Outcomes in newly diagnosed elderly glioblastoma patients after concomitant temozolomide administration and hypofractionated radiotherapy

This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70-84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine-DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals

The Modernization of Radiation Therapy Services in Cambodia: A Model of International Collaboration

PURPOSE: Cambodia is a Southeast Asian low-middle-income country with a population of >15 million. In 2020, Cambodia was estimated to have 18,375 new diagnoses of cancer and 12,638 deaths attributable to cancer. Cambodia was estimated to have a deficit of 16 megavoltage machines in 2012. Cambodia's radiation therapy services have suffered through the tumultuous events of the country's history, with intermittent services until the last decade. In recent years, Cambodia has undergone rapid economic growth and, with this, the development of its first comprehensive cancer center, the National Cancer Centre (NCC). METHODS AND MATERIALS: Planning for NCC began in the early 2000s, with the aim to provide comprehensive care, including modern radiation therapy services, to the public. Funding for the center was supplied primarily by the Cambodian government, assisted by donations from partners including the International Atomic Energy Agency. Training collaborations were formed with international partners, including the Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) of the Royal Australian and New Zealand College of Radiologists and the Asia-Pacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists and Engineers in Medicine. RESULTS: The main model of APROSIG/APSIG collaboration has been in-country training, including the posting of an Australian medical physicist and radiation therapist in Phnom Penh for a year's duration to oversee a safe and sustainable start to the radiation therapy program. The first linear accelerator patient was treated at NCC in March 2018 and the first brachytherapy patient in September 2018. Since that time, the department has treated to capacity, with very little machine downtime. NCC provides comprehensive cancer services including medical oncology, pediatric oncology, hematology, palliative care, surgical oncology, and nuclear medicine. Several challenges to expanding radiation therapy services currently exist, including human resources and cultural stigma. CONCLUSION: Despite many decades of tragedy and suffering, Cambodia serves as an example of successful implementation of modern radiation therapy in a low- and middle-income country. The keys to success have included local champions, support of the Ministry of Health, and willingness to embrace collaboration. The pandemic brings yet another challenge to cancer control in Cambodia, and novel training platforms are being explored

A 13-Year Retrospective Study on Primary Liver Cancer in Cambodia: A Strikingly High Hepatitis C Occurrence among Hepatocellular Carcinoma Cases

International audienceObjectives: Hepatocellular carcinoma (HCC) is the main type of primary liver cancer (PLC) worldwide, but cholangiocarcinoma (CCA) may be predominant in some specific regions of Southeast Asia. The aim of the present study was to delineate a pattern of Cambodian PLC patients attending the Calmette Hospital in the Cambodian capital Phnom Penh. Materials and Methods: A total of 553 medical charts diagnosing PLCs from January 2003 to May 2015 were obtained from both the Oncology and Hepato-Gastroenterology Departments of the Calmette Hospital. Results: HCC was the predominant type of PLC recorded, with 511 cases (92.4%), whereas CCA represented merely 7.6% (42 cases) of the overall series. Hepatitis B virus (HBV; 44.3%) and hepatitis C virus (HCV; 43%) infection rates were similar among the HCC patients, while small subsets of CCA patients were infected with HBV (15.4%) or HCV (11.5%). Most HCC (84%) and CCA (73.8%) patients received palliative treatment only. Conclusion: The present study indicates that HCC is the main form of primary hepatic neoplasm among PLC patients attending a hospital in Cambodia. HBV and HCV infections represented equivalent burdens and major contributing factors to HCC. Therefore, the implementation of prevention programs for these infectious agents should become a priority for health policy makers in the country

Colorectal cancer in young Cambodians

Aim: Colorectal cancer (CRC) is a common disease in the older population, but it has become increasingly evident that it is also not infrequent in the young. The aim of this study was to describe the epidemiological, clinical and pathological characteristics of CRC in young Cambodians. Methods: We examined clinical and pathological data from all CRC cases registered in the two reference centres for gastrointestinal tumours in Cambodia between 2005-2010. Age-specific CRC incidence rates were computed using the national population census 2008 data from the National Institute of Statistics. We compared differences in distribution of tumour location, histology, differentiation and UICC/TNM stage in two age groups, namely = 40. Results: During this period, there were 356 new CRC cases, of which 29.8% affected patients younger than 40. This proportion is the second highest in the world, with a higher proportion only reported in Egyptian population. The crude incidence was 2.82 and 2.36 per 100,000 in females and males, respectively. Adenocarcinoma was the most common histologic type, and >50% of all tumours occurred in the colon, with no appreciable variation between the two age groups. Mucin-producing and advanced-grade tumours were twice more frequent in the young. Conclusion: The unusually high CRC proportion in the young in our study could be due to referral bias. Nevertheless, together with the continuous exposure to hazardous environmental agents and the prevalent consanguinity in Cambodia, this question warrants further research to advance our understanding of CRC risk factors and perhaps genetic-environmental interactions in CRC epidemiology in young adults