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Year 2008

JN : J Med Assoc Thai. 2008 Feb;91(2):215-24.
TI : A two-year experience of implementing 3 dimensional radiation therapy and intensity-modulated radiation therapy for 925 patients in King Chulalongkorn Memorial Hospital.
AU : Lertbutsayanukul C, Shotelersuk K, Khorprasert C, Sanghangthum T, Oonsiri S, Ayuthaya II, Jumpangern C, Suriyapee S, Rojpornpradit P.
EN-AB: BACKGROUND AND OBJECTIVE: Three dimensional conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT) have been implemented at Department of Therapeutic Radiation and Oncology, King Chulalongkorn Memorial Hospital (KCMH) since July 2005. This is the first study in Thailand to evaluate the pattern of care and utilization of 3D CRT and IMRT for treatment in each individual cancer. MATERIAL AND METHOD: Between July 2005 and July 2007, 925 newly diagnosed cancer patients underwent IMRT or 3D CRT at KCMH. The authors retrospectively reviewed the experience and utilization of 3D CRT and IMRT for each disease site and region. RESULTS: There were 471 males and 454 females. There were 332 patients (35.9%) treated with IMRT. Among the 332 IMRT patients, there were 100, 32 and 27 nasopharyngeal, lung and prostate cancers, respectively. On the contrary, 593 patients (64.1%) were treated with 3D CRT. Among these, breast, cervix and lung cancers were the most common diseases. Except for head and neck as well as genitourinary cancer 3D CRT was still the main technique used in more than 60% of the patients at KCMH. CONCLUSION: 3D CRT and IMRT have been successfully implemented at KCMH for 2 years. Three dimensional conformal radiation therapy was still the main technique used in more than 60% of the patients at KCMH. Prospective studies evaluating tumor control and treatment sequelae are expected. (NO 18389987)

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Year 2007

JN : J Med Assoc Thai. 2007 Apr;90(4):823-8.
TI : Radiation dose to medical staff in interventional radiology.
AU : Oonsiri S, Jumpangern C, Sanghangthum T, Krisanachinda A, Suriyapee S.
EN-AB: OBJECTIVE: The purposes of the present study were to determine the dose to medical staff in interventional radiology at different locations on the body measured by thermoluminescent dosimeter (TLD) and to relate the medical staff dose to patient dose measured by the dose-area product (DAP) meter. MATERIAL AND METHOD: The present study covered 42 patients in three interventional radiology procedures with three x-ray machines. Thermoluminescent dosimeters were stuck at eight positions on the radiologist's skin during the procedure. In addition, direct reading from the DAP meter placed in front of the collimator of the x-ray tube, was recorded to estimate the patient radiation dose. RESULTS: The surface dose to the primary radiologist showed maximum value at the left forearm of 407 microGy. The ratios between the maximum interventional radiologist surface dose and patient dose are 12.88 microGy per 10 Gycm2 for transarterial oily chemoembolization TOCE (Siemens Polystar), 22.58 microGy per 10 Gycm2 for transarterial oily chemoembolization TOCE (Siemens Neurostar), 148.29 microGy per 10 Gycm2 for percutaneous transhepatic biliary drainage PTBD (Siemens Polystar) and 100.46 microGy per 10 Gycm2for endoscopic retrograde cholangiopancreatography ERCP (GE Advantx). CONCLUSION: The interventional radiologist surface dose can be estimated from the mentioned ratio if the patient dose is measured. This will help the radiologists to avoid receiving an excess dose during their work. (NO 17487142)

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Year 2006

JN : J Med Assoc Thai. 2006 Dec;89(12):2068-76.
TI : Intensity-modulated radiation therapy in head-and-neck cancer, first report in Thailand.
AU : Lertbutsayanukul C, Khorprasert C, Shotelersuk K, Jumpangern C, Sanghangthum T, Oonsiri S, Ayuthaya II, Suriyapee S, Wadwongtham W, Supanakorn S, Kerekanjanarong V, Rojpornpradit P.
EN-AB: OBJECTIVE: This is the first report in Thailand to evaluate the efficacy of using intensity-modulated radiotherapy (IMRT) in the primary treatment of head-and-neck cancer. MATERIAL AND METHOD: From July 2005 to March 2006, eighteen patients with head and neck cancer were treated with IMRT, fourteen of which were nasopharyngeal cancer. The median age at diagnosis was 52 years (range 23-58 years). The treatment plan composed of two sequential plans for PTV-low risk (50Gy in 25 fractions) and PTV-high risk (20Gy in 10 fractions). Chemotherapy was given to 13 patients with locoregionally advanced disease (stage T3/T4 and N2/3) using cisplatin (n = 3) or carboplatin (n = 10) every 3 weeks during the course of radiation therapy. RESULTS: The median overall treatment time was 49 days (range, 43-57 days), and 77.8 percent of the patients completed 35 fractions within 50 days. The clinical complete response and partial response rates at 3 months after complete radiation were 71.4% and 28.6%, respectively. However at the median follow-up of 5.6 months, the complete response rate increased to 89%. Treatment break during RT range from 3 to 7 days, was observed in three patients. All of them received concurrent chemoradiation. No distant metastasis was noted. CONCLUSION: The authors' experience of using concurrent chemotherapy with IMRT for a cohort of patients with head and neck carcinoma showed a very high rate response rate at early follow-up. Long-term clinical outcome is expected. (NO 17214058)

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Year 2004

JN : Int J Radiat Oncol Biol Phys. 2004 Aug 1;59(5):1424-31.
TI : Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma.
AU : Lertsanguansinchai P, Lertbutsayanukul C, Shotelersuk K, Khorprasert C, Rojpornpradit P, Chottetanaprasith T, Srisuthep A, Suriyapee S, Jumpangern C, Tresukosol D, Charoonsantikul C.
EN-AB: PURPOSE: Intracavitary brachytherapy plays an important role in the treatment of cervical carcinoma. Previous results have shown controversy between the effect of dose rate on tumor control and the occurrence of complications. We performed a prospective randomized clinical trial to compare the clinical outcomes between low-dose-rate (LDR) and high-dose-rate (HDR) intracavitary brachytherapy for treatment of invasive uterine cervical carcinoma. METHODS AND MATERIALS: A total of 237 patients with previously untreated invasive carcinoma of the uterine cervix treated at King Chulalongkorn Memorial Hospital were randomized between June 1995 and December 2001. Excluding ineligible, incomplete treatment, and incomplete data patients, 109 and 112 patients were in the LDR and HDR groups, respectively. All patients were treated with external beam radiotherapy and LDR or HDR intracavitary brachytherapy using the Chulalongkorn treatment schedule. RESULTS: The median follow-up for the LDR and HDR groups was 40.2 and 37.2 months, respectively. The actuarial 3-year overall and relapse-free survival rate for all patients was 69.6% and 70%, respectively. The 3-year overall survival rate in the LDR and HDR groups was 70.9% and 68.4% (p = 0.75) and the 3-year pelvic control rate was 89.1% and 86.4% (p = 0.51), respectively. The 3-year relapse-free survival rate in both groups was 69.9% (p = 0.35). Most recurrences were distant metastases, especially in Stage IIB and IIIB patients. Grade 3 and 4 complications were found in 2.8% and 7.1% of the LDR and HDR groups (p = 0.23). CONCLUSION: Comparable outcomes were demonstrated between LDR and HDR intracavitary brachytherapy. Concerning patient convenience, the lower number of medical personnel needed, and decreased radiation to health care workers, HDR intracavitary brachytherapy is an alternative to conventional LDR brachytherapy. The high number of distant failure suggests that other modalities such as systemic concurrent or adjuvant chemotherapy might lower this high recurrence, especially in Stage IIB and IIIB. (NO 15275728)

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Year 2003

JN : J Med Assoc Thai. 2003 Jul;86(7):603-11.
TI : Intracranial germ cell tumors: experience in King Chulalongkorn Memorial Hospital.
AU : Shotelersuk K, Rojpornpradit P, Chottetanaprasit T, Lertbutsayanukul C, Lertsanguansinchai P, Khorprasert C, Asavametha N, Suriyapee S, Jumpangern C.
EN-AB: A retrospective study was performed on 69 patients with intracranial germ cell tumors who were treated at the Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital from 1990 to 2000. Median age was 15 years. Forty-two cases (60.87%) had histologically confirmed germinoma or nongerminomatous germ cell tumors. Germinoma was the predominate histology followed by mixed germ cell tumors. Pineal and suprasellar regions were the two leading sites, hydrocephalus (85.5%) and diplopia (57.97%) were the two most common clinical presentations. Only 13 cases had the result of cerebrospinal fluid (CSF) cytology or magnetic resonance imagine (MRI) of the spine before initial treatment. Serum tumor markers, Alpha fetoprotein and beta-human chorionic gonadotropin, were available in 66.67 per cent. Total or partial tumor removal were feasible in 24 cases. Whole brain irradiation was given in almost all cases with the median dose of 3,600 cGy. The median total tumor dose was 5,400 cGy. Whole spine radiation was utilized in 17 cases. The mean follow-up time was 41 months. The five-year disease free survival was 73.59 per cent. Overall 3 and 5 year survival rates were 86.45 per cent and 81.64 per cent, respectively. (NO 12948253)

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Year 2001

AU : Lertbutsayanukul C, Lertsanguansinchai P, Shotelersuk K, Khorprasert C, Rojpornpradit P, Asavametha N, Pataramontree J, Suriyapee S, Tresukosol D, Termrungruanglert W.
TI : Results of radiation therapy in stage 1B cervical carcinoma at King Chulalongkorn Memorial Hospital : fifteen-year experience.
JN : J Med Assoc Thai 2001 Jun ; 84 (Suppl 1) : S216-27
EN-AB: A retrospective study was performed on 131 patients with stage 1B cervical carcinoma who were referred and treated with external beam radiation and intracavitary brachytherapy at the Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between February 1985 and February 2000. Primary outcomes were overall survival rate, progression free survival rate, recurrence, and treatment-related complications. The treatment results from different sources of intracavitary radiation therapy were secondary endpoints. The number of patients treated with Ra-226, Cs-137, and Ir-192 intracavitary irradiation were 12, 84, and 35 patients respectively. The median follow-up times were 69, 59, and 21 months for Ra-226, Cs-137, and Ir-192, respectively. Actuarial 5-year overall survival rate was 89 per cent. The 5-year progression free survival rate was 80 per cent. Actuarial 5-year survival and progression free survival rate were comparable among different sources of intracavitary brachytherapy (p = 0.553 and p=0.793, respectively). The overall recurrent rate was 16.8 per cent. Of the recurrence; 40.9 per cent was locoregional, 54.6 per cent was distant failure, and 4.5 per cent was combined locoregional and distant failure. The overall complication rate was 25.95 per cent. The severe complication rates (Grade III-V) from treatment occurred in the urinary bladder (0.76%) and in the small bowel (0.76%.) These results suggest that radiation therapy alone is an effective treatment for stage 1B cervical carcinoma. Additionally, all types of intracavitary brachytherapy provide comparable clinical results. (NO 07282)

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Year 1998

AU : Suriyapee S, Jumpangern C, Toin N.
TI : Standard plan for low dose rate Cs-137.
JN : Journal of the Society of Radiation Oncology of Thailand = มะเร็งวิวัฒน์ 1998 ; 4 (2) : 25-32
EN-AB: The standard treatment plan for low dose rate Cs-137 ideal insertion of carcinoma of cervix has been used for patients in some hospital due to the limitation of time and treatment planning system. To study that individualisation calculation is different or comparable to the standard plan, the treatment plans of 15 patients were selected to compare the calculated dose rate at point A with the standard dose rate. The patients were treated with the standard applicator of 5-6 cm uterine tube long and a pair of ovoids of half small, small or medium size. The insertions were done two times about 2 weeks separation. The loading followed to the Manchester system. The study for 30 insertions showed to average calculated dose rate at point A of 158.58ฑ 11.95 cGy/hr compare to the standard dose rate of 155.01 cGy/hr. The average dose rate at point B is 46.23 2.75 cGy/hr. which is 29.15 per cent of point A. The dose rate at point A varies from 146.02 cGy/hr to 199.45 cGy/hr which 22 of 30 insertions (73.3 per cent) have the dose rate at point A within 5 per cent of the standard dose rate. The standard dose rate can be used only if the cephalad surface of ovoids are in the same level with the flange of uterine tube. However, the anatomy and the extension of the disease including the skill of the insertor are the limitation factors. (NO 05625)

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Year 1996

AU : Suriyapee S, Jumpangern C, Puangnak C.
TI : Dose calculation for the half blocked fields defined by independent jaws.
JN : Asean Journal of Radiology 1996 May-Aug ; 2 (2) : 119-124 (NO 04925)

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Year 1994

AU : Suriyapee S, Kanokjiraporn S, Srimanoroth S, Leelasomsiri D.
TI : Calibration of electron beams at Chulalongkorn Hospital, Bangkok. Vienna
CONF : Proceedings of an international symposium on measurement assurance in dosimetry, International Atomic Energy Agency 1994 : 427-433 (NO 03909)

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Year 1992

AU : Pholshivin P, Thitathan S, Rojpornpradit P, Rachatapiti P, Pattaramontri J, Suriyapee S.
TI : Survival in stage III non-small-cell lung cancer.
JN : จุฬาลงกรณ์เวชสาร = Chulalongkorn Medical Journal 1992 Mar ; 36 (3) : 207-215
EN-AB: This retrospective study compared the survival results of 59 stage III non-small-cell lung cancer patients treated by radiotherapy - chemotherapy and combined modality. The onew and two-year survival rates of radical dose radiotherapy +/- chemotherapy were significantly superior to palliative doses, but no significant difference was seen when comparing between radiotherapy alone and combined modality. These, we recommend the use of radiotherapy, especially with curative doses, in cases of unresectable stage III non-small-cell lung cancer. Performance status, treated volume and fractionation schemes also play a role in the patients survival.
TH-AB: เป็นการศึกษาย้อนหลังเปรียบเทียบอัตราการรอดชีวิตผู้ป่วยมะเร็งปอด ระ ยะที่ 3 ชนิดไม่ใช่เซลล์เล็กที่รักษาด้วยรังสี +/- เคมีบำบัด เทียบกั บวิธีรักษาร่วมในผู้ป่วย 59 ราย ผลการศึกษา พบว่าผู้ป่วยที่ได้รับรัง สีในขนาดที่หายขาด (time-dose-fractionation มากกว่า 82) จะมีอัตราการรอดชีวิตสูงกว่ากลุ่มที่ได้รับรังสีขนาดบรรเ ทาอาการ (time-dose-fractionation น้อยกว่าหรือเท่ากับ 82) อย่างมีนัยสำคัญทา งสถิติ แต่ผู้ป่วยกลุ่มที่ได้รับรังสีรักษาเพียงอย่างเดียวไม่พบว่าอั ตราการรอดชีวิต ต่างกับกลุ่มที่ใช้วิธีรักษาร่วม ผู้เขียนจึงแนะนำให้ รักษาผู้ป่วยมะเร็งปอดระยะที่ 3 ชนิด ไม่ใช่เซลล์เล็ก ที่ไม่สามารถผ่ าตัดได้หมด ด้วยรังสีรักษาโดยเฉพาะให้ปริมาณรังสีในขนาดที่หายขาด ส่ว นสภาพทั่วไปของผู้ป่วยก่อนรักษา, ขอบเขตที่ฉายรังสีและลักษณะการให้รั งสี ก็เป็นปัจจัยที่สำคัญต่ออัตราการอยู่รอดของผู้ป่วยซึ่งต้องการการ ศึกษาต่อไป. (NO 02961)

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Year 1991

AU : Suriyapee S, Pataramontree J.
TI : The report of radiation survey around the linear accelerator site at Chulalongkorn Hospital.
JN : จุฬาลงกรณ์เวชสาร = Chulalongkorn Medical Journal 1991 Oct ; 35 (10) : 625-630
EN-AB: Clinic 1800 the therapy linear accelerator was installed at the Department of Radiology, Chulalongkorn Hospital in November 1989. The thickness of the linear accelerator building was calculated by a group of physicists based on the recommendation of NCRP for the purpose of radiation safety. Radiation monitoring was carried out around the accelerator by using the ionization chamber. The levels from meter readings were compared to that calculated dosage remained behind the barrier and the results are shown. There was nowhere that the radiation exceeded the maximal limit permissible for the personnel as well as the general public. The principle of the calculation was correct and the construction of the building was satisfactory. (NO 03204)

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Year 1990

AU : Lertsanguansinchai P, Rojpornpradit P, Thitathan S, Rajatapiti P, Kambhu Na-Ayudhya P, Pataramontree J, Suriyapee S.
TI : Analysis of 515 cases of cervical carcinoma treated with radiotherapy at Chulalongkorn Hospital.
JN : Chula Med J = จุฬาลงกรณ์เวชสารChulalongkorn Medical Journal 1990 Jan ; 34 (1) : 31-40
EN-AB: From January 98 to December 1983, 515 patients with cervical carcinoma had completed radiation treatment at the Radiotherapy Unit, Department of Radiology, Chulalongkorn University Hospital. Of 515 patients, 482 had completed the follow-up. The majority of patients were FIGO stage II and III. All patients had been followed for at least 5 years or until death. Local recurrences for stage II and III were 16.35% and 30.58% respectively. Distant metastases were 12.98% in stage II and 21.49% in stage III with the lung being the most frequent site for metastases. The 5-year actuarial survival rate in stage I, II, III and IV were 85.4%, 7.4%, 41.3% and 0% respectively, with a mean of 56.1%. Most treatment complications were grade 1, grade 3 complications were found in 2.70%. Rectum is the major site of treatment complication. (NO 04927)

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Year 1988

AU : Pataramontree J, Suriyapee S.
TI : Dose measurement of carcinoma of cervix treated with selectron.
JN : Chula Med J 1988 Apr ; 32 (4) : 349-356
EN-AB: Since May 1985, a Selectron low dose-rate, six channel machine with 40 mCi source has been used at Chulalongkorn Hospital, Bangkok. For a period of 1 year, 115 patients having carcinoma of the cervix have been treated in two sessions with the Selectron after their external irradiation. The standard Selectron applicators are loaded to reproduce the Manchester Radium Dosage System. The position of applicators in 115 cases were studied from radiographs. Then the wax phantom was designed according to mean value of patients'data and was used to measure the dose-rate at various reference points defined by ICRU no.38. The TLD-100 in the form of solid ribbons were used as dosimeters. The mean dose-rate at point A obtained from Cs-pellets is 196.05 cGy/hr. It varies 1-2 per cent according to the size and the distance of avoid seperation. The mean dose-rate at point B is about 34 per cent of dose-rate at point A or 69 cGy/hr. The maximum dose-rate at rectum (2.7 cm. below tandem) is about 65 per cent of the point A dose-rate or 128 cGy/hr. The maximum dose-rate at bladder (2.7 cm. above tandem) is about 78 per cent of the point A dose-rate or 153 cGy/hr. The TDF value at point A for the total dose of 7500 cGy, calculated at the condition of 20 per cent dose reduction for the change of RBE due to the higher dose-rate of Caesium with 2 weeks rest period, is calculated according to Ellis' Formular. The therapeutic ratio is also calculated from the time-dose-fractionation factors. (NO 01606)

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Year 1983

AU : Suriyapee S, Kamphu-Na-Ayudhya P, Rojpornpradit P.
TI : Studying the dose distribution of afterloading radium applicator.
JN : Thai J Radiol 1983 Oct ; 20 (2) : 75-80
EN-AB: The dose distribution of Fletcher afterloading radium applicator in wax phantom was studied by the method of the thermoluminescent dosimeter. The measured dose at various points using two different manufactured applicators are 8 percent lower than the calculated ones due to the absorption of the metallic wall of the applicator. From the radiograph of the two colpostats, one of them is shielded by tungsten at both ends and gives a 10-15 percent lower dose rate than the other one which is not shielded. This decrease in dose rate is of clinical significant and should be checked before using (NO 00155)

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