MATERIALS AND METHODS: A 21-point electronic survey (Federation of Asian Radiation Oncology Research Network [FERN]-S-005) was designed by the FERN and was circulated through the FARO research secretariat to the FARO council member countries and the responses were collected between August and November 2023.
RESULTS: Twelve of 14 member countries (85.7%) responded to the survey. Twenty-seven responses were received and 78% of the respondents belonged to government/teaching academic institute. 4/27 (14.8%) reported never using HYPO-RT for any of the clinical subsite of HNCs, while the majority (85.2%) used it for glottic cancers and 22% also used it for postoperative setting. Majority (77.7%) used a fractionation schedule with dose per fraction ranging between 2.2 and 2.5 Gy. 6/27 (22.2%) used AFRT for definitive setting and five of these also used concurrent chemoradiotherapy. 4/27 (14.8%) centers reported using HFRT. The most common reason (62.9%) for the limited usage of AFRT/HFRT was reported to be logistical, such as unavailability of machine slots, patient load, and so on.
CONCLUSION: The result of the survey suggests that among the ALFT strategies for HNCs, HYPO-RT schedules have common interest and feasibility among the FARO member countries and also highlights the challenges in the delivery of AFRT/HFRT in the Asian region.
METHOD: The model was formulated by integrating the Caputo fractional derivative with the previous cancer treatment model. Thereafter, the linear-quadratic with the repopulation model was coupled into the model to account for the cells' population decay due to radiation. The treatment process was then simulated with numerical variables, numerical parameters, and radiation parameters. The numerical parameters which included the proliferation coefficients of the cells, competition coefficients of the cells, and the perturbation constant of the normal cells were obtained from previous literature. The radiation and numerical parameters were obtained from reported clinical data of six patients treated with radiotherapy. The patients had tumor volumes of 24.1cm3, 17.4cm3, 28.4cm3, 18.8cm3, 30.6cm3, and 12.6cm3 with fractionated doses of 2 Gy for the first two patients and 1.8 Gy for the other four. The initial tumor volumes were used to obtain initial populations of cells after which the treatment process was simulated in MATLAB. Subsequently, a global sensitivity analysis was done to corroborate the model with clinical data. Finally, 96 radiation protocols were simulated by using the biologically effective dose formula. These protocols were used to obtain a regression equation connecting the value of the Caputo fractional derivative with the fractionated dose.
RESULTS: The final tumor volumes, from the results of the simulations, were 3.58cm3, 8.61cm3, 5.68cm3, 4.36cm3, 5.75cm3, and 6.12cm3, while those of the normal cells were 23.87cm3, 17.29cm3, 28.17cm3, 18.68cm3, 30.33cm3, and 12.55cm3. The sensitivity analysis showed that the most sensitive model factors were the value of the Caputo fractional derivative and the proliferation coefficient of the cancer cells. Lastly, the obtained regression equation accounted for 99.14% of the prediction.
CONCLUSION: The model can simulate a cancer treatment process and predict the results of other radiation protocols.
MATERIALS AND METHODS: SEA country-specific cancer incidence by tumor site for 2015, 2025 and 2035 was extracted from the GLOBOCAN database. We utilized the optimal radiotherapy utilization rate model by Wong et al. (2016) to calculate the optimal number of fractions for all tumor sites in each SEA country. The available machines (LINAC & Co-60) were extracted from the IAEA's Directory of Radiotherapy Centres (DIRAC) from which the number of available fractions was calculated.
RESULTS: The incidence of cancers in SEA countries are expected to be 1.1 mil cases (2025) and 1.4 mil (2035) compared to 0.9 mil (2015). The number of radiotherapy fractions needed in 2025 and 2035 are 11.1 and 14.1 mil, respectively, compared to 7.6 mil in 2015. In 2015, the radiotherapy fulfillment rate (RFR; required fractions/available fractions) varied between countries with Brunei, Singapore and Malaysia are highest (RFR > 1.0 - available fractions > required fractions), whereas Cambodia, Indonesia, Laos, Myanmar, Philippines, Timor-Leste and Vietnam have RFR
METHODS AND MATERIALS: Between October 2007 and May 2016, 106 patients with untreated squamous cell carcinoma of the cervix were enrolled in the present study. Radiation therapy consisted of pelvic irradiation (total dose, 50 Gy in 25 fractions including central shielding), prophylactic paraortic regional irradiation (36-40 Gy in 20 fractions), and either high- or low-dose-rate intracavitary brachytherapy (ICBT) according to institutional practice. The planned point A dose was 21 to 28 Gy in 3 to 4 fractions for high-dose-rate ICBT and 40 to 41 Gy in 1 to 2 fractions for low-dose-rate ICBT. Five cycles of weekly cisplatin (40 mg/m2) were administered during the radiation therapy course.
RESULTS: A total of 106 patients were enrolled. Of these, 9 had major protocol violations and 2 did not receive treatment because of worsened general condition. Thus, 95 patients were evaluable. The median follow-up was 56 months. Of the 95 patients, 76 (80%) received 4 or 5 cycles of chemotherapy. Acute grade 3 leukopenia was observed in 20 of the patients (21%), and late grade 3 gastrointestinal toxicity was observed in 3%. The 2-year local control, progression-free survival, and overall survival rate for all patients were 96%, 78%, and 90%, respectively.
CONCLUSIONS: The results indicated that prophylactic extended-field concurrent chemoradiation therapy using weekly cisplatin is feasible and effective for patients with locally advanced cervical cancer in East and Southeast Asia.