Thai cancer journal

Use of an Anastomotic Venous Coupler Device for Radial Forearm Free Flap Reconstruction Following Tongue Cancer Resection: A Case Report

2026-09-03T18:09:41+07:00

The anastomotic coupler is a microsurgical device for venous anastomosis in free tissue transfer. International literature has confirmed that it shortens anastomosis time, lowers thrombosis rates. We report a 60-year-old Thai woman with squamous cell carcinoma of the left lateral tongue, stage pT3N3bM0 (Stage IVB), who underwent left hemiglossectomy with left modified neck dissection and reconstruction with a radial forearm free flap. The arterial anastomosis was performed using a hand-sewn microsurgical technique, while the single venous anastomosis was performed to the facial vein using an anastomotic coupler device. The flap remained fully viable with no vascular complications throughout follow-up, including through postoperative concurrent chemoradiotherapy. This outcome is consistent with the safety profile reported abroad and represents the first documented use of this technology in a head and neck free flap within the Thai Ministry of Public Health system.

Survival Rate of Lung Cancer Patients after Diagnosis at the National Cancer Institute: An Update from the National Cancer Institute Hospital Based Cancer Registry between 2020 and 2024

2026-02-25T12:02:36+07:00

Background: Lung cancer is a leading cause of cancer-related mortality in Thailand and globally, particularly among patients diagnosed at an advanced stage. This study aimed to evaluate mortality rates, survival rates, and compare these among groups of lung cancer patients receiving treatment at the National Cancer Institute. The specific objectives were: (1) to evaluate the overall survival rate, survival time, and survival trends of lung cancer patients diagnosed and treated at the National Cancer Institute between 2020 and 2024; (2) to analyze and compare survival stratified by key variables including sex, age, cancer cell type, and disease stage; and (3) to determine survival trends for patients in each stage of the disease. Methods: This was a retrospective cohort study using data from the cancer registry database of the National Cancer Institute between January 1, 2020, and December 31, 2024. A total of 1,325 patients diagnosed with lung cancer (ICD-O-3: C33.9, C34.0–C34.9) were included. Vital status was followed up by linking with the mortality database of the National Health Security Office. Survival analysis was performed using the Kaplan-Meier method on 1,312 patients with complete data, with death as the event of interest. Differences in survival between groups were compared using the log-rank test. Median survival times were reported alongside 95% confidence intervals (CI). Results: Among the 1,325 patients, 56.53% were male with a mean age of 63.3 ± 11.1 years, and 43.47% were female with a mean age of 62.8 ± 11.8 years. The majority had non-small cell lung cancer (96.23%) and were diagnosed at stage IV (61.96%). There were 338 deaths observed, corresponding to a mortality rate of 25.51 per 100 person-years. The overall median survival time was 0.93 years (95% CI: 0.81–1.03), indicating that half of the patients died within approximately 11 months after diagnosis. The survival rates at 1, 2, 3, 4, and 5 years were 48.2%, 30.9%, 24.2%, 17.4%, and 12.9%, respectively. When stratified by sex, females had a significantly higher median survival of 1.38 years (95% CI: 1.15–1.58) compared to males, who had a median survival of 0.68 years (95% CI: 0.59–0.80). The 1-, 3-, and 5-year survival rates for females were 57.4%, 28.8%, and 19.7%, whereas for males, they were 41.1%, 20.6%, and 6.2%, respectively. When stratified by disease stage, prominent differences in survival were observed. stage II had a median survival of 4.60 years (95% CI: 3.08–upper limit not estimable), stage III was 1.25 years (95% CI: 0.99–1.69), and stage IV was 0.63 years (95% CI: 0.56–0.74). Kaplan-Meier trends demonstrated that patients in stage I-II experienced consistently higher survival, whereas stage IV showed a rapid decline in survival beginning in the first year. Conclusion: The majority of lung cancer patients were diagnosed at an advanced stage and exhibited a median survival of less than 1 year. Sex and disease stage were significantly associated with survival, with males and advanced-stage patients having a poor prognosis. The findings of this study reflect the critical need to improve early detection and increase access to effective treatments to reduce the mortality rate.

A real-world, retrospective, observational study to evaluate the safety and effectiveness of Fulvestrant (Eranfu) monotherapy in HR+/HER2- advanced breast cancer patients

2026-01-05T16:33:06+07:00

Background: Fulvestrant, a selective estrogen receptor degrader (SERD), is a standard endocrine therapy for HR-positive, HER2-negative advanced breast cancer (ABC). Despite the recent approval of combination regimens with targeted therapies, fulvestrant monotherapy remains widely used. However, real-world data from high-burden, resource-limited settings like Thailand are scarce. Objective: To evaluate the real-world safety and clinical effectiveness of generic fulvestrant (Eranfu) monotherapy in Thai patients with HR+/HER2- ABC across treatment lines. Methods: A retrospective review of 74 medical records of postmenopausal women (≥18 years) treated with fulvestrant between 1 January 2022 and 31 January 2024 was conducted. Of these, 29 patients met inclusion criteria: no prior endocrine therapy, relapse on/after adjuvant anti-estrogen therapy, or progression on anti-estrogen therapy, with ≥6 months of follow-up. Patients received Eranfu monotherapy as 1st line (n=4), 2nd line (n=15), or ≥3rd line (n=10). Safety was evaluated using CTCAE v5.0. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and overall response rate (ORR). Results: Median age was 61 years (range 43–89); 86.2% had ECOG performance status 0–1. Bone metastases were present in 55.2%, and 51.7% had visceral involvement. Patients had received up to two prior lines of endocrine or chemotherapy. Fulvestrant was well-tolerated, with only eight grade ≥4 adverse events. Median PFS was 3.67 months overall, longer in 1st line (6.73 months) than 2nd (3.27 months) or later lines (4.27 months). Median OS was 30.77 months. ORR was 14.2% overall and 50% with 1st line fulvestrant monotherapy. Conclusion: Fulvestrant demonstrated favorable safety and efficacy in Thai HR+/HER2- ABC patients, including those with visceral metastases and prior endocrine therapy. Improved results with 1st line use underscore the value of early initiation, supporting its continued role across treatment lines, especially in resource-limited settings.

A Comparative study of bladder volume to optimize radiation therapy in prostate cancer patients.

2026-07-03T13:36:49+07:00

Maintaining a full bladder volume on the radiation therapy day as close as possible to the simulation day is crucial for the accuracy and efficacy of prostate cancer treatment. This research aimed to compare bladder volume between the simulation day and the radiation therapy day in 33 patients at the National Cancer Institute, selected according to specified criteria. Bladder volume on the simulation day was calculated from CT simulator images and compared to bladder volume on the radiation therapy day from cone-beam computed tomography (CBCT) images.

The study results showed that the median bladder volume on the simulation day and the radiation day was 113.92 (91.08-134.38) and 112.08 (91.59-140.71) ml, respectively, which were not statistically significant (p = 0.057). However, bladder size along the X-axis (left-right) and Z-axis (head-foot) differed significantly (p<0.001 and p=0.032, respectively), but not significantly along the Y-axis (front-back) (p=0.465). Furthermore, urinary continence duration and the number of imaging sessions between the simulation day and the radiation day differed significantly (p<0.001). Generalized Estimating Equation (GEE) analysis revealed a statistically significant correlation between bladder volume (β =0.53, 95% CI: 0.24-0.84, p<0.001), with position. The bladder correlation was statistically significant across all three axes (p < 0.05), with the Z-axis (head-foot) showing the strongest correlation.

In summary, a comparative study of bladder volume between the treatment simulation day and the radiation therapy day found that full bladder preparation helps prostate cancer patients maintain their bladder volume levels. The bladder volume on the day of radiation therapy was not statistically significant (p = 0.057), with median values of 113.92 ml and 112.08 ml, respectively. The GEE model confirmed a statistically significant positive correlation between bladder volumes on both days (β = 0.53, p < 0.001). However, significant differences in bladder size were found in the X-axis (left-right) and Z-axis (head-foot) (p < 0.001 and p = 0.032, respectively), reflecting changes in bladder shape in these two directions. The Y-axis (anterior-posterior) did not show a statistically significant difference (p = 0.465). Furthermore, a statistically significant correlation (p < 0.001) was found between urinary continence duration and the number of pre irradiation CBCT scans. This reflects the inconsistency in daily urinary continence duration among patients, directly impacting bladder changes. Increasing the number of CBCT scans to adjust the bladder position before radiation therapy is crucial for treatment planning.

Comparison of 19-Gauge and 22-Guage needles in EUS-Guided Sampling of Subepithelial lesion and pancreatic tumor : A Study of Diagnostic Efficacy.

2026-08-31T11:11:39+07:00

Background: Endoscopic ultrasound-guided tissue sampling is an important diagnostic procedure for subepithelial lesions and pancreatic tumors. Needle gauge may influence tissue adequacy and diagnostic performance. Objective: To compare the efficacy of tissue acquisition between 19-gauge and 22-gauge needles. Methods: This comparative observational study included 72 patients who underwent endoscopic ultrasound-guided tissue sampling at Lopburi Cancer Hospital between October 1, 2024 and October 30, 2025. Fifteen patients were included in the 19-gauge needle group and 57 in the 22-gauge needle group. Data collected included lesion characteristics, number of needle passes, procedure time, pathological findings, and tissue adequacy. Descriptive statistics were used, and between-group comparisons were performed using Fisher’s exact test. Results: Adequate tissue for diagnosis was obtained in 93.3% of patients in the 19-gauge group and 80.7% in the 22-gauge group, with no statistically significant difference between the groups (OR 3.35, 95% CI 0.40–28.25, P=0.438). The mean procedure time was 31.53±12.45 minutes in the 19-gauge group and 34.67±11.76 minutes in the 22-gauge group, with no statistically significant difference (P=0.291). An additional analysis using a 40-minute cutoff showed a significant difference in the proportion of procedures completed within 40 minutes between the two groups (P=0.028). However, this cutoff was not prespecified in the original analysis plan. Conclusion: The 19-gauge and 22-gauge needles demonstrated comparable efficacy in obtaining adequate tissue for diagnosis. Although the 19-gauge needle showed
a trend toward a higher rate of tissue adequacy and a slightly shorter mean procedure time, the findings do not establish its superiority over the 22-gauge needle. Needle selection should therefore be based on lesion characteristics and location, patient-related factors, and operator experience.