Background: Shenzhen is a rapidly growing city in China with a population of over 11 million. The... more Background: Shenzhen is a rapidly growing city in China with a population of over 11 million. The Hong Kong University-Shenzhen Hospital (HKU-SZH) was established in 2012 as a new model of publicly funded health care in mainland China. The clinical oncology center of the HKU-SZH was launched in 2013 which pledged to provide integrated palliative care for advanced cancer patients. This study aims to retrospectively analyze the quality of end-of-life care amongst patients with advanced cancer during their last hospitalization in the HKU-SZH. Methods: Consecutive patients with advanced solid cancer who passed away in the HKU-SZH from March 2013 to February 2016 were analyzed. Clinical information regarding cancer diagnosis, anticancer treatments, and the aggressiveness of the treatment during the last month of life was recorded. The discussions on the Do-Not-Resuscitate (DNR) order with family members were reviewed. Results: From March 2013 to February 2016, 441 patients with advanced solid cancer passed away in the HKU-SZH. A minority of them (9.3%, 41/441) received cytotoxic chemotherapy in the last month of life. Younger patients had high odds of receiving chemotherapy in their last month of life (OR 2.6, P=0.006). Those who received chemotherapy in their last month of life showed a trend of higher odds of admission to the intensive care unit (OR 2.94, P=0.08). The vast majority of family members / care providers (92.3%, 407/441) consented to the DNR order suggested by oncologists. The rate of DNR acceptance in this cohort was higher than previous reports from mainland China. Within HKU-SZH, the rate was higher in the oncology center than in other departments (OR 5.1, P<0.001). The use of chemotherapy in the last month of life did not associated with the acceptance of DNR (OR 1.3, P=0.23). Conclusions: The integrated oncology service of the new public hospital HKU-SZH achieved a satisfactory level of end-of-life care in patients with advanced cancer. Further studies are warranted to improve the early integration of palliative care service and to investigate the impact of palliative care on costeffectiveness of oncology service.
International Journal of Radiation Oncology*Biology*Physics, 2019
Conclusion: The application of BS in radiotherapy for locally advanced cervical cancer patients c... more Conclusion: The application of BS in radiotherapy for locally advanced cervical cancer patients can maintain the stability of bladder volume better and reduce the incidence and grade of urinary tract side effects. No effect on the effective rate and the overall survival has been observed.
BACKGROUND AND PUPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcino... more BACKGROUND AND PUPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcinoma are common in Asians and are often indistinguishable clinically. Because their treatment depends on prompt diagnosis, we undertook this study to evaluate if power Doppler sonography could distinguish these two pathologic abnormalities. The intranodal vascular appearances of tuberculous neck nodes are compared with benign reactive neck nodes and metastatic nodes from nasopharyngeal carcinoma. METHODS: The appearances of power Doppler sonograms of 42 tuberculous nodes were compared with 28 metastatic nodes from nasopharyngeal carcinoma and 27 benign reactive nodes. The intranodal distribution of vessels and the intranodal vascular resistance of vessels were compared among these three groups. All examinations were performed by the same sonologist (A.A.), who had more than 3 years' scanning experience, and all data analysis was performed by the same investigator (M.Y.). RESULTS: The intranodal vascular distribution in tuberculous nodes was varied and simulated both benign and malignant disease. Avascularity of nodes and displacement of hilar vascularity were frequent in tuberculous nodes. Metastatic nodes from nasopharyngeal carcinoma (resistive index [RI], 0.81؎0.09; pulsatile index [PI], 1.91؎0.81) had a higher vascular resistance than did tuberculous nodes (RI, 0.71؎0.11; PI, 1.34؎0.55). Tuberculous nodes had a higher vascular resistance than did reactive nodes (RI, 0.66؎0.09; PI, 1.10؎0.26). CONCLUSION: Avascularity, displaced hilar vessels, and low intranodal vascular resistance are clues that may suggest the tuberculous nature of neck nodes. However, there is overlap of appearance between tuberculous nodes, benign reactive neck nodes, and metastatic nodes. Thus, histologic analysis is often required for a definitive diagnosis.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2002
To study the clinical outcomes of patients with invasive or non-invasive breast cancer after brea... more To study the clinical outcomes of patients with invasive or non-invasive breast cancer after breast conservation treatment. Retrospective study. Clinical oncology department of a public hospital, Hong Kong. Two hundred and three patients who received postlumpectomy radiotherapy at the Pamela Youde Nethersole Eastern Hospital between January 1994 and June 1999. Adjuvant radiotherapy with or without systemic adjuvant treatment. Actuarial local control rate, progression-free survival rate, disease-specific survival rate, and cosmetic score. The median follow-up was 3.5 years. Two of the 25 patients with carcinoma in situ only developed local recurrence; the 5-year actuarial local control rate was 91.3%. Among the 178 patients with invasive cancer, seven had a local recurrence and 12 developed distant metastases without local failure. The 5-year actuarial local control, progression-free survival, and disease-specific survival rates for patients with invasive cancer were 95.5%, 85.8%, an...
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2010
Delayed presentation is an important obstacle to improving cancer treatment outcomes. We aimed to... more Delayed presentation is an important obstacle to improving cancer treatment outcomes. We aimed to study the magnitude of this problem in Hong Kong and the factors associated with delayed presentation of patients with symptomatic breast cancers. Retrospective study using self-administered questionnaires. Clinical Oncology Department in a regional public hospital in Hong Kong. A total of 158 Chinese women with breast cancer referred to our hospital between October 2006 and December 2007 consented to participate in this study. Among these, 59 (37%) patients were referred after having surgery in private sector. The mean total delay (from first symptom to treatment) was 22 weeks. The mean patient delay (from first symptom to first consultation) was 13 weeks, constituting the largest component (60%) of the total delay. After symptom onset, the delay exceeded 12 weeks for consulting a doctor in 29%, and for receipt of treatment in 52% of them. Low family income (<HK$5000 per month; P<...
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2012
OBJECTIVE. To evaluate the clinical outcome and safety of stereotactic ablative radiotherapy for ... more OBJECTIVE. To evaluate the clinical outcome and safety of stereotactic ablative radiotherapy for medically inoperable stage I non-small-cell lung carcinoma. DESIGN. Retrospective case series. SETTING. Pamela Youde Nethersole Eastern Hospital, Hong Kong. PATIENTS. All patients with medically inoperable stage I non-small-cell lung carcinoma receiving stereotactic ablative radiotherapy since its establishment in 2008. MAIN OUTCOME MEASURES. Disease control rate, overall survival, and treatment toxicities. RESULTS. Sixteen stage I non-small-cell lung carcinoma patients underwent the procedure from June 2008 to November 2011. The median patient age was 82 years and the majority (81%) had moderate-to-severe co-morbidity based on the Adult Comorbidity Evaluation 27 index. With a median follow-up of 22 months, the 2-year primary tumour control rate, disease-free survival and overall survival rates were 91%, 71% and 87%, respectively. No grade 3 (National Cancer Institute Common Terminology ...
Background XELOX (capecitabine + oxaliplatin) and FOLFOX 4 (5-FU + folinic acid + oxaliplatin) ha... more Background XELOX (capecitabine + oxaliplatin) and FOLFOX 4 (5-FU + folinic acid + oxaliplatin) have shown similar improvements in survival in patients with metastatic colorectal cancer (MCRC). A US cost-minimization study found that the two regimens had similar costs from a healthcare provider perspective but XELOX had lower costs than FOLFOX4 from a societal perspective, while a Japanese cost-effectiveness study found XELOX had superior cost-effectiveness. This study compared the costs of XELOX and FOLFOX4 in patients with MCRC recently treated in two oncology departments in Hong Kong. Methods Cost data were collected from the medical records of 60 consecutive patients (30 received XELOX and 30 FOLFOX4) from two hospitals. Drug costs, outpatient visits, hospital days and investigations were recorded and expressed as cost per patient from the healthcare provider perspective. Estimated travel and time costs were included in a societal perspective analysis. All costs were classed as e...
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 1998
This is a descriptive study of 168 patients with nasopharyngeal carcinoma who were referred to pu... more This is a descriptive study of 168 patients with nasopharyngeal carcinoma who were referred to public oncology departments for primary treatment between July and September 1996. The mean duration from the onset of the symptoms to histological diagnosis was 5.0 months; the duration ranged from 6.1 months (for patients presenting with nasal symptoms) to 1.8 months (for those with cranial nerve dysfunction). The mean period between the onset of symptoms and the seeking of medical advice was 2.9months. For 54% of the patients, there was a further delay of up to 2.4 months between the initial medical consultation and referral to the appropriate specialist. The majority (84%) of patients attended public institutions for histological confirmation. The mean total time taken from the onset of symptoms to the commencement of radiotherapy was 6.5 months (range, 1.3-74.0 months)---45% of the delay was attributed to the patient, 20% to initial consultations, 14% to diagnostic arrangement, and 21...
Cancers of the head and neck region often present with nodal involvement. There is a long-standin... more Cancers of the head and neck region often present with nodal involvement. There is a long-standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, Sandra Nuyts and Heleen Bollen are shared first authors. This paper was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).
Objectives: Patients with advanced local recurrence of nasopharyngeal carcinoma (NPC) have a poor... more Objectives: Patients with advanced local recurrence of nasopharyngeal carcinoma (NPC) have a poor prognosis. Retreatment by external radiotherapy is frequently the only option but results are usually poor. This study was conducted to evaluate the benefits of adding induction chemotherapy with cisplatin and gemcitabine before reirradiation for locally recurrent NPC. Methods: Twenty patients with locally recurrent NPC not amenable to brachytherapy or surgery were enrolled between September 2001 and October 2003. The T stage distribution at recurrence was 5% rT2, 30% rT3, and 65% rT4. Induction chemotherapy consisted of cisplatin 40 mg/m 2 and gemcitabine 1.25 g/m 2 days 1 and 8 for 3 times per week for 3 cycles, followed by reirradiation using intensity-modulated radiotherapy. Results: A total of 58 chemotherapy cycles were administered to patients and most received 3 cycles. Hematological toxicities were mild, with grade 3 and 4 neutropenia in 55% and 5% of patients, respectively, and grade 3 thrombocytopenia in 5%. After chemotherapy, 15 patients achieved partial response (75%). Seventeen patients received external reirradiation and one had radiosurgery after chemotherapy. Severe acute radiation toxicities were uncommon. After a median follow-up of 14.5 months, 55% of patients had locoregional progression and 45% had died. The 1-year locoregional progression-free, local progression-free, and overall survival rates were 63%, 68%, and 80%, respectively. In patients with external reirradiation, the 1-year local progression-free and overall survival rates were 75% and 88%. Patients with rT2-3 stage had significantly better 1-year local control rates than those with rT4 stage (100% versus 52%). Conclusions: The combination cisplatin and gemcitabine is active and well-tolerated in locally recurrent NPC. The current approach of using induction chemotherapy before reirradiation may improve the outcome of patients with advanced local recurrence and merits further investigation.
Background: Cancer outcomes vary widely among different countries. However, comparisons of cost-e... more Background: Cancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators. Methods: Cancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1-(ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS. Results: Substantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412-$9361). Conclusions: Similar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity.
Since its establishment in 1957, the International Atomic Energy Agency (IAEA) has striven to pro... more Since its establishment in 1957, the International Atomic Energy Agency (IAEA) has striven to promote global access to reliable and affordable radiotherapy, with much of its latest focus being in developing countries. While nasopharyngeal cancer (NPC) is highly curable by radiotherapy with excellent outcomes in developed countries, the outcomes in low- and middle-income countries (LMICs) are disappointing. Although the reasons for this are complex and multifactorial, improving the accessibility and quality of radiotherapy in these countries is fundamental. With concerted effort from experts and advocates around the world, ongoing initiatives are supported by the IAEA to combat the challenges in LMICs.
The international geographic distribution of NPC is unique among malignancies. Incidence rates ca... more The international geographic distribution of NPC is unique among malignancies. Incidence rates can exceed 20 per 100,000 personyears among males and 10 per 100,000 person-years among females in southern China. Intermediate rates are observed in Southeast Asia, North Africa, the Middle East, and the Arctic, as well as among Asian and Pacific Islander migrant populations, while rates generally remain below 1 per 100,000 throughout the rest of the world. The agespecific incidence rate peaks at around 45-59 years in high-incidence areas, whereas a small early incidence peak at ages 15-19 years is followed by a later peak at around 65-79 years in low-incidence areas. The male-to-female incidence ratio is consistently around 2-3 or greater. Much of the striking geographic variation may be attributable to certain risk factors, such as certain HLA alleles and consumption of Chinese-style salted fish, whose geographic distribution mirrors that of NPC. Other NPC risk factors, such as EBV infection, are ubiquitous, yet are almost certainly modified by geographically heterogeneous co-factors. Most established risk factors for NPC are associated with undifferentiated NPC, although tobacco smoking is more strongly associated with squamous cell NPC. The recent worldwide decline in NPC incidence, especially in high-incidence regions, points to an important role of modifiable environmental risk factors that could serve as targets for further disease prevention.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2009
It has been proposed that young women should not be treated by breast conservation treatment beca... more It has been proposed that young women should not be treated by breast conservation treatment because of a higher risk of local recurrences and worse survival. We therefore examined whether breast conservation treatment in young Chinese women yielded inferior clinical outcomes compared to modified radical mastectomy. Retrospective study. Clinical oncology department in a public hospital in Hong Kong. A total of 258 Chinese women with invasive breast cancer, aged below 40 years, and referred between January 1994 and July 2006. A total of 124 (48%) and 134 (52%) patients were treated by breast conservation treatment and modified radical mastectomy, respectively. Mastectomy patients tended to have larger primary tumours (P<0.001) and more nodal involvement (P<0.001). At a median follow-up of 6.5 years, there was no significant difference in the local failure-free survival rate (92% vs 93%, P=0.324) and loco-regional failure-free survival rate (89% vs 88%, P=0.721) in patients havi...
Purpose This randomized study compared the results achieved by concurrent chemoradiotherapy (CRT)... more Purpose This randomized study compared the results achieved by concurrent chemoradiotherapy (CRT) versus radiotherapy (RT) alone for nasopharyngeal carcinoma (NPC) with advanced nodal disease. Patients and Methods Patients with nonkeratinizing/undifferentiated NPC staged T1-4N2-3M0 were randomized to CRT or RT. Both arms were treated with the same RT technique and dose fractionation. The CRT patients were given cisplatin 100 mg/m2 on days 1, 22, and 43, followed by cisplatin 80 mg/m2 and fluorouracil 1,000 mg/m2/d for 96 hours starting on days 71, 99, and 127. Results From 1999 to January 2004, 348 eligible patients were randomly assigned; the median follow-up was 2.3 years. The two arms were well-balanced in all prognostic factors and RT parameters. The CRT arm achieved significantly higher failure-free survival (72% v 62% at 3-year, P = .027), mostly as a result of an improvement in locoregional control (92% v 82%, P = .005). However, distant control did not improve significantly ...
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], Aug 20, 2018
To review the current aspects of knowledge related to the risk of cerebrovascular events in patie... more To review the current aspects of knowledge related to the risk of cerebrovascular events in patients receiving head and neck radiotherapy. A literature search was performed in PubMed. Papers meeting selection criteria were reviewed. We provide an update on the problem by identifying key studies that have contributed to our current understanding of the epidemiology, radiologic features, pathogenesis, and treatment of the disease. The incidence of carotid artery stenosis ranged from 18 to 38% in patients who underwent radiotherapy for head and neck cancer versus from 0 to 9.2% among the nonirradiated patients. Neck irradiation increases the intima-media thickness of the carotid artery wall. These changes are the earliest visible alteration in the carotid wall and are also detected with color Doppler ultrasonography. Endovascular treatment with a carotid angioplasty and stenting is the first-line treatment for most symptomatic patients. Radiation-induced atherosclerosis is a different ...
Background: Shenzhen is a rapidly growing city in China with a population of over 11 million. The... more Background: Shenzhen is a rapidly growing city in China with a population of over 11 million. The Hong Kong University-Shenzhen Hospital (HKU-SZH) was established in 2012 as a new model of publicly funded health care in mainland China. The clinical oncology center of the HKU-SZH was launched in 2013 which pledged to provide integrated palliative care for advanced cancer patients. This study aims to retrospectively analyze the quality of end-of-life care amongst patients with advanced cancer during their last hospitalization in the HKU-SZH. Methods: Consecutive patients with advanced solid cancer who passed away in the HKU-SZH from March 2013 to February 2016 were analyzed. Clinical information regarding cancer diagnosis, anticancer treatments, and the aggressiveness of the treatment during the last month of life was recorded. The discussions on the Do-Not-Resuscitate (DNR) order with family members were reviewed. Results: From March 2013 to February 2016, 441 patients with advanced solid cancer passed away in the HKU-SZH. A minority of them (9.3%, 41/441) received cytotoxic chemotherapy in the last month of life. Younger patients had high odds of receiving chemotherapy in their last month of life (OR 2.6, P=0.006). Those who received chemotherapy in their last month of life showed a trend of higher odds of admission to the intensive care unit (OR 2.94, P=0.08). The vast majority of family members / care providers (92.3%, 407/441) consented to the DNR order suggested by oncologists. The rate of DNR acceptance in this cohort was higher than previous reports from mainland China. Within HKU-SZH, the rate was higher in the oncology center than in other departments (OR 5.1, P<0.001). The use of chemotherapy in the last month of life did not associated with the acceptance of DNR (OR 1.3, P=0.23). Conclusions: The integrated oncology service of the new public hospital HKU-SZH achieved a satisfactory level of end-of-life care in patients with advanced cancer. Further studies are warranted to improve the early integration of palliative care service and to investigate the impact of palliative care on costeffectiveness of oncology service.
International Journal of Radiation Oncology*Biology*Physics, 2019
Conclusion: The application of BS in radiotherapy for locally advanced cervical cancer patients c... more Conclusion: The application of BS in radiotherapy for locally advanced cervical cancer patients can maintain the stability of bladder volume better and reduce the incidence and grade of urinary tract side effects. No effect on the effective rate and the overall survival has been observed.
BACKGROUND AND PUPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcino... more BACKGROUND AND PUPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcinoma are common in Asians and are often indistinguishable clinically. Because their treatment depends on prompt diagnosis, we undertook this study to evaluate if power Doppler sonography could distinguish these two pathologic abnormalities. The intranodal vascular appearances of tuberculous neck nodes are compared with benign reactive neck nodes and metastatic nodes from nasopharyngeal carcinoma. METHODS: The appearances of power Doppler sonograms of 42 tuberculous nodes were compared with 28 metastatic nodes from nasopharyngeal carcinoma and 27 benign reactive nodes. The intranodal distribution of vessels and the intranodal vascular resistance of vessels were compared among these three groups. All examinations were performed by the same sonologist (A.A.), who had more than 3 years' scanning experience, and all data analysis was performed by the same investigator (M.Y.). RESULTS: The intranodal vascular distribution in tuberculous nodes was varied and simulated both benign and malignant disease. Avascularity of nodes and displacement of hilar vascularity were frequent in tuberculous nodes. Metastatic nodes from nasopharyngeal carcinoma (resistive index [RI], 0.81؎0.09; pulsatile index [PI], 1.91؎0.81) had a higher vascular resistance than did tuberculous nodes (RI, 0.71؎0.11; PI, 1.34؎0.55). Tuberculous nodes had a higher vascular resistance than did reactive nodes (RI, 0.66؎0.09; PI, 1.10؎0.26). CONCLUSION: Avascularity, displaced hilar vessels, and low intranodal vascular resistance are clues that may suggest the tuberculous nature of neck nodes. However, there is overlap of appearance between tuberculous nodes, benign reactive neck nodes, and metastatic nodes. Thus, histologic analysis is often required for a definitive diagnosis.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2002
To study the clinical outcomes of patients with invasive or non-invasive breast cancer after brea... more To study the clinical outcomes of patients with invasive or non-invasive breast cancer after breast conservation treatment. Retrospective study. Clinical oncology department of a public hospital, Hong Kong. Two hundred and three patients who received postlumpectomy radiotherapy at the Pamela Youde Nethersole Eastern Hospital between January 1994 and June 1999. Adjuvant radiotherapy with or without systemic adjuvant treatment. Actuarial local control rate, progression-free survival rate, disease-specific survival rate, and cosmetic score. The median follow-up was 3.5 years. Two of the 25 patients with carcinoma in situ only developed local recurrence; the 5-year actuarial local control rate was 91.3%. Among the 178 patients with invasive cancer, seven had a local recurrence and 12 developed distant metastases without local failure. The 5-year actuarial local control, progression-free survival, and disease-specific survival rates for patients with invasive cancer were 95.5%, 85.8%, an...
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2010
Delayed presentation is an important obstacle to improving cancer treatment outcomes. We aimed to... more Delayed presentation is an important obstacle to improving cancer treatment outcomes. We aimed to study the magnitude of this problem in Hong Kong and the factors associated with delayed presentation of patients with symptomatic breast cancers. Retrospective study using self-administered questionnaires. Clinical Oncology Department in a regional public hospital in Hong Kong. A total of 158 Chinese women with breast cancer referred to our hospital between October 2006 and December 2007 consented to participate in this study. Among these, 59 (37%) patients were referred after having surgery in private sector. The mean total delay (from first symptom to treatment) was 22 weeks. The mean patient delay (from first symptom to first consultation) was 13 weeks, constituting the largest component (60%) of the total delay. After symptom onset, the delay exceeded 12 weeks for consulting a doctor in 29%, and for receipt of treatment in 52% of them. Low family income (<HK$5000 per month; P<...
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2012
OBJECTIVE. To evaluate the clinical outcome and safety of stereotactic ablative radiotherapy for ... more OBJECTIVE. To evaluate the clinical outcome and safety of stereotactic ablative radiotherapy for medically inoperable stage I non-small-cell lung carcinoma. DESIGN. Retrospective case series. SETTING. Pamela Youde Nethersole Eastern Hospital, Hong Kong. PATIENTS. All patients with medically inoperable stage I non-small-cell lung carcinoma receiving stereotactic ablative radiotherapy since its establishment in 2008. MAIN OUTCOME MEASURES. Disease control rate, overall survival, and treatment toxicities. RESULTS. Sixteen stage I non-small-cell lung carcinoma patients underwent the procedure from June 2008 to November 2011. The median patient age was 82 years and the majority (81%) had moderate-to-severe co-morbidity based on the Adult Comorbidity Evaluation 27 index. With a median follow-up of 22 months, the 2-year primary tumour control rate, disease-free survival and overall survival rates were 91%, 71% and 87%, respectively. No grade 3 (National Cancer Institute Common Terminology ...
Background XELOX (capecitabine + oxaliplatin) and FOLFOX 4 (5-FU + folinic acid + oxaliplatin) ha... more Background XELOX (capecitabine + oxaliplatin) and FOLFOX 4 (5-FU + folinic acid + oxaliplatin) have shown similar improvements in survival in patients with metastatic colorectal cancer (MCRC). A US cost-minimization study found that the two regimens had similar costs from a healthcare provider perspective but XELOX had lower costs than FOLFOX4 from a societal perspective, while a Japanese cost-effectiveness study found XELOX had superior cost-effectiveness. This study compared the costs of XELOX and FOLFOX4 in patients with MCRC recently treated in two oncology departments in Hong Kong. Methods Cost data were collected from the medical records of 60 consecutive patients (30 received XELOX and 30 FOLFOX4) from two hospitals. Drug costs, outpatient visits, hospital days and investigations were recorded and expressed as cost per patient from the healthcare provider perspective. Estimated travel and time costs were included in a societal perspective analysis. All costs were classed as e...
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 1998
This is a descriptive study of 168 patients with nasopharyngeal carcinoma who were referred to pu... more This is a descriptive study of 168 patients with nasopharyngeal carcinoma who were referred to public oncology departments for primary treatment between July and September 1996. The mean duration from the onset of the symptoms to histological diagnosis was 5.0 months; the duration ranged from 6.1 months (for patients presenting with nasal symptoms) to 1.8 months (for those with cranial nerve dysfunction). The mean period between the onset of symptoms and the seeking of medical advice was 2.9months. For 54% of the patients, there was a further delay of up to 2.4 months between the initial medical consultation and referral to the appropriate specialist. The majority (84%) of patients attended public institutions for histological confirmation. The mean total time taken from the onset of symptoms to the commencement of radiotherapy was 6.5 months (range, 1.3-74.0 months)---45% of the delay was attributed to the patient, 20% to initial consultations, 14% to diagnostic arrangement, and 21...
Cancers of the head and neck region often present with nodal involvement. There is a long-standin... more Cancers of the head and neck region often present with nodal involvement. There is a long-standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, Sandra Nuyts and Heleen Bollen are shared first authors. This paper was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).
Objectives: Patients with advanced local recurrence of nasopharyngeal carcinoma (NPC) have a poor... more Objectives: Patients with advanced local recurrence of nasopharyngeal carcinoma (NPC) have a poor prognosis. Retreatment by external radiotherapy is frequently the only option but results are usually poor. This study was conducted to evaluate the benefits of adding induction chemotherapy with cisplatin and gemcitabine before reirradiation for locally recurrent NPC. Methods: Twenty patients with locally recurrent NPC not amenable to brachytherapy or surgery were enrolled between September 2001 and October 2003. The T stage distribution at recurrence was 5% rT2, 30% rT3, and 65% rT4. Induction chemotherapy consisted of cisplatin 40 mg/m 2 and gemcitabine 1.25 g/m 2 days 1 and 8 for 3 times per week for 3 cycles, followed by reirradiation using intensity-modulated radiotherapy. Results: A total of 58 chemotherapy cycles were administered to patients and most received 3 cycles. Hematological toxicities were mild, with grade 3 and 4 neutropenia in 55% and 5% of patients, respectively, and grade 3 thrombocytopenia in 5%. After chemotherapy, 15 patients achieved partial response (75%). Seventeen patients received external reirradiation and one had radiosurgery after chemotherapy. Severe acute radiation toxicities were uncommon. After a median follow-up of 14.5 months, 55% of patients had locoregional progression and 45% had died. The 1-year locoregional progression-free, local progression-free, and overall survival rates were 63%, 68%, and 80%, respectively. In patients with external reirradiation, the 1-year local progression-free and overall survival rates were 75% and 88%. Patients with rT2-3 stage had significantly better 1-year local control rates than those with rT4 stage (100% versus 52%). Conclusions: The combination cisplatin and gemcitabine is active and well-tolerated in locally recurrent NPC. The current approach of using induction chemotherapy before reirradiation may improve the outcome of patients with advanced local recurrence and merits further investigation.
Background: Cancer outcomes vary widely among different countries. However, comparisons of cost-e... more Background: Cancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators. Methods: Cancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1-(ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS. Results: Substantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412-$9361). Conclusions: Similar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity.
Since its establishment in 1957, the International Atomic Energy Agency (IAEA) has striven to pro... more Since its establishment in 1957, the International Atomic Energy Agency (IAEA) has striven to promote global access to reliable and affordable radiotherapy, with much of its latest focus being in developing countries. While nasopharyngeal cancer (NPC) is highly curable by radiotherapy with excellent outcomes in developed countries, the outcomes in low- and middle-income countries (LMICs) are disappointing. Although the reasons for this are complex and multifactorial, improving the accessibility and quality of radiotherapy in these countries is fundamental. With concerted effort from experts and advocates around the world, ongoing initiatives are supported by the IAEA to combat the challenges in LMICs.
The international geographic distribution of NPC is unique among malignancies. Incidence rates ca... more The international geographic distribution of NPC is unique among malignancies. Incidence rates can exceed 20 per 100,000 personyears among males and 10 per 100,000 person-years among females in southern China. Intermediate rates are observed in Southeast Asia, North Africa, the Middle East, and the Arctic, as well as among Asian and Pacific Islander migrant populations, while rates generally remain below 1 per 100,000 throughout the rest of the world. The agespecific incidence rate peaks at around 45-59 years in high-incidence areas, whereas a small early incidence peak at ages 15-19 years is followed by a later peak at around 65-79 years in low-incidence areas. The male-to-female incidence ratio is consistently around 2-3 or greater. Much of the striking geographic variation may be attributable to certain risk factors, such as certain HLA alleles and consumption of Chinese-style salted fish, whose geographic distribution mirrors that of NPC. Other NPC risk factors, such as EBV infection, are ubiquitous, yet are almost certainly modified by geographically heterogeneous co-factors. Most established risk factors for NPC are associated with undifferentiated NPC, although tobacco smoking is more strongly associated with squamous cell NPC. The recent worldwide decline in NPC incidence, especially in high-incidence regions, points to an important role of modifiable environmental risk factors that could serve as targets for further disease prevention.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2009
It has been proposed that young women should not be treated by breast conservation treatment beca... more It has been proposed that young women should not be treated by breast conservation treatment because of a higher risk of local recurrences and worse survival. We therefore examined whether breast conservation treatment in young Chinese women yielded inferior clinical outcomes compared to modified radical mastectomy. Retrospective study. Clinical oncology department in a public hospital in Hong Kong. A total of 258 Chinese women with invasive breast cancer, aged below 40 years, and referred between January 1994 and July 2006. A total of 124 (48%) and 134 (52%) patients were treated by breast conservation treatment and modified radical mastectomy, respectively. Mastectomy patients tended to have larger primary tumours (P<0.001) and more nodal involvement (P<0.001). At a median follow-up of 6.5 years, there was no significant difference in the local failure-free survival rate (92% vs 93%, P=0.324) and loco-regional failure-free survival rate (89% vs 88%, P=0.721) in patients havi...
Purpose This randomized study compared the results achieved by concurrent chemoradiotherapy (CRT)... more Purpose This randomized study compared the results achieved by concurrent chemoradiotherapy (CRT) versus radiotherapy (RT) alone for nasopharyngeal carcinoma (NPC) with advanced nodal disease. Patients and Methods Patients with nonkeratinizing/undifferentiated NPC staged T1-4N2-3M0 were randomized to CRT or RT. Both arms were treated with the same RT technique and dose fractionation. The CRT patients were given cisplatin 100 mg/m2 on days 1, 22, and 43, followed by cisplatin 80 mg/m2 and fluorouracil 1,000 mg/m2/d for 96 hours starting on days 71, 99, and 127. Results From 1999 to January 2004, 348 eligible patients were randomly assigned; the median follow-up was 2.3 years. The two arms were well-balanced in all prognostic factors and RT parameters. The CRT arm achieved significantly higher failure-free survival (72% v 62% at 3-year, P = .027), mostly as a result of an improvement in locoregional control (92% v 82%, P = .005). However, distant control did not improve significantly ...
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], Aug 20, 2018
To review the current aspects of knowledge related to the risk of cerebrovascular events in patie... more To review the current aspects of knowledge related to the risk of cerebrovascular events in patients receiving head and neck radiotherapy. A literature search was performed in PubMed. Papers meeting selection criteria were reviewed. We provide an update on the problem by identifying key studies that have contributed to our current understanding of the epidemiology, radiologic features, pathogenesis, and treatment of the disease. The incidence of carotid artery stenosis ranged from 18 to 38% in patients who underwent radiotherapy for head and neck cancer versus from 0 to 9.2% among the nonirradiated patients. Neck irradiation increases the intima-media thickness of the carotid artery wall. These changes are the earliest visible alteration in the carotid wall and are also detected with color Doppler ultrasonography. Endovascular treatment with a carotid angioplasty and stenting is the first-line treatment for most symptomatic patients. Radiation-induced atherosclerosis is a different ...
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Papers by Anne Lee