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Year 2007

JN : Gynecol Oncol. 2007 Jan;104(1):15-23. Epub 2006 Sep 25.
TI : A randomized phase III trial of concurrent chemoradiotherapy in locally advanced cervical cancer: preliminary results.
AU : Veerasarn V, Lorvidhaya V, Kamnerdsupaphon P, Suntornpong N, Sangruchi S, Lertsanguansinchai P, Khorprasert C, Sookpreedee L, Udompunturak S.
EN-AB: OBJECTIVE: Concurrent chemoradiation is the standard treatment for locally advanced cervical cancer. This study was a preliminary result of a randomized two arms, prospective, open-label phase III trial comparing the activity and safety of the concurrent chemoradiation of Tegafur-Uracil and carboplatin or carboplatin alone in locally advanced cervical cancer. MATERIALS AND METHODS: The stage IIB-IIIB cervical cancer patients were randomized to have Tegafur-Uracil 225 mg/m(2)/day orally, 5 days a week and carboplatin 100 mg/m(2) IV over 30-60 min, weekly on day 1 concurrent with standard radiotherapy (Group A) or carboplatin alone concurrent with standard radiotherapy (Group B). RESULTS: Four hundred and sixty-nine patients were randomized to Group A (n=234) or Group B (n=235). The tumor response at 3-month follow-up time showed no significant difference. The only prognostic factor to improve the complete response rate was the hemoglobin level. The patients in Group A, who had Hb <10 gm/dL had the relatively better change to complete response of 1.48 compared to that in Group B (P 0.025, 95% CI 1.07, 2.04). No severe toxicity or adverse event had been reported. The median follow-up time for Group A and Group B was 12.6 and 11.8 months, respectively. There was no statistical difference in PFS and OS. CONCLUSION: Concurrent chemoradiation by Tegafur-Uracil and carboplatin showed no difference in tumor response rate or treatment toxicity compared to carboplatin alone. The combination drugs might have benefit in poor prognostic patients such as the baseline Hb <10 gm/dL. (NO 16996583)

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Year 2006

JN : J Med Assoc Thai. 2006 Nov;89(11):1874-84.
TI : Preoperative capecitabine with pelvic radiotherapy for locally advanced rectal cancer (phase I trial).
AU : Veerasarn V, Phromratanapongse P, Lorvidhaya V, Lertsanguansinchai P, Lertbutsayanukul C, Panichevaluk A, Boonnuch W, Chinswangwatanakul V, Lohsiriwat D, Rojanasakul A, Thavichaigarn P, Jivapaisarnpong P.
EN-AB: OBJECTIVE: Phase I multicenter study defined the maximal tolerated dose (MTD), dose-limiting toxicity (DLT) and safety profile of capecitabine in combination with preoperative radiation for patients with locally advanced rectal cancer (LARC). MATERIAL AND METHOD: Patients were treated with oral capecitabine (700, 800, 900, 1000, 1100 and 1200 mg/m2 twice daily continuously) plus preoperative whole pelvic irradiation (45-46 Gy in 23-25 fractions over 5-6 weeks). Surgery was performed at the median of 42 days after chemoradiation treatment. RESULTS: Twenty-seven patients were in this trial. Eighteen patients (3 per dose level) had received capecitabine from 700 mg/m2 twice daily to the highest dose level of 1200 mg/m2 twice daily. There were no grade 3/4 DLTs during dose escalation, a further nine patients were included at the highest capecitabine dose. Two of the twelve patients (16%) receiving capecitabine 1200 mg/m2 twice daily developed grade 3 diarrhea and discontinued treatment. There were no other grade 3/4 adverse events. After capecitabine chemoradiation, 24 of 27 patients (89%) received definite surgery. Primary and lymph node down staging occurred in ten patients (42%). Sphincter-sparing surgery was performed in seven patients (26%) and abdominal-perineal resection was performed in 17 patients (63%). CONCLUSION: Preoperative capecitabine chemoradiation based on continuous daily capecitabine is very well tolerated in patients with LARC. The authors did not reach the MTD in the present study. (NO 17205868)

JN : Cancer Lett. 2006 Aug 8;239(2):292-7. Epub 2005 Oct 21.
TI : High frequency of mutation of epidermal growth factor receptor in lung adenocarcinoma in Thailand.
AU : Sriuranpong V, Chantranuwat C, Huapai N, Chalermchai T, Leungtaweeboon K, Lertsanguansinchai P, Voravud N, Mutirangura A.
EN-AB: Recent reports have suggested influences of racial difference on the frequency of mutation of EGFR in lung cancer. We therefore sought to characterize the frequency and pattern of mutation of EGFR in lung adenocarcinoma in Thai patients. Overall, EGFR catalytic domain mutations were detected in 35/61 (57.4%). We found 29/60 (48.3%) of exon 19 deletions, 5/54 (9.3%) of exon 21 point mutations, and 1/54 (1.9%) of double-mutation of both exons. The presence of these mutations was significantly associated with non-smoking habit. In summary, we report a strikingly high prevalence of mutation of EGFR in Thai lung adenocarcinoma, which may explain the high response rate to the treatment with TKI among Asian populations. (NO 16243431)

JN : J Med Assoc Thai. 2006 Aug;89(8):1120-6.
TI : Pain and quality of life of cancer patients: a multi-center study in Thailand.
AU : Thienthong S, Pratheepawanit N, Limwattananon C, Maoleekoonpairoj S, Lertsanguansinchai P, Chanvej L.
EN-AB: OBJECTIVE: To identify the association between Quality Of Life (QOL) and pain intensity, and the magnitude of change of pain scores that have a clinically significant impact on patients' QOL. DESIGNS: Multi-center; prospective cohort study. MATERIAL AND METHOD: Patients suffering from cancer pain were recruited from seven university hospitals and three tertiary care centers in Thailand. The FACT-G and the Brief Pain Inventory were used to assess QOL and cancer pain severity, respectively, at study entry and at two-week follow-up. RESULTS: Five-hundred-and-twenty patients were recruited with a mean age of 52. The majority (76%) reported two sites of pain with 80% being treated at either step 2 or 3 (WHO guidelines of pain management). After two weeks, the average level of maximum pain was reduced from 6.6 to 4.8 (mean difference = -1.8, p < 0.001) and the QOL was improved from 58.6 to 61.0 (mean difference = 2.4, p < 0.001). There was a high correlation between the average change of pain intensity and QOL scores (rs = -0.42, p < 0.001). The results show that changes of pain scores of at least three points (3 out of 10) were required for a minimal important difference of FACT-G scores, indicating a significant change on patients' QOL. Pain deterioration had slightly more impact on QOL than pain improvement. A 3-point pain deterioration impaired QOL 10.3 points while 3-point reduction increased QOL only 7.6 points. CONCLUSION: The present findings suggest the importance of pain management. The change of pain scores of at least three points (out of 10 points) had statistical and clinical significance to patients' QOL. (NO 17048419)

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Year 2005

JN : J Med Assoc Thai. 2005 Sep;88 Suppl 4:S200-6.
TI : Reducing radiation dose to pelvic small bowel in cervical cancer patients treated with Ir-192 intracavitary brachytherapy by using urinary bladder distension.
AU : Sukhaboon J, Shotelersuk K, Lertsanguansinchai P, Khorprasert C.
EN-AB: OBJECTIVES: Several techniques and devices have been used in an attempt to minimize radiation dose to gastrointestinal tract while giving pelvic radiation. We evaluated the effect of urinary bladder distension to displace pelvic small bowel out of intracavitary brachytherapy field to minimize radiation dose to small bowel in cervical cancer patients. MATERIAL AND METHOD: Eleven cervical cancer patients who received Ir-192 intracavitary brachytherapy with tandem and transverse ovoids were included in this study. Oral contrast material was used to visualize pelvic small bowel. Urinary bladder was distended by injection 125-200 ml. normal saline solution. Pelvic radiograph, anteroposterior and lateral view, was performed before and after bladder distention for brachytherapy treatment planning and comparing radiation dose at small bowel. RESULTS: The average maximum radiation dose at small bowel before and after bladder distension were 3123 cGy and 1998 cGy respectively. The summation of small bowel dose was reduced 54.17% (p = 0.002). CONCLUSION: Urinary bladder distension could effectively displace pelvic small bowel and reduce the radiation dose to small bowel from Ir-192 intracavitary brachytherapy in cervical cancer patients. (NO 16623029)

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Year 2004

JN : Radiother Oncol. 2004 Nov;73(2):179-85.
TI : Reduced recurrence of late hemorrhagic radiation cystitis by WF10 therapy in cervical cancer patients: a multicenter, randomized, two-arm, open-label trial.
AU : Veerasarn V, Khorprasert C, Lorvidhaya V, Sangruchi S, Tantivatana T, Narkwong L, Kongthanarat Y, Chitapanarux I, Tesavibul C, Panichevaluk A, Puribhat S, Sangkittipaiboon S, Sookpreedee L, Lertsanguansinchai P, Phromratanapongse P, Rungpoka P, Trithratipvikul S, Lojanapiwat B, Ruangdilokrat S, Ngampanprasert P.
EN-AB: BACKGROUND AND PURPOSE: To evaluate the efficacy and the safety of WF10 as adjunct to standard treatment in the management of late hemorrhagic radiation cystitis compared to standard treatment alone. PATIENTS AND METHODS: Cervical cancer patients with Grade 2 or 3 late hemorrhagic radiation cystitis, were randomized and treated with WF10 0.5 ml/kg body weight, diluted in physiological saline or 5% dextrose water 250 ml, intravenous infusions over 2 h on 5 consecutive days, every 3 weeks for 2 cycles plus standard treatment (WF10 group) or standard treatment alone (control group). Fifty patients in each group were evaluated by questioning; urinalysis and cystoscopy during a 1 year follow up. RESULTS: At week 7, 37 patients (74%) in the WF10 group and 32 patients (64%) in the control group showed complete resolution in objective hematuria (P = 0.28). Significantly lower use of antibiotics (P = 0.002) and antispasmodics (P < 0.001) was found in the WF10 group. Among the responders, 24 patients (77%) in the control group experienced recurrent objective hematuria, whereas in the WF10 group only 17 patients (47%) experienced a recurrence (P = 0.01). Recurrence of objective hematuria occurred significantly faster in the control group as evidenced by Kaplan-Meier and log-rank statistics (P = 0.004), suggesting a long-term effect of WF10. Cystoscopy, at the end of the treatment period and after the one year follow up showed overall improvement without significant difference between two groups. No severe toxicity was monitored. CONCLUSIONS: WF10 therapy is a safe, non-invasive and convenient method in the management of late hemorrhagic radiation cystitis. WF10 therapy, as adjunct to standard treatment, has significantly reduced recurrence of objective hematuria, compared to standard treatment alone, during a one year follow up. (NO 15542165)

JN : J Med Assoc Thai. 2004 Sep;87 Suppl 2:S168-74.
TI : Pattern of local-regional recurrence in patient with early breast cancer after mastectomy: an analysis of 357 cases at King Chulalongkorn Memorial Hospital.
AU : Lertsanguansinchai P, Lertbutsayanukul C, Chatamra K, Shotelersuk K, Voravud N, Khorprasert C.
EN-AB: A retrospective review was performed on 357 patients with early stage I-IIIA operable breast cancer who were treated with mastectomy and referred to the clinic at the Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between Jan 1991 and Dec 2001. Patients characteristics, treatment modalities and pattern of local and regional failure were evaluated. The median and mean age in the present study were 49 and 50.2 years, respectively. Stage I, II and IIIA were 10.9%, 79.6% and 9.5%, respectively. One hundred and ninety-seven patients (55.2%) received postoperative radiation therapy (RT). Adjuvant chemotherapy was given in 247 patients (69.2%) while 122 patients (34.2%) received adjuvant hormonal therapy. Sixty one patients (17.1%) received both adjuvant chemotherapy and hormonal therapy. However, 12.6% (45/357) did not receive any adjuvant treatment. Median follow up time was 42.6 months (range 6-136 months). Ipsilateral supraclavicular node and chest wall were the most common sites of local-regional recurrence. The chest wall recurrence rate was 10.4% (37/357), which was 16.9% (27/160) in the non postoperative radiation (No RT) group and 5.1% (10/197) in the postoperative radiation (RT) group. For ispilateral supraclavicular node, the recurrence rate was 10.6% (38/357), which was 15.6% (25/160) and 6.6% (13/197) for non RT and RT groups, respectively. The incidence of ipsilateral axilla, ipsilateral internal mammary node and ipsilateral infraclavicular node recurrence rate were 4.2%, 3.6% and 0.8%, respectively. Overall, chest wall and ipsilateral supraclavicular node were the most common sites of local-regional recurrence in early stage operable breast cancer who underwent mastectomy Postoperative adjuvant radiation therapy decreased the risk of local-regional recurrence. (NO 16083182)

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)

JN : Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1226-32.
TI : Concurrent mitomycin C, 5-fluorouracil, and radiotherapy in the treatment of locally advanced carcinoma of the cervix: a randomized trial.
AU : Lorvidhaya V, Chitapanarux I, Sangruchi S, Lertsanguansinchai P, Kongthanarat Y, Tangkaratt S, Visetsiri E.
EN-AB: PURPOSE: This is a prospective, Phase III multicenter randomized trial to assess the effectiveness of concurrent intravenous mitomycin C, oral 5-fluorouracil (5-FU), and radiotherapy (RT) in locally advanced carcinoma of the cervix. METHODS AND MATERIALS: Between January 1988 and November 1994, 926 patients with locally advanced carcinoma of the cervix, FIGO Stage IIB-IVA, were entered into this study. The patients were randomized into four arms, as follows: Arm 1: conventional RT; Arm 2: conventional RT and adjuvant chemotherapy; Arm 3: conventional RT plus concurrent chemotherapy; Arm 4: conventional RT plus concurrent chemotherapy and adjuvant chemotherapy. Concurrent chemotherapy consisting of intravenous mitomycin C at 10 mg/m(2) was given on Days 1 and 29, and oral 5-FU at 300 mg/day was administered on Days 1-14 and 29-42 during RT. Adjuvant chemotherapy of 5-FU orally at 200 mg/day was given for three courses of 4 weeks, with a 2-week rest every 6 weeks. Six centers participated in the trial. RESULTS: The median follow-up time was 89 months. Acute side effects were generally higher in concurrent arms, but most of the patients tolerated the treatment well. Bone marrow toxicity was also higher in concurrent arms. The 5-year actuarial disease-free survival (DFS) was 48.2%, 54.1%, 64.5%, and 59.7% for arms 1, 2, 3, and 4, respectively. The pattern of failure revealed a significant increase in locoregional recurrence in the nonconcurrent chemoradiotherapy arm. The local recurrence was 25.5%, 20.6%, 14.3%, and 17.6% for arms 1, 2, 3, and 4, respectively. The metastatic rates were not significantly different in all four arms. At the time of analysis, there were no increases in late side effects, especially in gastrointestinal and genitourinary systems. CONCLUSIONS: Concurrent chemotherapy, mitomycin C, and 5-FU together with conventional RT showed an improved DFS rate when compared with conventional RT alone in patients with locally advanced carcinoma of the cervix. (NO 12654431)

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Year 2002

AU : Lertsanguansinchai P, Chottetanaprasith T, Chatamra K, Sampatanukul P, Wannakrairot P, Rojpornpradit P, Shotelersuk K, Lertbutsayanukul C, Boonjunwetwat D, Vajragupta L.
TI : Estrogen and progesterone receptors status in Thai female breast cancer patients : an analysis of 399 cases at King Chulalongkorn Memorial Hospital.
JN : J Med Assoc Thai 2002 Jun ; 85 (Suppl 1) : S193-S202
EN-AB: A retrospective review was performed on 576 patients who have been diagnosed breast cancer and referred to Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between January 1995-September 2001. There were three hundred ninety nine cases of invasive breast cancer that available for estrogen (ER) and/or progesterone (PR) receptor status. The mean and median age in our study were 49.6 year and 49.0 year respectively. About 60.9 per cent of the patients were pre and peri-menopause and 37.8 per cent were post-menopause. Most of the histological cell type were invasive ductal carcinoma which comprised of 92.7 per cent. Histologic grading were nearly equal for moderately and poorly differentiated grade: 43.66 per cent and 40.66 per cent. The results of our study showed 53.4 per cent of 399 patients had ER positive and 42.1 per cent of 380 patients had PR positive. The proportion of ER+PR+, ER+PR-, ER-PR+, and ER-PR- were 36.31 per cent, 15.53 per cent, 5.79 per cent and 42.37 per cent respectively. Older age and post-menopause women had higher ER+. While patients with increase tumor size, poorly differentiated grading, increase positivity of axillary lymph nodes and higher stage have more chance of ER negative and PR negative. (NO 07577)

AU : Lertbutsayanukul C, Lertsanguansinchai P.
TI : Concurrent chemoradiation for head and neck cancer.
JN : Chula Med J 2002 Jan ; 46 (1) : 11-17 (NO 08000)

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Year 2001

AU : Shotelersuk K, Rojpornpradit P, Khorprasert C, Lertsanguansinchai P, Asavametha N.
TI : A 11-year experience of radiation therepy for Medulloblastoma at King Chulalongkorn Memorial Hospital.
JN : Chula Med J 2001 Sep ; 45 (9) : 755-765 (NO 06828)

AU : Chottetanaprasith T, Lertsanguansinchai P.
TI : Chemotherapy and radiation therapy for cervical cancer.
JN : Chula Med J 2001 Sep ; 45 (9) : 811-823 (NO 06833)

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)

AU : Areechareonlert S, Huiprasert P, Lertsanguansinchai P, Noppakun N.
TI : Primary inflammatory carcinoma of the female breast.
JN : ว.โรคผิวหนัง = Thai J Dermatol 2001 ; 17 (1) : 48-52 (NO 07447)

AU : เทวินทร์ โชติธนประสิทธิ์, ประเสริฐ เลิศสงวนสินชัย.
TI : มะเร็งปอดชนิด non-small cell lung cancer
JN : ว.สมาคมรังสีรักษาและมะเร็งวิทยาแห่งประเทศไทย = J Soc Radiat Oncol Thai 2001 Jul-Dec ; 7 (2) : 63-76 (NO 07475)

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Year 2000

AU : Voravud N, Sriuranpong V, Lertsaguansinchai P.
TI : Recombinant interferon-alpha 2b and megestrol acetate in patients with advanced renal cell carcinoma.
JN : J Med Assoc Thai 2000 Feb ; 83 (2) : 123-128 (NO 07067)

AU : Ratanatharathorn V, Lorvidhaya V, Kraipiboon P, Sirachainan E, Maoleekoonpairoj S, Phromratanapongse P, Cheirsilpa A, Tangkaratt S, Srimuninnimit V, Pattaranutaporn P, Lertsanguansinchai P.
TI : Phase II study of concurrent chemoradiotherapy for inoperable (bulky) stage III (A/B) non-small cell lung cancer (NSCLC) : a preliminary report.
JN : J Med Assoc Thai 2000 Jan ; 83 (1) : 85-92 (NO 07283)

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Year 1999

AU : Voravud N, Lertsanguansinchai P, Wacharapuk T.
TI : Multimodality therapy of rectal cancer.
JN : Chula Med J 1999 ธ.ค. ; 43 (1) : 901-914
EN-AB: Rectal carcinoma has a tendency to recur locally after surgery. Preoperative and postoperative radiotherapy have been evaluated in several trials. Despite no definite improvement in survival, many studies have shown a reduction in the rate of local recurrence. The possibility that concomitant distant metastasis have been testes in experimental models and clinical trials with promising results. Combined-modality therapy is integral to the adjuvant management to rectal cancer. In patients with clinically resectable disease, the role of radiation is to decrease local recurrence; in the preoperative setting, radiation increases the chance of sphincter preservation. The role of the chemotherapy is to further enhance the benefits of radiation as well as improve survival. This seview focuses on the results of previous and current clinical trials regrading the adjuvant combined modality therapy for rectal carcinoma. Standard adjuvant therapy for transmural (T3) and/or node-positive rectal cancer is pelvic radiation plus fluorouracil (5-FU) based chemotherapy. Randomized trials are in progress to determine the appropiate chemotherapeutic agents and their optimal routes of administration, as well as to compare to role of the pre-versus postoperative 5-FU-based combined modality therapy. In addition, oral chemotherapy such as tegafur and uracil (UFT) and leucovorin plus pre-or postoperative radiation therapy are under active investigation in patients with rectal cancer. Although the results of combined modality therapy are encouraging, the search for innovative treatment approaches needs to continue including new radiation and surgical techniques as well as new chemotherapeutic agents. (NO 06506)

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Year 1998

AU : Charuruks N, Voravud N, Termrungruanglert W, Lertsanguansinchai P, Tresukosol D, Niruthisard S, Sirisabya N.
TI : 13-cis-Retinoi acid and interferon-alpha2a therapy in locally advanced squamous cell carcinoma of the cervix : p53 alteration, proliferating cell nuclear antigen expression and angiogenesis response..
JN : J Obstet Gynecol Res 1998 Oct ; 24 (5) : 335-41
EN-AB: Aims To evaluate prognostic importance of p53 alteration, PCNA expression and vascularisation response in patients with locally advanced cervical squamous cell carcinoma (SCC) after combination therapy with 13-Cis- retinoic acid (13CRA) and interteron-alpha2a (IFN-(alpha2a). methods-13cRA and IFN-alpha2a were administered to Patients with locally advanced cervical SCC for 8 weeks. Formalin fixed, paraffin embedded tissues sections obtained from 10 patients pre- and post-therapy with 13CRA and IFN-alpha2a, respectively, were stained immunohistochemically with anti-P53 clone DO-7, anti-PCN JC70. Results- p53 Alteratior was demonstrated in 5 of 10 (50 percent) patients acid 3 of 10 (30 percent) patients pre- and post-therapy, respectively. There was no correlation between p53 alteration and prognosis. The expression, of PCNA appeared to correlate with disease severity. After therapy, two patients with complete response had lower PCNA expression whereas the non-responder demonstrated the oppsite result. The vascularisation showed a correlation with PCNA and prognosis. In the response group, patients had lower microvessel count. 79.3 (range 63-92) vessel/mm2 while the metastalic group exhibited higher count. 96.5 (range 89-104) vessel/mm2. Conclusions The present study suggests that p53 alteration is neither related to the prognosis of cervical SCC nor is it influenced by the combination therapy while PCNA expression and vascularisation might be constitute potential markes for tumorigenesis prognosis acid responsiveness to this novel regimen of 13cRA and IFN-alpha23a. (NO 05326)

AU : Mutirangura A, Sriuranpong V, Termrungraunglert W, Tresukosol D, Lertsaguansinchai P, Voravud N, Niruthisard S.
TI : Telomerase activity and human papillomavirus in malignant, premalignant and benign cervical lesions.
JN : Br J CancerBritish Journal of Cancer 1998 Oct ; 78 (7) : 933-9
EN-AB: The purpose of this study was to define a correlation between telomerase activity and human papillomavirus (HPV) in normal control tissue and in benign, premalignant and malignant cervical lesions. Telomerase activity was detectable in 33 out of 34 cases of squamous-cell carcinoma, five out of six cases of microinvasive carcinoma, 8 out of 20 cases and two out of six cases of high- and low-grade squamous intraepithelial lesions (SILs) respectively. The higher frequency of positive telomerase in invasive carcinoma compared with SILs was observed in both HPV-associated and non-associated groups. Whereas 92.6 of HPV-positive and 100 of HPV-negative invasive lesions expressed telomerase, only 50 of HPV-positive and 25 of HPV-negative SILs did. Interestingly, telomerase activity was also detectable in 13 out of 28 cases of benign lesions regardless of the presence of HPV. In conclusion, there may be two roles of telomerase in the cervix. The first one would present in benign lesions; the second is associated with cancer development and activated during the late stage of multistep carcinogenesis in both HPV-positive and-negative groups. (NO 05356)

AU : Mutirangura A, Pornthanakasem W, Theamboonlers A, Sriuranpong V, Lertsanguansinchi P, Yenrudi S, Voravud N, Supiyaphun P, Poovorawan Y.
TI : Epstein-Barr viral DNA in serum of patients with nasopharyngeal carcinoma.
JN : Clinical Cancer Research 1998 Mar ; 4 (3) : 665-9
EN-AB: This study evaluated Epstein-Barr virus (EBV) DNA in sera of 42 patients with nasopharyngeal carcinoma (NPC) and 82 healthy individuals who had been infected previously with EBV. Thirteen of 42 NPC samples were positive for EBV DNA in their sera, whereas all 82 normal controls were negative. In addition, EBV typing between primary tumors and sera showed identical results, suggesting that serum EBV DNA represented tumor DNA. To evaluate the importance of the serum NPC DNA, clinical data and tumor phenotypes including age, sex, WHO type, EBV type, stage, tumor invasion, metastasis, and apoptosis were correlated with serum EBV DNA, and only apoptosis was found statistically significant. In conclusion, EBV DNA was detectable in the serum of some patients with NPC, represented tumor DNA, and might have clinical implications in the future. (NO 05393)

AU : Rojpornpradit P, Khorprasert C, Shotelersuk K, Lertsanguansinchai P.
TI : Results of radiation therapy for glottic cancer.
JN : จุฬาลงกรณ์เวชสาร = Chulalongkorn Medical Journal 1998 Jul ; 42 (7) : 495-504
EN-AB: Background : Cure and voice preservation are the primary concerns for patients seeking treatment for glottic cancer. The efficacy of radiation therapy, either alone or in combination with surgery, in glottic cancer was assessed. Objective : To review the results of radiation treatment in patients with glottic cancer. Setting : Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University. Subjects : Seventy-eight patients with histologically proven squamous cell carcinoma of the glottis, from January 1983-December 1989. Design : Retrospective study. Patients : The records of 78 patients with age-range of 33-84 (mean age equal 60.3) were reviewed There were 74 (94.9 per cent) males and 4 (5.1 per cent) females. The male to female ratio was 18.5:1. All had histologically proven squamous cell carcinoma. Method : The survival rate was calculated using the product limit estimate of Kaplan and Meier. Comparions of survival were made using the log rank test. A p-value of less than or equal to 0.05 was considered significant. Results : Seventy-eight glottic cancers had been treated by radiotherapy (RT). Either alone or in combination with surgery (S+RT). The overall 5-Year survival rate was 91.3 per cent for T1N0M0, 50.6 per cent for T3N0M0 and 53.5 per cent for any TN1-3M0. The locoregional control rates for patients treated with RT for the corresponding groups were 92.0 per cent, 28.6 per cent and 40.0 per cent with surgical salvage rate of 100.0 per cent, 60.0 per cent and 0 per cent respectively. For patients treated with S+RT the locoregional control rate was 71.4 per cent for T3N0M0 and 41.7 per cent for any TN1-3M0 with radiation salvage rate of 25.0 per cent and 14.4 per cent respectively. The rates of laryngeal voice preservation in the RT group were 92.0 per cent for T1N0M0, 75.0 per cent for T2N0M0, 64.3 per cent for T3N0M0 did not influence the survival. The number of patients in T2N0M0, T4N0M0 and anyTanyNM1 were too small to obtain any meaningful analysis. Death from intercurrent disease was found to be 42.9 per cent. Conclusion : Glottic cancer is radiocurable. Preservation of the larynx can be achieved with radiotherapy without jeopardizing survival. (NO 05619)

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Year 1995

AU : Rojvachiranond N, Vajrabukka T, Lertsanguansinchai P, Voravud N.
TI : Adjuvant therapy for rectal cancer.
JN : จุฬาลงกรณ์เวชสาร = Chulalongkorn Medical Journal 1995 ; 39 (2) : 137-158
EN-AB: The risk of recurrence after curative resection of rectal cancers is related to both disease extension beyond the rectal wall and to nodal involvement. Adjuvant therapy plays an important role to decrease local or systemic failure of patients with rectal cancer who have moderate to high risk of relapse after surgical resection. Irradiation diminished the rate of local recurrence in two prospective trials, but this has not translated into an improvement in overall survival in view of a lack of impact on distant metastasis. Combined modality adjuvants of radiotherapy and chemotherapy demonstrated efficacy of local and systemic control of disease in two prospectively randomized trials. (GTSG 7175 and Mayo/NCC TG 794751). Therapeutic gains achieved with combination treatment programs might be offset by an unnecessary increase in complications unless physicians select patients that have definite indications for treatment, and work closely to optimize delivery of the combined modaties. (NO 02556)

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Year 1993

AU : Rojpornpradit P, Thitathan S, Lertsanguansinchai P, Rajatapiti P, Phunrassami T.
TI : Radiation therapy for carcinoma of the endometrium. our experience during the period 1977-1983.
JN : Chulalongkorn Medical Journal 1993 ; 37 (3) : 173-182
EN-AB: The authors evaluated 106 cases of endometrial carcinoma. The median age at presentation was 57 years. Seventeen patients (16 per cent) were hypertensive and 13 (12 per cent) were diabetic. The most common presenting symptom was abnormal vaginal bleeding which constituted 76 per cent of the patients. The distribution of the disease by stage was: stage I equal 59 per cent, stage II equal 15 per cent, stage III equal 12 per cent, stage IV equal 3 per cent, unknown stage equal 11 per cent. The most common histology was adenocarcinoma which accounted for 85.9 percent of the patients. Thirty-five patients (36 per cent) were treated by radiation alone. Pre-and post-operative radiation was used in 28 patients (29 per cent) and 33 patients (34 per cent), respectively. Overall five-year survival was 78.6 per cent. The survival rates for stages I, II, III and IV were 88.8 per cent, 79.4 per cent, 36.9 per cent and 0 per cent, respectively. Statistical analysis showed the age of the patients at presentation significantly influenced survival (p 0.025). Radiation method, histologic grade and uterine length could not be shown to influence survival. Measures to prevent patients lost to follow-up were proposed. (NO 02771)

AU : Lertsanguansinchai P, Thitathan S, Rojpornpradit P, Rajatapiti P.
TI : Phase III study of radiotherapy alone versus combination of mitomycin-C and 5-FU plus radiation in locally advanced cervical cancer. preliminary results.
JN : Chulalongkorn Medical Journal 1993 ; 37 (7) : 461-468
EN-AB: Between November 1988 and September 1990, 52 cases of advanced stage IIB and IIIB cancer of the uterine cervix at the Radiotherapy Unit, Department of Radiology, Chulalongkorn University Hospital were divided into 2 treatment groups; 25 patients were treated by conventional irradiation alone while another 27 patients were treated by combination of mitomycin C and 5-FU concomittently with conventional irradiation. There were no obvious benefits in locoregional control, but there were decreased in distant metastases in the chemotherapy arm. Median disease-free survival rate (31.3 mo) was 32 per cent for control group as compared to 51.9 per cent (28.3 mo) for chemotherapy group. There were more immediate adverse events in the chemotherapy arm than the radiotherapy arm. (NO 02783)

AU : Rojpornpradit P, Thitathan S, Lertsanguansinchai P, Rajatapiti P, Asavametha P, Khorprasert C.
TI : Results of radical and adjunctive radiotherapy of esophageal carcinoma.
JN : Chulalongkorn Medical Journal 1993 ; 37 (10) : 631-638
EN-AB: A retrospective analysis of 62 patients with various types of localized esophageal cancer treated with radical or adjunctive radiotherapy was carried out; 71 per cent were males, 29.0 percent females. The median age of presentation was 61 years, ranging from 33 to 81 for the entire sample. The most common presenting symptom (90.4 per cent) was dysphagia. The distribution of the disease by site was: upper esophagus 24.2 per cent, mid-esophagus 64.5 per cent,lower esophagus 11.3 per cent. In all 62 patients, the histology of the tumors was squamous cell carcinoma. Twenty-nine per cent of the patients had well-differentiated carcinoma; in 32.3 per cent it was moderately differentiated and in 12.9 per cent poorly differentiated. Tumor lengths were: up to 5.0 cm 17.7 per cent, between 5.0 and 10.0 cm 38.7 per cent, and more than 10.0 cm 9.7 per cent. The overall two-year survival rate was 21.0 per cent; median survival was five months. Sex, patient age, tumor location, tumor length and histological grade was found not to influence survival. Types of surgical treatment and radiation dose were found to be significant prognostic factors in survival. Patients treated by radical surgery plus radiotherapy or radiotherapy alone had superior survival rates, i.e. 31.8 per cent and 23.7 per cent, respectively, compared with patients who received palliative surgery plus radiotherapy (p less than 0.05). A TDF greater than 82 had an obviously better survival rate (30.4 per cent) than a TDF equal to or less than 82 (p less than 0.25). Prospects for improvement in radiotherapy were proposed. (NO 02796)

AU : Rojpornpradit P, Lertsanguansinchai P, Thitathan S, Rajatapiti P, Wangsupachat S.
TI : Adjuvant chemotherapy for non-metastatic osteosarcoma of the extremity a preliminary report.
JN : Chulalongkorn Medical Journal 1993 ; 37 (12) : 735-741
EN-AB: Nine cases seven males and two females of non-metastatic osteosarcoma of the extremity were treated with chemotherapy in an adjuvant fashion. The primary lesion was in the distal femur in five patients, the proximal tibia in two, and one each in the distal tibia and proximal femur. Pre-operative chemotherapy with intra-arterial cisplatin (100 mglm2) and intravenous dexorubicin (60 mglm2) was administered in two patients. Post-operatively, cisplatin (100 mglm2) and dexorubicin (60 mglm2) were given intravenously for one year. Doxorubicin was given until the dose reached a total of 450 mglm'. Surgery consisted of limb-sparing surgery in four of the cases, above-knee amputation in three, and one each of hip-disarticulation and below-knee-amputation. Four of the nine patients were disease-free past 24 months. The two-year disease-free survival rate was 50.1 per cent and overall survival was 87.5 per cent. Refinements in treatment and more thorough pre-treatment investigations are discussed. (NO 02806)

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Year 1992

AU : Lertsanguansinchai P, Thithathan S, Rojpornpradit P, Rajatapiti P.
TI : Nasopharyngeal carcinoma (NPC). a retrospective review of 184 patients treated with radiotherapy.
JN : Chulalongkorn Medical Journal 1992 ; 36 (11) : 829-837
EN-AB: One hundred and eighty-four patients with nasopharyngeal carcinoma (NPC) were treated with radiation therapy at the Division of Radiotherapy, Department of Radiology, Chulalongkorn Hospital, Thailand, from Jan. 1982 to Dec. 1986. The study comprised 121 males and 63 females ranging in age from 13 to 76 years (mean equal 45.6 years). The majority (72.2 per cent) of the patients presented in stage IV. Three-year actuarial survival rates according to stage were as follows: Stage I, 62.7 per cent; Stage II, 100; stage III, 50.8 per cent and stage IV, 49.6 per cent. The overall three-year actuarial survival rate and disease-free survival (DFS) rate were 52.8 per cent and 49.4 per cent respectively. There was no difference in the survival rate between the T 1-2 category and T3-4 category (52.6 per cent and 53.1 per cent, P greater than 0.5). The N-category showed a higher survival rate for the N-negative (NO) group than the N-positive (n1-3) group (79.4 per cent and 39.1 per cent less than .001). Regarding the incidence of distant metastasis correlated with the nodal status, body metastasis was the most common. (NO 02735)

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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 1989

AU : Lertsanguansinchai P, Kamphu-Na-Ayudhya P, Thitathan S, Rajatapiti P, Rojanapornpradit P.
TI : Treatment of carcinoma of the cervix with Co-60 and Cs-137.
JN : Chula Med J 1989 Mar ; 33 (3) : 195-205
EN-AB: From May 1985 to December 1986 a total of 174 cases of carcinoma of the cervix had completed treatment with Co-60 whole pelvic irradiation combined with intracavitary insertion by remote control afterloading system with Cs-137 (dose rate at point A 196.05 cGy/hr). The maximum dose aimed at point A was not more than 7500 cGy. The results of the minimum 20 months follow up showed that locoregional failure for stage 2 and stage 3 were 15.48 per cent and 32.20 per cent respectively. Complication occurred mostly in the rectum but were mild in all cases (Grade 1). (NO 01607)

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