Neck Unit, The Royal Marsden London, London, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Chris Nutting
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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18
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Co M, Ngan RKC, Mang OWK, Tam AHP, Wong KH, Kwong A. Clinical outcomes of patients with ductal carcinoma in situ in Hong Kong: 10-year territory-wide cancer registry study. Hong Kong Med J 2020; 26:486-491. [PMID: 33277445 DOI: 10.12809/hkmj198203] [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: 11/05/2022] Open
Abstract
BACKGROUND Incidence of ductal carcinoma in situ (DCIS) has increased in recent decades because of breast cancer screening. This study comprised a long-term survival analysis of DCIS using 10-year territory-wide data from the Hong Kong Cancer Registry. METHODS This study included all patients diagnosed with DCIS in Hong Kong from 1997 to 2006. Exclusion criteria were age <30 years or ≥70 years, lobular carcinoma in situ, Paget's disease, and co-existing invasive carcinoma. Patients were stratified into those diagnosed from 1997 to 2001 and those diagnosed from 2002 to 2006. The 5- and 10-year breast cancer-specific survival rates were evaluated; standardised mortality ratios were calculated. RESULTS Among the 1391 patients in this study, 449 were diagnosed from 1997 to 2001, and 942 were diagnosed from 2002 to 2006. The mean age at diagnosis was 49.2±9.2 years. Overall, 51.2% of patients underwent mastectomy and 29.5% received adjuvant radiotherapy. The median follow-up interval was 11.6 years; overall breast cancer-specific mortality rates were 0.3% and 0.9% after 5 and 10 years of follow-up, respectively. In total, 109 patients (7.8%) developed invasive breast cancer after a considerable delay. Invasive breast cancer rates were comparable between patients diagnosed from 1997 to 2001 (n=37, 8.2%) and those diagnosed from 2002 to 2006 (n=72, 7.6%). CONCLUSION Despite excellent long-term survival among patients with DCIS, these patients were more likely to die of breast cancer, compared with the general population of women in Hong Kong.
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Affiliation(s)
- M Co
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong.,Department of Surgery, Queen Mary Hospital, Hong Kong
| | - R K C Ngan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong.,Hong Kong Cancer Registry, Hospital Authority, Hong Kong.,Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - O W K Mang
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - A H P Tam
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - K H Wong
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong.,Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - A Kwong
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong.,Department of Surgery, Queen Mary Hospital, Hong Kong
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19
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Ng-Cheng-Hin B, Nutting C, Newbold K, Bhide S, McQuaid D, Dunlop A, Harrington K, Wong KH. The impact of restricted length of treatment field and anthropometric factors on selection of head and neck cancer patients for treatment on the MR-Linac. Br J Radiol 2020; 93:20200023. [PMID: 32436787 PMCID: PMC7336067 DOI: 10.1259/bjr.20200023] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study investigates the impact of a restricted craniocaudal (CC) field length of <20 cm on the selection of head and neck cancer (HNC) patients who can be treated on the MR-Linac using a single isocentre technique. We also assess the effects of anthropometric factors and the neck position on the CC field length. METHODS 110 HNC patients who underwent radical primary or adjuvant radiotherapy were retrospectively analysed. We assessed the proportion of treatment fields with a CC length of <20 cm and the effects of gender, height, hyo-sternal neck length (distance from superior surface of hyoid to sternal notch measured on the coronal reconstruction of the planning CT) and neck position on CC length. RESULTS 95% of HNC patients had a CC field length <20 cm. Female patients showed a significantly shorter median CC length than male patients in both extended (p = 0.0003) and neutral (p = 0.008) neck positions. Neck position influenced the median CC length with neutral neck being significantly shorter than extended neck (p = 0.0119). Patient height and hyo-sternal neck length showed positive correlation with the CC length, with neck length in neutral position having the strongest correlation (r = 0.65, p = 0.0001 and r = 0.63, p < 0.0001, respectively for extended neck; r = 0.55, p = 0.0070 and r = 0.80, p < 0.0001, respectively for neutral neck). A hyo-sternal neck length of <14.6 cm predicted a CC length of <20 cm in neutral neck position. CONCLUSION The majority of patients with HNC at the Royal Marsden Hospital have anthropometric features compatible with their being treated on the MR-Linac using a single isocentre technique. The absolute CC field size may vary according to primary tumour site, patient factors and neck position. A hyo-sternal neck length cut-off of 14.6 cm in the neutral neck position can be used as a surrogate marker for suitability of treatment on MR-Linac. ADVANCES IN KNOWLEDGE This paper highlights the potential impact of a restricted CC field in HNC patient selection for the MR-Linac treatment. This is the first report to suggest the use of neck length as a surrogate marker for suitability of treatment on the MR-Linac.
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Affiliation(s)
- Brian Ng-Cheng-Hin
- The Institute of Cancer Research and Royal Marsden NHS Trust, Head and Neck Radiotherapy and Imaging, Sutton, United Kingdom
| | - Christopher Nutting
- The Institute of Cancer Research and Royal Marsden NHS Trust, Head and Neck Radiotherapy and Imaging, Sutton, United Kingdom
| | - Kate Newbold
- The Institute of Cancer Research and Royal Marsden NHS Trust, Head and Neck Radiotherapy and Imaging, Sutton, United Kingdom
| | - Shreerang Bhide
- The Institute of Cancer Research and Royal Marsden NHS Trust, Head and Neck Radiotherapy and Imaging, Sutton, United Kingdom
| | - Dualta McQuaid
- Joint Department of Physics, The Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, United Kingdom
| | - Alex Dunlop
- Joint Department of Physics, The Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, United Kingdom
| | - Kevin Harrington
- The Institute of Cancer Research and Royal Marsden NHS Trust, Head and Neck Radiotherapy and Imaging, Sutton, United Kingdom
| | - Kee Howe Wong
- The Institute of Cancer Research and Royal Marsden NHS Trust, Head and Neck Radiotherapy and Imaging, Sutton, United Kingdom
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20
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Ng LFH, Tsang HHC, Wong FHY, Law MWC, Chong WH, Ho CHN, Fung JKJ, Chan CCY, Li LSK, Wong KT, Chan JCX, Lam SHY, Wong KH, Kwok PL, Xu L, Lai TKK, Cheng KK, Hon TYW, Hui JYH, Kwok SKY, Ma JKF. Radiological Findings in COVID-19 and Adaptive Approach in Radiology Departments: Literature Review and Experience sharing. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017218] [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)
- LFH Ng
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - HHC Tsang
- Department of Radiology and Organ Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - FHY Wong
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - MWC Law
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong
| | - WH Chong
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CHN Ho
- Department of Radiology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - JKJ Fung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - CCY Chan
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - LSK Li
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - KT Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong
| | - JCX Chan
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - SHY Lam
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - KH Wong
- Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
| | - PL Kwok
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - L Xu
- Department of Radiology and Organ Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - TKK Lai
- Department of Radiology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - KK Cheng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - TYW Hon
- Department of Radiology, United Christian Hospital, Kwun Tong, Hong Kong
| | - JYH Hui
- Department of Radiology, United Christian Hospital, Kwun Tong, Hong Kong
| | - SKY Kwok
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - JKF Ma
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
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Lee TY, Lam MHC, Cheung KM, Cheng HC, Ngan RKC, Wong KH. Gemcitabine Plus Nanoparticle Albumin-bound Paclitaxel for Patients with Inoperable Pancreatic Cancer: Experience at a Single Oncology Centre. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017076] [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)
- TY Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - MHC Lam
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - KM Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - HC Cheng
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - RKC Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
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22
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Fok L, Cheung KM, Kwok YL, Wong KH. Treatment Outcomes in Patients Receiving Regorafenib for Metastatic Colon Cancer. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- L Fok
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - KM Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - YL Kwok
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
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Lam TH, Wong KH, Chan KK, Chan MC, Chao DV, Cheung AN, Fan CY, Ho J, Hui EP, Lam KO, Law CK, Law WL, Loong HH, Ngan RK, Tsang TH, Wong MC, Yeung RM, Ying AC, Ching R. Recommendations on prevention and screening for colorectal cancer in Hong Kong. Hong Kong Med J 2019; 24:521-526. [PMID: 30318477 DOI: 10.12809/hkmj177095] [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: 11/05/2022] Open
Abstract
Colorectal cancer is the commonest cancer in Hong Kong. The Cancer Expert Working Group on Cancer Prevention and Screening was established in 2002 under the Cancer Coordinating Committee to review local and international scientific evidence, assess and formulate local recommendations on cancer prevention and screening. At present, the Cancer Expert Working Group recommends that average-risk individuals aged 50 to 75 years and without significant family history consult their doctors to consider screening by: (1) annual or biennial faecal occult blood test, (2) sigmoidoscopy every 5 years, or (3) colonoscopy every 10 years. Increased-risk individuals with significant family history such as those with a first-degree relative diagnosed with colorectal cancer at age ≤60 years; those who have more than one first-degree relative diagnosed with colorectal cancer irrespective of age at diagnosis; or carriers of genetic mutations associated with familial adenomatous polyposis or Lynch syndrome should start colonoscopy screening earlier in life and repeat it at shorter intervals.
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Affiliation(s)
- T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - K Kl Chan
- The Hong Kong College of Obstetricians and Gynaecologists, Hong Kong
| | - M Cm Chan
- Hospital Authority (Surgical), Hong Kong
| | - D Vk Chao
- The Hong Kong College of Family Physicians, Hong Kong
| | - A Ny Cheung
- The Hong Kong College of Pathologists, Hong Kong
| | - C Ym Fan
- Professional Development and Quality Assurance, Department of Health, Hong Kong
| | - J Ho
- World Cancer Research Fund Hong Kong, Hong Kong
| | - E P Hui
- Hong Kong College of Physicians, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - C K Law
- Hong Kong College of Radiologists, Hong Kong
| | - W L Law
- The College of Surgeons of Hong Kong, Hong Kong
| | - H Hf Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - R Kc Ngan
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - T Hf Tsang
- Hong Kong College of Community Medicine, Hong Kong
| | - M Cs Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - R Mw Yeung
- Hospital Authority (Non-surgical), Hong Kong
| | - A Ch Ying
- The Hong Kong Anti-Cancer Society, Hong Kong
| | - R Ching
- Centre for Health Protection, Department of Health, Hong Kong
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Chan CK, Wong KH, Lee MP, Chan KC, Leung CC, Leung EC, Chan WK, Mak IK. Risk factors associated with 1-year mortality among patients with HIV-associated tuberculosis in areas with intermediate tuberculosis burden and low HIV prevalence. Hong Kong Med J 2019; 24:473-483. [PMID: 30262675 DOI: 10.12809/hkmj187303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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 Data are limited regarding risk factors for mortality among patients with human immunodeficiency virus (HIV)-associated tuberculosis (TB) in areas with low HIV prevalence and intermediate TB burden, such as the Western Pacific region. This study aimed to assess such risk factors in Hong Kong, which has an intermediate TB burden and low HIV prevalence. METHODS We conducted a retrospective cohort analysis of adult patients reported to the Hong Kong TB-HIV Registry between 2006 and 2015. Baseline characteristics were compared with Kaplan-Meier estimates. Cox proportional hazards regression modelling was used to identify factors associated with mortality. RESULTS Of 299 patients studied, 21 (7.0%) died within 12 months of anti-TB treatment (median [interquartile range], 7.5 [3.8-10] months). The median age of death was 54 (interquartile range, 40.5-75.0) years. The cause of death was TB in five and unrelated to TB in the remaining 16. Cox proportional hazards regression showed that older age (adjusted hazard ratio=4.5; 95% confidence interval [CI]=1.4-14.9), history of drug addiction (4.6; 95% CI=1.6-13.0), and low baseline CD4 cell count of <50/μL (2.9; 95% CI=1.1-7.7) were independent risk factors for death within 12 months. CONCLUSION This study complements previous studies by providing information regarding risk factors associated with mortality among patients with HIV-associated TB in areas with intermediate TB burden and low HIV prevalence. The results from our study may guide targeted measures to improve survival in other areas with intermediate TB burden and low HIV prevalence, such as the Western Pacific region.
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Affiliation(s)
- C K Chan
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong
| | - K H Wong
- Head Office, Centre for Health Protection, Department of Health, Hong Kong
| | - M P Lee
- Department of Medicine, Queen Elizabeth Hospital, Hospital Authority, Hong Kong
| | - K Cw Chan
- Integrated Treatment Centre, Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong
| | - C C Leung
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong
| | - E Cc Leung
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong
| | - W K Chan
- Integrated Treatment Centre, Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong
| | - I Ky Mak
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong
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Molassiotis A, Cheng HL, Lopez V, Au JSK, Chan A, Bandla A, Leung KT, Li YC, Wong KH, Suen LKP, Chan CW, Yorke J, Farrell C, Sundar R. Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy. BMC Cancer 2019; 19:132. [PMID: 30736741 PMCID: PMC6368751 DOI: 10.1186/s12885-019-5302-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background There are inconsistencies in the literature regarding the prevalence and assessment of chemotherapy-induced peripheral neuropathy (CIPN). This study explored CIPN natural history and its characteristics in patients receiving taxane- and platinum-based chemotherapy. Patients and methods Multi-country multisite prospective longitudinal observational study. Patients were assessed before commencing and three weekly during chemotherapy for up to six cycles, and at 6,9, and 12 months using clinician-based scales (NCI-CTCAE; WHO-CIPN criterion), objective assessments (cotton wool test;10 g monofilament); patient-reported outcome measures (FACT/GOG-Ntx; EORTC-CIPN20), and Nerve Conduction Studies. Results In total, 343 patients were recruited in the cohort, providing 2399 observations. There was wide variation in CIPN prevalence rates using different assessments (14.2–53.4%). Prevalence of sensory neuropathy (and associated symptom profile) was also different in each type of chemotherapy, with paclitaxel (up to 63%) and oxaliplatin (up to 71.4%) showing the highest CIPN rates in most assessments and a more complex symptom profile. Peak prevalence was around the 6-month assessment (up to 71.4%). Motor neurotoxicity was common, particularly in the docetaxel subgroup (up to 22.1%; detected by NCI-CTCAE). There were relatively moderately-to-low correlations between scales (rs = 0.15,p < 0.05-rs = 0.48 p < 0.001), suggesting that they measure different neurotoxicity aspects from each other. Cumulative chemotherapy dose was not associated with onset and course of CIPN. Conclusion The historical variation reported in CIPN incidence and prevalence is possibly confounded by disagreement between assessment modalities. Clinical practice should consider assessment of motor neuropathy for neurotoxic chemotherapy. Current scales may not be all appropriate to measure CIPN in a valid way, and a combination of scales are needed.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China.
| | - Hui Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Joseph S K Au
- The Hong Kong Adventist Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Aishwarya Bandla
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore, Singapore
| | - K T Leung
- Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Y C Li
- Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - K H Wong
- Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Choi Wan Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, University of Manchester, UK and Christie NHS Foundation Trust, Manchester, UK
| | - Carole Farrell
- Division of Nursing, Midwifery & Social Work, University of Manchester, UK and Christie NHS Foundation Trust, Manchester, UK
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore.
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26
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Lam TH, Wong KH, Chan KK, Chan MC, Chao DV, Cheung AN, Fan CY, Ho J, Hui EP, Lam KO, Law CK, Law WL, Loong HH, Ngan RK, Tsang TH, Wong MC, Yeung RM, Ying AC, Ching R. Recommendations on prevention and screening for breast cancer in Hong Kong. Hong Kong Med J 2018; 24:298-306. [PMID: 29926793 DOI: 10.12809/hkmj177037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
In Hong Kong, breast cancer is the most common cancer among women and poses a significant health care burden. The Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) was set up in 2002 by the Cancer Coordinating Committee to review and assess local and international scientific evidence, and to formulate recommendations for cancer prevention and screening. After considering the local epidemiology, emerging scientific evidence, and local and overseas screening practices, the CEWG concluded that it was unclear whether population-based breast cancer screening did more harm than good in local asymptomatic women at average risk. The CEWG considers that there is insufficient evidence to recommend for or against population-based mammography screening for such individuals. Women who consider breast cancer screening should be adequately informed about the benefits and harms. The CEWG recommends that all women adopt primary preventive measures, be breast aware, and seek timely medical attention for suspicious symptoms. For women at high risk of breast cancer, such as carriers of confirmed BRCA1/2 deleterious mutations and those with a family history of breast cancer, the CEWG recommends that they seek doctor's advice for annual mammography screening and the age at which the process should commence. Additional annual screening by magnetic resonance imaging is recommended for confirmed BRCA1/2 mutation carriers or women who have undergone radiation therapy to the chest between the age of 10 and 30 years. Women at moderate risk of breast cancer should discuss with doctors the pros and cons of breast cancer screening before making an informed decision about mammography screening every 2 to 3 years.
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Affiliation(s)
- T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K H Wong
- DDepartment of Health, Hong Kong
| | - K Kl Chan
- The Hong Kong College of Obstetricians and Gynaecologists, Hong Kong
| | - M Cm Chan
- Hospital Authority (Surgical), Hong Kong
| | - D Vk Chao
- The Hong Kong College of Family Physicians, Hong Kong
| | - A Ny Cheung
- The Hong Kong College of Pathologists, Hong Kong
| | - C Ym Fan
- Professional Development and Quality Assurance, Department of Health, Hong Kong
| | - J Ho
- World Cancer Research Fund Hong Kong, Hong Kong
| | - E P Hui
- Hong Kong College of Physicians, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - C K Law
- Hong Kong College of Radiologists, Hong Kong
| | - W L Law
- The College of Surgeons of Hong Kong, Hong Kong
| | - H Hf Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - R Kc Ngan
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - T Hf Tsang
- Hong Kong College of Community Medicine, Hong Kong
| | - M Cs Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - R Mw Yeung
- Hospital Authority (Non-surgical), Hong Kong
| | - A Ch Ying
- The Hong Kong Anti-Cancer Society, Hong Kong
| | - R Ching
- Centre for Health Protection, Department of Health, Hong Kong
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Cheung KM, Ngan RKC, Chow JCH, Lee TY, Li KWS, Cheng HC, Leung CWL, Yiu HHY, Yau S, Au JSK, Wong KH. Can Neoadjuvant Chemotherapy before Definitive Surgery Improve Outcome in Operable Stage IVA Oral Cavity Cancers? Hong Kong J Radiol 2018. [DOI: 10.12809/hkjr1816962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Dean JA, Welsh LC, Wong KH, Aleksic A, Dunne E, Islam MR, Patel A, Patel P, Petkar I, Phillips I, Sham J, Schick U, Newbold KL, Bhide SA, Harrington KJ, Nutting CM, Gulliford SL. Normal Tissue Complication Probability (NTCP) Modelling of Severe Acute Mucositis using a Novel Oral Mucosal Surface Organ at Risk. Clin Oncol (R Coll Radiol) 2017; 29:263-273. [PMID: 28057404 PMCID: PMC6175048 DOI: 10.1016/j.clon.2016.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 12/23/2022]
Abstract
AIMS A normal tissue complication probability (NTCP) model of severe acute mucositis would be highly useful to guide clinical decision making and inform radiotherapy planning. We aimed to improve upon our previous model by using a novel oral mucosal surface organ at risk (OAR) in place of an oral cavity OAR. MATERIALS AND METHODS Predictive models of severe acute mucositis were generated using radiotherapy dose to the oral cavity OAR or mucosal surface OAR and clinical data. Penalised logistic regression and random forest classification (RFC) models were generated for both OARs and compared. Internal validation was carried out with 100-iteration stratified shuffle split cross-validation, using multiple metrics to assess different aspects of model performance. Associations between treatment covariates and severe mucositis were explored using RFC feature importance. RESULTS Penalised logistic regression and RFC models using the oral cavity OAR performed at least as well as the models using mucosal surface OAR. Associations between dose metrics and severe mucositis were similar between the mucosal surface and oral cavity models. The volumes of oral cavity or mucosal surface receiving intermediate and high doses were most strongly associated with severe mucositis. CONCLUSIONS The simpler oral cavity OAR should be preferred over the mucosal surface OAR for NTCP modelling of severe mucositis. We recommend minimising the volume of mucosa receiving intermediate and high doses, where possible.
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Affiliation(s)
- J A Dean
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - L C Welsh
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - K H Wong
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Aleksic
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - E Dunne
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M R Islam
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Patel
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - P Patel
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - I Petkar
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - I Phillips
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Sham
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - U Schick
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - K L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - K J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - C M Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S L Gulliford
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
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Lee SS, Ma K, Chu EKY, Wong KH. The phenomenon of missing doses in a cohort of HIV patients with good adherence to highly active antiretroviral therapy. Int J STD AIDS 2016; 18:167-70. [PMID: 17362548 DOI: 10.1258/095646207780132497] [Citation(s) in RCA: 5] [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: 11/18/2022]
Abstract
A self-administered questionnaire survey was conducted in a specialist HIV clinical service in Hong Kong. A total of 76 male Chinese patients who had been on highly active antiretroviral therapy for over one year were enrolled. All except one had undetectable viral load at the time of the assessment. Though a majority (76%) scored 100% in self-reporting adherence rating, one-third of these had in fact missed at least one dose in the preceding four-week period. Men having sex with men had a lower tendency of missing dose than heterosexuals (13.6% versus 42%, P = 0.019). There was no association between missing doses and clinical staging or the regimens. The study revealed that missing doses may occur despite report of almost complete adherence, which, in the long run, could be a cause for concern.
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Affiliation(s)
- S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong.
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30
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Sin WW, Lin AW, Chan KC, Wong KH. Management of health care workers following occupational exposure to hepatitis B, hepatitis C, and human immunodeficiency virus. Hong Kong Med J 2016; 22:472-7. [PMID: 27562987 DOI: 10.12809/hkmj164897] [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 Needlestick injury or mucosal contact with blood or body fluids is well recognised in the health care setting. This study aimed to describe the post-exposure management and outcome in health care workers following exposure to hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) during needlestick injury or mucosal contact. METHODS This case series study was conducted in a public clinic in Hong Kong. All health care workers with a needlestick injury or mucosal contact with blood or body fluids who were referred to the Therapeutic Prevention Clinic of Department of Health from 1999 to 2013 were included. RESULTS A total of 1525 health care workers were referred to the Therapeutic Prevention Clinic following occupational exposure. Most sustained a percutaneous injury (89%), in particular during post-procedure cleaning or tidying up. Gloves were worn in 62.7% of instances. The source patient could be identified in 83.7% of cases, but the infection status was usually unknown, with baseline positivity rates of hepatitis B, hepatitis C, and HIV of all identified sources, as reported by the injured, being 7.4%, 1.6%, and 3.3%, respectively. Post-exposure prophylaxis of HIV was prescribed to 48 health care workers, of whom 14 (38.9%) had been exposed to known HIV-infected blood or body fluids. The majority (89.6%) received HIV post-exposure prophylaxis within 24 hours of exposure. Drug-related adverse events were encountered by 88.6%. The completion rate of post-exposure prophylaxis was 73.1%. After a follow-up period of 6 months (or 1 year for those who had taken HIV post-exposure prophylaxis), no hepatitis B, hepatitis C, or HIV seroconversions were detected. CONCLUSIONS Percutaneous injury in the health care setting is not uncommon but post-exposure prophylaxis of HIV is infrequently indicated. There was no hepatitis B, hepatitis C, and HIV transmission via sharps or mucosal injury in this cohort of health care workers.
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Affiliation(s)
- W Wy Sin
- Special Preventive Programme, Centre for Health Protection, Department of Health, Kowloon Bay Health Centre, Hong Kong
| | - A Wc Lin
- Special Preventive Programme, Centre for Health Protection, Department of Health, Kowloon Bay Health Centre, Hong Kong
| | - K Cw Chan
- Special Preventive Programme, Centre for Health Protection, Department of Health, Kowloon Bay Health Centre, Hong Kong
| | - K H Wong
- Special Preventive Programme, Centre for Health Protection, Department of Health, Kowloon Bay Health Centre, Hong Kong
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31
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Naftalin CM, Chan KCW, Wong KH, Cheung SW, Chan RCY, Lee SS. CYP2B6-G516T genotype influences plasma efavirenz concentration in a Hong Kong population, allowing potential individualization of therapy. HIV Med 2014; 15:63-4. [PMID: 24299220 DOI: 10.1111/hiv.12076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- C M Naftalin
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
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32
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Lin AWC, Chan KCW, Chan WK, Wong KH. Authors' reply. Hong Kong Med J 2013; 19:561. [PMID: 24310668] [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: 06/02/2023] Open
Affiliation(s)
- Ada W C Lin
- Special Preventive Programme, Centre for Health Protection, Department of Health, Kowloon Bay Health Centre, 9 Kai Yan Road, Kowloon Bay, Kowloon, Hong Kong
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Chan CK, Wong KH, Leung CC, Tam CM, Chan KCW, Pang KW, Chan WK, Mak IKY. Treatment outcomes after early initiation of antiretroviral therapy for human immunodeficiency virus-associated tuberculosis. Hong Kong Med J 2013; 19:474-83. [PMID: 23926173 DOI: 10.12809/hkmj133937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
OBJECTIVE To evaluate the optimal timing for initiating antiretroviral therapy in patients with human immunodeficiency virus (HIV)-associated tuberculosis in Hong Kong. DESIGN Historical cohort. SETTING. Tuberculosis and Chest Service and Special Preventive Programme, Public Health Service Branch, Centre for Health Protection, Department of Health, Hong Kong. PATIENTS Consecutive patients with HIV-associated tuberculosis in a territory-wide TB-HIV registry encountered from 1996 to 2009. RESULTS Of the 260 antiretroviral therapy-naïve patients with HIV-associated tuberculosis, 32 (12%) had antiretroviral therapy initiated within 2 months after starting anti-tuberculosis treatment (early antiretroviral therapy). Early antiretroviral therapy was associated with a more favourable outcome (cure or treatment completion without relapse) at 24 months (91% vs 67%; P=0.007) than those with antiretroviral therapy started later or not initiated, and remained an independent predictor of a favourable outcome after adjustment for potential confounders. Adverse effects from anti-tuberculosis drugs tended to occur more frequently in patients with early antiretroviral therapy (13/32 or 41%) compared with the remainder (59/228 or 26%; P=0.08). A significantly higher proportion of patients in the former group experienced immune reconstitution inflammatory syndrome than in the latter group (7/32 or 22% vs 9/228 or 4%; P<0.001). There was no death attributable to immune reconstitution inflammatory syndrome. CONCLUSIONS Early initiation of antiretroviral therapy is associated with more favourable tuberculosis treatment outcomes in patients with HIV-associated tuberculosis with a low CD4 count (<200/µL). Drug co-toxicity and immune reconstitution inflammatory syndrome that may be increased by earlier initiation of antiretroviral therapy does not undermine tuberculosis treatment outcomes to a significant extent.
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Affiliation(s)
- C K Chan
- Tuberculosis and Chest Service, Public Health Service Branch, Centre for Health Protection, Department of Health, Hong Kong
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34
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Lin AWC, Chan KCW, Chan WK, Wong KH. Tuberculin sensitivity testing and treatment of latent tuberculosis remains effective for tuberculosis control in human immunodeficiency virus-infected patients in Hong Kong. Hong Kong Med J 2013; 19:386-92. [PMID: 23926172 DOI: 10.12809/hkmj133892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate whether a policy to treat latent tuberculosis identified by annual tuberculin sensitivity testing is effective for tuberculosis control in human immunodeficiency virus-infected patients in Hong Kong. DESIGN Historical cohort study. SETTING Integrated Treatment Centre, Department of Health, Hong Kong. PATIENTS Patients infected with human immunodeficiency virus without a history of tuberculosis were offered annual tuberculin sensitivity testing, coupled with treatment of latent tuberculosis if they tested positive. All such patients were followed for new tuberculosis. RESULTS In all, 1154 patients on antiretroviral therapy, contributing to 5587 patient-years of observation, were analysed; 1032 patients (89%) received annual tuberculin sensitivity testing. Their baseline characteristics, including CD4 counts and other risk factors for tuberculosis, did not differ significantly from those who declined testing. The overall incidence rate of tuberculosis was 0.59 case per 100 patient-years. It was lower in those who received annual tuberculin sensitivity testing than those who did not (0.41 vs 3.85 per 100 patient-years; P<0.0001). Only a low baseline CD4 count and a history of tuberculin sensitivity testing were shown to be significant indicators of incident tuberculosis using multivariate analysis. The hazard ratio was 0.36 (95% confidence interval, 0.16-0.85; P=0.02) for those with a baseline CD4 count of 100/mm3 or above, and 0.26 (95% confidence interval, 0.08-0.77; P=0.016) for those who received annual tuberculin sensitivity testing. The incidence of tuberculosis was highest within 90 days of antiretroviral therapy initiation. CONCLUSION The established policy continues to be effective. The high risk of tuberculosis during the early period of antiretroviral therapy supports early use of tuberculin sensitivity testing. Alternatively, the strategy of universal isoniazid preventive therapy at antiretroviral therapy initiation could be studied for those with very low baseline CD4 counts.
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Affiliation(s)
- A W C Lin
- Integrated Treatment Centre, Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong
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Lin AWC, Wong KH, Chan K, Chan WK. Accelerating prevention of mother-to-child transmission of HIV: ten-year experience of universal antenatal HIV testing programme in a low HIV prevalence setting in Hong Kong. AIDS Care 2013; 26:169-75. [PMID: 23869699 DOI: 10.1080/09540121.2013.819402] [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: 10/26/2022]
Abstract
Hong Kong has a low prevalence of HIV infection at less than 0.01%. Universal Antenatal HIV Testing Programme (UATP) was launched in all public antenatal units in September 2001. In 2008, voluntary rapid HIV testing was introduced in all public labour units to fill up the gap for pregnant women without HIV testing during the antenatal period. This study evaluated the performance of UATP and rapid HIV testing with indicators. From September 2001 to December 2011, process and outcome indicators for monitoring and evaluation were collected from the service providers in the form of monthly return of workload statistics and case-based statistics of each identified HIV-positive pregnancy via reporting forms. A total of 479,160 antenatal HIV tests and 2,675 rapid tests were performed in the study period. The acceptance rate for UATP and rapid HIV testing was 98% and 80.4% respectively. With the implementation of rapid HIV testing in January 2008, the proportion of pregnant women with HIV status discerned before delivery increased from 84.9% in 2006 to over 99.5% since 2008. The HIV prevalence in UATP and rapid HIV testing was 0.02% and 0.1% respectively. Fifty-three (68%) out of 78 HIV-infected pregnant women identified from the programme have delivered locally. Forty-three (81%) of them delivered by caesarean section and 50 (94%) of them were given antiretrovirals for intervention. Only three children born before the implementation of rapid HIV testing were HIV-infected. In conclusion, UATP and its rapid HIV testing component have been highly accepted and effective in the prevention of perinatal HIV transmission in Hong Kong.
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Affiliation(s)
- Ada W C Lin
- a Special Preventive Programme, Department of Health , Centre for Health Protection , Hong Kong , China
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Siu SWK, Law M, Liu RKY, Wong KH, Soong IS, Kwok AOL, Ng KH, Lam PT, Leung TW. Use of methylphenidate for the management of fatigue in Chinese patients with cancer. Am J Hosp Palliat Care 2013; 31:281-6. [PMID: 23650644 DOI: 10.1177/1049909113487022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/16/2022] Open
Abstract
UNLABELLED REASON FOR THE STUDY: Studies on methylphenidate for cancer-related fatigue showed conflicting results. This prospective study aims to determine whether methylphenidate is useful for relieving fatigue in Chinese patients with cancer. Chinese Version of Brief Fatigue Inventory (BFI-C) was administered on days 1, 8, and 29. Methylphenidate dose on day 1 was 5 mg daily then adjusted after day 8 according to response and side effects tolerance. MAIN FINDINGS Only 48% of the 25 recruited patients were on methylphenidate by day 29. Overall, no significant improvement in fatigue level was observed after methylphenidate, though benefits were shown in subgroups with age ≤ 65 and higher baseline BFI-C values. PRINCIPAL CONCLUSIONS Methylphenidate may be useful for management of cancer-related fatigue in selected Chinese patients.
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Affiliation(s)
- Steven W K Siu
- 1Department of Clinical Oncology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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Alqahtani A, Hamid K, Kam A, Wong KH, Abdelhak Z, Razmovski-Naumovski V, Chan K, Li KM, Groundwater PW, Li GQ. The pentacyclic triterpenoids in herbal medicines and their pharmacological activities in diabetes and diabetic complications. Curr Med Chem 2013; 20:908-931. [PMID: 23210780] [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] [Received: 08/15/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 06/01/2023]
Abstract
Pentacyclic triterpenoids including the oleanane, ursane and lupane groups are widely distributed in many medicinal plants, such as Glycyrrhiza species, Gymnema species, Centella asiatica, Camellia sinensis, Crataegus species and Olea europaea, which are commonly used in traditional medicine for the treatment of diabetes and diabetic complications. A large number of bioactive pentacyclic triterpenoids, such as oleanolic acid, glycyrrhizin, glycyrrhetinic acid, ursolic acid, betulin, betulinic acid and lupeol have shown multiple biological activities with apparent effects on glucose absorption, glucose uptake, insulin secretion, diabetic vascular dysfunction, retinopathy and nephropathy. The versatility of the pentacyclic triterpenes provides a promising approach for diabetes management.
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Affiliation(s)
- A Alqahtani
- Faculty of Pharmacy, University of Sydney, NSW 2006, Australia
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Wong KH, Mang OWK, Au KH, Law SCK. Incidence, mortality, and survival trends of ovarian cancer in Hong Kong, 1997 to 2006: a population-based study. Hong Kong Med J 2012; 18:466-474. [PMID: 23223646] [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: 06/01/2023] Open
Abstract
OBJECTIVES To assess the incidence and mortality of ovarian cancer, and the survival patterns of the invasive epithelial ovarian carcinoma in Hong Kong based on population-based cancer registry data. DESIGN Historical cohort study. SETTING Hong Kong. PATIENTS All patients with ovarian cancer diagnosed between 1997 and 2006 were included. Patients eligible for survival analysis were followed up until 31 December 2007. MAIN OUTCOME MEASURES Age-standardised incidence and mortality rates with their estimated annual percent changes were determined. Cumulative observed and relative survival rates were estimated using a period approach. RESULTS During the study period, in Hong Kong there was a steadily increasing ovarian cancer incidence rate (1.4% annually) but a steadily decreasing mortality rate (1.9% annually). The improvement in mortality was mainly in the age-group of 50-69 years (4.7% annually). Invasive epithelial ovarian carcinoma accounted for 79.6% of the study cohort. The 2-year and 5-year relative survival rates were 75.8% and 63.1%, respectively. Those diagnosed in the period 2002 to 2006 had significantly better survival than those diagnosed in the period 1997 to 2001 (65.3% vs 60.7%; P=0.008); a significant improvement was evident for patients with stage II disease and in the age-group of 50-69 years. Multivariate analyses confirmed that age, histological subtype, FIGO stage, and the period of diagnosis were independent prognostic indicators of invasive epithelial ovarian carcinoma. CONCLUSION In Hong Kong, invasive epithelial ovarian carcinoma showed an increasing incidence and an improving survival trend over the period 1997 to 2006. The survival data derived from this study provides a baseline from which to monitor the effectiveness of ovarian cancer treatment in Hong Kong.
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Affiliation(s)
- K H Wong
- Hong Kong Cancer Registry, Queen Elizabeth Hospital, Jordan, Hong Kong.
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Chen JHK, Wong KH, Li PCK, Chan KKC, Lee MP, To SWC, Yam WC. In-house human immunodeficiency virus-1 genotype resistance testing to determine highly active antiretroviral therapy resistance mutations in Hong Kong. Hong Kong Med J 2012; 18:20-24. [PMID: 22302906] [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: 05/31/2023] Open
Abstract
OBJECTIVE To determine the frequency of highly active antiretroviral therapy resistance mutations in the viral pol gene of human immunodeficiency virus-1 (HIV-1) genotypes that circulate in Hong Kong, by means of an in-house HIV-1 genotyping system. DESIGN Retrospective study. SETTING Two HIV clinics in Hong Kong. PATIENTS A modified in-house genotyping resistance test was used to sequence the partial pol gene in 1165 plasma samples from 965 patients. The performance of our test was cross-compared with the US Food and Drug Administration-approved ViroSeq HIV-1 genotyping system. The results of genotyping were submitted to the Stanford HIV-1 drug resistance database for analysis. RESULTS The cost-effective in-house genotypic resistance test (US$40) demonstrated comparable performance to the US Food and Drug Administration-approved ViroSeq system. The detection limit of this in-house genotypic resistance test could reach 400 copies/mL for both HIV-1 subtype B and CRF01_AE, which were the predominant genotypes in Hong Kong. Drug resistance mutations were detected only in post-treatment samples from treatment-failure patients. However, there was no significant difference in the frequency of drug resistance mutations between subtype B and CRF01_AE. CONCLUSION Our cost-effective in-house genotypic resistance test detected no significant difference in drug resistance-related mutations frequencies between HIV-1 subtype B and CRF01_AE in Hong Kong. A drug resistance-related mutations database for different HIV-1 genotypes should be established in Hong Kong to augment guidance for HIV treatment.
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Affiliation(s)
- Jonathan H K Chen
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
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Wong KH, Siu G, Chan TM, Liu TL, Tham CC, Poon WS. A patient with monocular visual loss. Hong Kong Med J 2011; 17:163-164. [PMID: 21471601] [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: 05/30/2023] Open
Affiliation(s)
- K H Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Tong DKH, Law S, Wong KH. The use of self-expanding metallic stents (SEMS) is effective in symptom palliation from recurrent tumor after esophagogastrectomy for cancer. Dis Esophagus 2010; 23:660-5. [PMID: 20545971 DOI: 10.1111/j.1442-2050.2010.01077.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The efficacy of using self-expanding metallic stent (SEMS) for palliation of symptoms because of tumor recurrence after prior esophagogastrectomy has not been properly assessed despite the well recognized use of SEMS in patients without prior surgery. The aim of this study is to evaluate the efficacy and safety of using SEMS in patients who had prior esophagogastrectomy. The study group included 35 patients with carcinoma of esophagus or cardia documented to have loco-regional recurrence after esophagogastrectomy and in whom SEMS were placed for palliation. The median age was 67 (ranged 41-85). The indications for stenting were dysphagia caused by recurrence at the esophageal anastomosis (n= 4) and in the esophageal remnant (n= 5), or extrinsic compression from mediastinal nodal disease (n= 7); gastric outlet obstruction produced by extrinsic tumor compression (n= 13); and tracheo-esophageal fistulae (n= 6). Forty-three stenting procedures were performed, and the technical success rate was 97.6%. The dysphagia score improved from 4.66 to 2.54 (P < 0.001). All patients with tracheo-esophageal fistula had their symptoms successfully palliated. The immediate complication rate was 14% (n= 5); two patients had stent malpositioning, two had inadequate opening of their stents, and one had a failed stenting procedure. On follow-up, 15 (42.8%) patients required a total of 22 re-intervention procedures for various reasons: endoscopic dilatation (five dilatations in three patients), removal of foreign bodies (nine procedures in four patients), and insertion of a second SEMS related to tumor growth (eight stents in eight patients). There was no procedure-related mortality. The median survival was short at 42 days (range 5-290 days), mostly related to advanced disease stage. SEMS in patients with recurrent tumor after esophagogastrectomy is safe and effective.
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Affiliation(s)
- D K-H Tong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Abstract
Three antigenic fractions from the cell walls of eight strains of mycobacteria were studied. Isolation and purification of these antigens were effected by enzymatic digestions, differential and sucrose gradient centrifugations, dialyses, and column chromatography. Two of the fractions were termed cell wall tuberculins (CWT-1, solubilized with lipase; CWT-2, solubilized with lysozyme); the third was termed "C" (cross-reacting) antigen. All appeared to be lipopolysaccharides. The CWT antigens, as compared with purified protein derivatives (human), were relatively species (group)-specific in both double immunodiffusion and guinea pig skin tests; in the latter, the reactions resembled those of delayed hypersensitivity. The C antigens reacted heterologously in double immunodiffusion and skin tests; the latter were the "immediate" type of reaction.
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Affiliation(s)
- K H Wong
- Department of Bacteriology, University of California, Los Angeles, California 90024
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Chan CK, Alvarez Bognar F, Wong KH, Leung CC, Tam CM, Chan KCW, Ho CF, Chan WK, Mak IKY. The epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong. Hong Kong Med J 2010; 16:192-198. [PMID: 20519755] [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: 05/29/2023] Open
Abstract
OBJECTIVE To evaluate the epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong. DESIGN Retrospective study. SETTING Tuberculosis and Chest Service and Special Preventive Programme, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region. PATIENTS Cases reported to the TB/HIV Registry jointly kept by the Tuberculosis and Chest Service and Special Preventive Programme from 1996 to 2006 were reviewed. The Registry includes cases of human immunodeficiency virus-associated tuberculosis diagnosed in the two services, and cases referred from regional hospitals under the Hong Kong Hospital Authority and the private sector. RESULTS Tuberculosis has become an increasingly important acquired immunodeficiency syndrome-defining illness in Hong Kong, and overtook Pneumocystis jiroveci pneumonia for the first time as the most common primary acquired immunodeficiency syndrome-defining illness in 2005 (accounting for 39% and 31% of all such illnesses, respectively in that year). The presentation of human immunodeficiency virus-associated tuberculosis is often atypical. In these patients moreover, there was a slightly higher rate of multidrug-resistant tuberculosis (2%) than in the general population (range, 0.7-1.5%). CONCLUSIONS Programmes for the provider-initiated human immunodeficiency virus testing policy to reduce diagnostic delays should continue and be enhanced. Continual surveillance of both conditions is imperative, especially in view of a possible link between human immunodeficiency virus and multidrug-resistant tuberculosis.
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Affiliation(s)
- C K Chan
- Tuberculosis and Chest Service, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong.
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Lee SS, Lee KCK, Tse ICT, Lee MP, Wong KH, Li PCK, Sung JY. Profiling advanced disease in an Asian clinical human immunodeficiency virus cohort: comparison of two definitions for acquired immunodeficiency syndrome. Hong Kong Med J 2010; 16:199-206. [PMID: 20519756] [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: 05/29/2023] Open
Abstract
OBJECTIVE To compare advanced human immunodeficiency virus disease defined immunologically and clinically by evaluating the characteristics of human immunodeficiency virus patients in Hong Kong. DESIGN Retrospective observational study. SETTING A human immunodeficiency virus cohort database established at a university and the major human immunodeficiency virus specialist services in Hong Kong. PATIENTS Patients diagnosed with acquired immunodeficiency syndrome at the study centres between 1985 and 2006 were included. MAIN OUTCOME MEASURES Comparison of advanced human immunodeficiency virus disease defined (a) clinically as World Health Organization stage IV, and (b) immunologically as a CD4 count lower than 350/microL. RESULTS Between 1985 and 2006, a total of 1317 patients, a majority of whom Chinese, were evaluated. Of these, 914 (69%) and 335 (25%) fulfilled the criteria for immunologically and clinically defined advanced disease, respectively. The mean age of the study population was 38 years and male-to-female ratio 4:1. There were two peaks in the frequency distribution of CD4 counts, one at a low count of less than 100/microL and the other between 200 and 400/microL. All except four with clinically defined advanced disease had CD4 counts lower than 350/microL on presentation. Of those with immunologically defined advanced disease, men having sex with men accounted for a lower proportion in the clinically advanced category, and Pneumocystis pneumonia was the commonest advanced disease at presentation. CONCLUSIONS Both clinical and immunological definitions provide a consistent means for assessing advanced disease, the implications of which are different. Such profiling has been made possible through the operation of a standardised cohort database, which is useful in (1) enhancing human immunodeficiency virus epidemiology studies, and (2) evaluating the performance of public health services.
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Affiliation(s)
- S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong.
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Woo OT, Chung WK, Wong KH, Chow AT, Wong PK. Photocatalytic oxidation of polycyclic aromatic hydrocarbons: intermediates identification and toxicity testing. J Hazard Mater 2009; 168:1192-1199. [PMID: 19361920 DOI: 10.1016/j.jhazmat.2009.02.170] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 02/27/2009] [Accepted: 02/28/2009] [Indexed: 05/27/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are hydrophobic pollutants and their low water solubility limits their degradation in aqueous solution. The presence of water-miscible solvent such as acetone can increase the water solubility of PAHs, however acetone will also affect the degradation of PAH. In this study the effects of acetone on the photocatalytic degradation efficiency and pathways of 5 selected PAHs, namely naphthalene (2 rings), acenaphthylene (3 rings), phenanthrene (3 rings), anthracene (3 rings) and benzo[a]anthracene (4 rings) were investigated. The Microtox toxicity test was used to determine whether the PCO system can completely detoxify the parental PAHs and its intermediates. The addition of 16% acetone can greatly alter the degradation pathway of naphthalene and anthracene. Based on intermediates identified from degradation of the 5 PAHs, the location of parental PAHs attacked by reactive free radicals can be correlated with the localization energies of different positions of the compound. For toxicity analysis, irradiation by UV light was found to induce acute toxicity by generating intermediates/degradation products from PAHs and possibly acetone. Lastly, all PAHs (10 mg l(-1)) can be completely detoxified by titanium dioxide (100 mg l(-1)) within 24h under UVA irradiation (3.9 mW cm(-2)).
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Affiliation(s)
- O T Woo
- Department of Biology, The Chinese University of Hong Kong, Shatin, NT Hong Kong SAR, China
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Li G, Wong KH, Zhang X, Hu C, Yu JC, Chan RCY, Wong PK. Degradation of Acid Orange 7 using magnetic AgBr under visible light: the roles of oxidizing species. Chemosphere 2009; 76:1185-91. [PMID: 19596389 DOI: 10.1016/j.chemosphere.2009.06.027] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 05/03/2023]
Abstract
AgBr was creatively immobilized on a magnetic substrate (SiO(2)-coated Fe(3)O(4) nanoparticle, SFN) to achieve magnetic separation after visible light-driven photocatalytic oxidation (PCO). The resulted Ag/AgBr/SFN was characterized by TEM, vibrating sample magnetometer and other techniques. It is found that the average diameter of the Ag/AgBr/SFN particle is less than 20 nm. The typical superparamagnetic behavior of Ag/AgBr/SFN implies that the catalyst can be magnetically separated. The physicochemical features of the used Ag/AgBr/SFN after visible light irradiation were not dramatically changed by X-ray diffraction, UV-Vis diffuse reflectance spectra and Fourier transform-infrared analysis. SiO(2) interlayer was proven to slightly increase the degradation efficiency for an azo dye Acid Orange 7. UV-Vis spectra and HPLC analysis indicated that the dye was oxidized and decomposed. The photoactivity of Ag/AgBr/SFN was partly maintained after successive PCO under visible light. In order to evaluate the roles of e(-)-h(+) pairs and reactive oxygen species, the quenching effect was examined by employing Ag/AgBr/SFN and commercial TiO(2) (P-25) under visible light (lambda>400 nm) and UV-A irradiation, respectively. Active h(+) and the resulting (*)OH played the major roles for degradation. The effect of active h(+) and (*)OH were proven to be highly dependent on the concentration of photocatalysts. The effect of (*)OH was more obvious for P-25, while that of active h(+) was more predominant for Ag/AgBr/SFN.
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Affiliation(s)
- Guoting Li
- Department of Biology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
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Wong KH, Coert JH, Robinson PH, Meek MF. Comparison of assessment tools to score recovery of function after repair of traumatic lesions of the median nerve. ACTA ACUST UNITED AC 2009; 40:219-24. [PMID: 16911995 DOI: 10.1080/02844310600652878] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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: 10/24/2022]
Abstract
In this paper the recovery after repair of the median nerve has been used to compare different assessment tools for evaluation of peripheral nerve function: touch (moving 2-point discrimination (2PD); Semmes-Weinstein (SW) monofilament, motor (Medical Research Council (MRC) scale), combined motor and sensory (Dellon modification of the Moberg pick up test; Moberg Recognition test), and pain (visual analogue scale; pinprick-test). The mean (SD) age of our 28 patients was 28 (12) years. The mean (SD) follow-up period was 5 years, 2 months (2 years, 8 months). On the operated side three patients (11%) had a moving 2PD of less than 4 mm. The results of the moving 2PD were compared with those of the SW monofilaments, but with a poor correlation. The MRC score correlated well with opposition movement of the thumb and muscle wasting (p<0.01). We recommend a number of tests to evaluate (the chronological return of) peripheral nerve function.
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Affiliation(s)
- K H Wong
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Lu SG, Mak CL, Pang GKH, Wong KH, Cheah KW. Blue-shift and intensity enhancement of photoluminescence in lead-zirconate-titanate-doped silica nanocomposites. Nanotechnology 2008; 19:035702. [PMID: 21817587 DOI: 10.1088/0957-4484/19/03/035702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Transparent PbZr(0.52)Ti(0.48)O(3) (PZT)-doped silica nanocomposites were fabricated via a modified sol-gel process. The nanocomposites were annealed at different temperatures between 740 and 800 °C in order to produce PZT crystallites with different particle sizes. X-ray diffraction analysis indicated that the embedded PZT nanoparticles were crystallized with a perovskite structure while the SiO(2) matrix was still in an amorphous state. Transmission electron microscopy confirmed that the PZT particles were of nanosize with perovskite structure and dispersed within the SiO(2) matrix. Photoluminescence spectra of the samples were measured between 10 and 290 K. The pure silica matrix showed an emission band at 3.20 eV and a weak emission band at 2.65 eV. They were noticeably suppressed in the PZT/SiO(2) nanocomposites. An additional emission band at ∼2.30 eV, due to transition within the PZT crystallites, was identified. This emission band showed a large blue-shift with decreasing PZT crystallite size and a substantially enhanced intensity as compared with that of bulk PZT ceramics. Our studies demonstrate the typical quantum size effect of ferroelectric-doped nanocomposites and the large influence of the silica matrix on the PL intensity of the embedded PZT particles.
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Affiliation(s)
- S G Lu
- Department of Applied Physics and Materials Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Lee PM, Wong KH. Universal antenatal human immunodeficiency virus (HIV) testing programme is cost-effective despite a low HIV prevalence in Hong Kong. Hong Kong Med J 2007; 13:199-207. [PMID: 17548908] [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: 05/15/2023] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of universal antenatal human immunodeficiency virus (HIV) testing in Hong Kong. DESIGN Cost-effectiveness analysis from the health care provider's perspective. SETTING Public antenatal clinics in Hong Kong. PARTICIPANTS All pregnant women who gave birth in Hong Kong during the inclusive period 1 September 2001 and 31 December 2004. MAIN OUTCOME MEASURES The primary endpoints were (i) the cost per HIV infection avoided and (ii) the cost per life-year gained. RESULTS From 2001 to 2004, a total of 160,878 deliveries were recorded in Hong Kong; and 75% of the corresponding women had HIV testing before delivery. In all, 28 women tested HIV-positive and gave birth to 15 babies, one of which was HIV-positive. The mother of the infected baby presented late in labour, without her HIV status being diagnosed and thus missed the opportunity for prompt intervention. Assuming a natural transmission rate of 25%, it was estimated that six out of seven anticipated HIV infections among the newborns had been avoided. The cost for implementation of the programme for the first 3 years was HKD12 227 988. Hence, the average costs per HIV infection averted and per discounted life-year gained were HKD2 037 998 and HKD79 099, respectively. Sensitivity analysis showed that both the coverage and the loss-to-follow-up rate were the major determinants of the cost-effectiveness of the universal antenatal testing programme in Hong Kong. CONCLUSION The universal antenatal testing programme in Hong Kong is largely efficient. In view of the low prevalence of HIV infection, high rates of HIV testing and uptake of antiretroviral prophylaxis are crucial to the success of the programme.
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Affiliation(s)
- P M Lee
- Red Ribbon Centre, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong.
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Chen JHK, Wong KH, Chan K, Lam HY, Lee SS, Li P, Lee MP, Tsang DN, Zheng BJ, Yuen KY, Yam WC. Evaluation of an in-house genotyping resistance test for HIV-1 drug resistance interpretation and genotyping. J Clin Virol 2007; 39:125-31. [PMID: 17449318 DOI: 10.1016/j.jcv.2007.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Revised: 02/22/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The human immunodeficiency virus type 1 (HIV-1) genotyping resistance test (GRT) has been considered essential for HIV-1 drug resistance monitoring. However, it is not commonly used in some developing countries in Asia and Africa due to its high running cost. OBJECTIVE This study aims to evaluate a new low-cost in-house GRT for both subtype B and non-B HIV-1. STUDY DESIGN The in-house GRT sequenced the entire protease and 410 codons of reverse transcriptase (RT) in the pol gene. Its performance on drug resistance interpretation was evaluated against the FDA-approved ViroSeq HIV-1 Genotyping System. Particularly, a panel of 235 plasma samples from 205 HIV-1-infected patients in Hong Kong was investigated. The HIV-1 drug resistance-related mutations detected by the two systems were compared. The HIV-1 subtypes were analyzed through the REGA HIV-1 Genotyping Tool and env phylogenetic analysis. RESULTS Among the 235 samples, 229 (97.4%) were successfully amplified by both in-house and ViroSeq systems. All PCR-negative samples harbored viral RNA at <400 copies/mL. The in-house and ViroSeq system showed identical drug resistance-related mutation patterns in 216 out of 229 samples (94.3%). The REGA pol genotyping results showed 93.9% (215/229) concordance with the env phylogenetic results including HIV-1 subtype A1, B, C, D, G, CRF01_AE, CRF02_AG, CRF06_cpx, CRF07_BC, CRF08_BC, CRF15_01B and other recombinant strains. The cost of running the in-house GRT is only 25% of that for the commercial system, thus making it suitable for the developing countries in Asia and Africa. CONCLUSIONS Overall, our in-house GRT provided comparable results to those of the commercial ViroSeq genotyping system on diversified HIV-1 subtypes at a more affordable price which make it suitable for HIV-1 monitoring in developing countries.
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Affiliation(s)
- J H K Chen
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR, China
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