Brachytherapy in the Treatment of Anorectal Cancer

Brachytherapy in the Treatment of Anorectal Cancer. Nowadays in the treatment of Malignant diseases, besides therapeutically results, the patient’s quality of life is considered very important and needs special attention. It is imperative to develop a therapy method that will yield results which gives more comfort to the patient, in particular concerning Malignancies in organs with important functions and having cosmetic aspects. One modality, which can be used in special cases, that gives good results and good quality of life for the patient is brachytherapy. Brachytherapy is a method of radiotherapy by placing or inserting a radiation source in the target area in order to give a radiation dose enough to kill cancer cells but with a low dosage for the surrounding important organs. The use of brachytherapy has flourished by the findings of several radiation sources such as iridium, which can be implanted in several Malignant locations. In anorectal Malignancy, implantation and intracavity brachytherapy with or without external radiation give good results in saving the anal sphincter and its function

The Role of Irradiation in Hypophyseal Adenoma

Pituitary adenomas are histopathologically benign, however the clinical presentations are often quite severe. These clinical signs are due to the tumor mass effect, hormonal disturbances or both. Besides that, these tumors often recurred after treatment. The treatment of pituitary tumors have developed greatly with the improvement of techniques of several modalities such as surgery, radiation and medication. Multimodality treatment is often used for optimal results in treating these tumors. Radiotherapy is a cytotoxic agent using ion radiation for the treatment of pituitary tumors in combination with other methods. Post-surgical radiotherapy has shown to decrease the recurrence rate significantly (22-71% vs 8-23%). At present there has been rapid improvements in radiation techniques for pituitary tumors. These developments are not only based upon the increase of know-how in computer technology and radiation instruments, but are also based upon the development of cellular and molecular biology in connection with normal and tumor tissues. The objective in developing radiation methods and techniques is to create a high radiation dose, homogeneous in the target area with low radiation dose in normal tissue. The development in science and technology, in particular concerning computer science, have created the development of radiation techniques and methods. This paper elaborates on several aspects of radiation in the treatment of pituitary

Stereotactic Ablative Body Radiotherapy (SABR) in the Management Spinal Metastases: a Brief Overview*

It is well known that radiotherapy provides successful pain relief in bone metastases. Advancements in imaging and radiotherapy delivery technology have enabled safe delivery of higher dose radiotherapy, which will produce more durable tumor control. Over the last decades stereotactic radiosurgery (SRS), which delivers high dose radiation, has been successfully used for the treatment of intracranial lesions. The good results obtained in SRS have led to development of extra cranial stereotactic radiosurgery known as stereotactic ablative body radiotherapy (SABR). This review paper enlightens indication, target definition, efficacy and toxicity in spinal SABR

The Physician Tendency in Stereotactic Radiosurgery Dose Prescription in Benign Intracranial Tumor at Dr. Cipto Mangunkusumo National Hospital, Jakarta

Stereotactic radiosurgery (SRS) is one of the treatment modalities for benign intra-cranial tumor, especiallyfor the tumor located next to the critical neural structure. The prescribed dose for radiosurgery depends onthe maximal tumor diameter and surrounding normal tissue tolerance dose. This cross sectional study wasconducted to evaluate the physician’s tendency in radiosurgery dose prescription. We observed treatmentplanning data of 32 patients with benign intra-cranial tumor, which had been treated with SRS at Dr. CiptoMangunkusumo National Hospital in 2009-2010. The peripheral dose, organ at risk (OAR) dose limitiationand maximum tumor diameter were recorded. We compared our SRS dose with dose limitation, whichallowed safer dosing based on maximal tumor diameter perspective and the nearest OAR dose constraint.From maximal tumor diameter perspective, we prescribed mean±SD radiosurgery doses, which were11.63±2.21Gy, 10.21±1.29Gy and 9.88±1.07Gy for the tumor size ≤2cm, 2.01-3cm and 3,01-4cm respectively.Our radiosurgery dose was the lowest than dose limitation based on the nearest OAR perspective, followedby maximal tumor diameter perspective. It was concluded that radiosurgery dose had the tendency to beinfluenced by surrounding healthy tissue tolerance rather than maximal tumor diameter

Primary treatment results of Nasopharyngeal Carcinoma (NPC) in Yogyakarta, Indonesia

INTRODUCTION Nasopharyngeal Carcinoma (NPC) is a major health problem in southern and eastern Asia. In Indonesia NPC is the most frequent cancer in the head and neck area. NPC is very sensitive to radiotherapy resulting in 3-year disease-free and overall survival of approximately 70% and 80%, respectively. Here we present routine treatment results in a prospective study on NPC in a top referral; university hospital in Indonesia. METHODS All NPC patients presenting from September 2008 till January 2011 at the ear, nose and throat (ENT) department of the Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia, were possible candidates. Patients were included if the biopsy was a histological proven NPC without distant metastasis and were assessed during counselling sessions prior to treatment, as being able to complete the entire treatment. RESULTS In total 78 patients were included for treatment analysis. The median time between diagnosis and start of radiotherapy is 120 days. Forty-eight (62%) patients eventually finished all fractions of radiotherapy. The median duration of the radiotherapy is 62 days for 66 Gy. Median overall survival is 21 months (95% CI 18–35) from day of diagnosis. CONCLUSION The results presented here reveal that currently the treatment of NPC at an Indonesian hospital is not sufficient and cannot be compared to the treatment results in literature. Main reasons for these poor treatment results are (1) a long waiting time prior to the start of radiotherapy, (2) the extended overall duration of radiotherapy and (3) the advanced stage of disease at presentation.Maarten A. Wildeman, Renske Fles, Camelia Herdini, Rai S. Indrasari, Andrew D. Vincent, Maesadji Tjokronagoro, Sharon Stoker, Johan Kurnianda, Baris Karakullukcu, Kartika W. Taroeno- Hariadi, Olga Hamming-Vrieze, Jaap M. Middeldorp, Bambang Hariwiyanto, Sofia M. Haryana, I. Bing Ta

The Practice of Paediatric Radiation Oncology in Low- and Middle-income Countries: Outcomes of an International Atomic Energy Agency Study

Giselvania, Angela/0000-0002-3396-0660WOS:000627418700003PubMed: 33250288Aims: Childhood cancer survival is suboptimal inmost low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' Materials and methods: A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. Results: Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. Conclusions: Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. in many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. in some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd.YIAEAInternational Atomic Energy Agency [E3.30.31]This study was funded through the IAEA Coordinated Research Project E3.30.31: Paediatric radiation oncology practice in low and middle income countries: a pattern of care study by the International Atomic Energy Agency

Effects of SGLT2 inhibitor administration on blood glucose level and body weight in type 1 diabetes rat model

The prevalence of diabetes worldwide is increasing and 629 million people are projected to have diabetes by 2045, and the most significant burden of the disease being concentrated in low- and middle-income countries (LMICs). Type 2 diabetes is mainly treated with insulin adjunctive therapies such as metformin to improve insulin sensitivity and sodium-glucose co-transporter 2 (SGLT2) inhibitors to lower blood glucose levels. However, there was limited study on the application of SGLT2 inhibitors on type 1 diabetes, particularly empagliflozin. Therefore, this study aimed to determine the effect of SGLT2 inhibitors on blood glucose levels and body weights in a rat model of type 1 diabetes. To mimic type 1 diabetes, the rats were injected with streptozotocin 60 mg intra-peritoneally. Twenty-four rat models were randomly divided into four groups: normal rat group (negative control), untreated diabetic rat group (positive control), type 1 diabetic rats treated with metformin, and type 1 diabetic rats treated with empagliflozin. Blood glucose levels and body weight were recorded before and after induced with streptozotocin and on weeks 4, 6, 8 and 10 of the treatment with anti-diabetic drugs. This study found that the blood glucose levels before and after treatment significantly decreased in all groups (p<0.05), except in the negative control group. Similar results were observed in body weight of the rats, which all groups experienced weight loss, except the negative control. These results suggested that apart from being used in type 2 diabetes, SGLT2 inhibitors may also be used as a treatment for type 1 diabetes

Flow-cytometric DNA content and S-phase fraction values as a prognostic factor on nasopharyngeal cancer - a preliminary report

[no abstract available

Breast-conserving treatment versus mastectomy in T1-2N0 breast cancer: which one is better for Indonesian women?

Background: This study aimed to compare the treatment outcomes between the use of breast-conserving treatment (BCT) and mastectomy for T1-2N0 breast cancer patients.Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January 2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center. The endpoints of this study were overall survival (OS), local  recurrence (LR), contra-lateral breast cancer (CBC), distant metastasis (DM), and disease-free survival (DFS).Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR (7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%, p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 – 7.21, p = 0.03) and DFS (HR 2.32; 95% CI 1.06 – 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI 0.17 – 0.80) and DFS (HR 0.38; 95% CI 0.19 – 0.78).Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS. (Med J Indones. 2012;21:220-4)Keywords: Breast-conserving treatment, mastectomy, outcomes</p