Thai cancer journal

Risk factors associated neutropenia and prevention strategies in colorectal cancer patients undergoing chemotherapy

Yuthapong Suwannapong — 2024-10-09

Neutropenia is a common adverse effect in patients undergoing chemotherapy, leading to treatment delays, prolonged therapy duration, and an increased risk of severe infections. This study aims to identify factors associated with neutropenia and develop preventive measures in colorectal cancer patients receiving intravenous chemotherapy. The study included 261 colorectal cancer patients receiving intravenous chemotherapy at the chemotherapy unit of Nan hospital from January 1, 2021, to April 30, 2024. Patient history data were collected from medical records and analyzed using descriptive statistics and logistic regression. The results indicated that 168 patients (64.37%) experienced neutropenia, with 128 patients (49.04%) having at least one episode of grade 2 or higher severity (ANC<1,500 cells/mm²). Factors significantly associated with grade 2 or higher neutropenia included female gender OR=2.47; 95%CI: 1.44-4.23; P=0.001), stage 3 cancer (OR=2.61; 95%CI: 1.18-5.72; P=0.017), FOLFOX4 chemotherapy regimen (OR=6.61; 95%CI: 1.27-34.47; P=0.025) The multidisciplinary team collaboratively developed preventive measures implemented in the unit. Proactive measures include dose reduction of chemotherapy or administration of G-CSF in female patients receiving FOLFOX4 regimens. Reactive measures involve educating and promoting appropriate self-care practices to prevent and reduce the risk of severe neutropenia. These strategies aim to enhance treatment efficacy and improve patients' quality of life

Exploring Febrile Neutropenia as Non-Cardiac Fatal Toxicities of Anthracycline-Based Chemotherapy: Incidence and Predictive Factors among Breast Cancer Patients – A Retrospective Analysis at Surin Hospital Cancer Center.

Chalermchai Lertanansit — 2024-10-08

In the ongoing battle against breast cancer, chemotherapy remains a critical tool alongside immunotherapy and targeted therapy. Anthracycline-based regimens stand out as powerful chemotherapy agents in this fight. However, alongside therapeutic advancements, febrile neutropenia (FN) poses a significant challenge as a potentially fatal non-cardiac toxicity. Attention to managing FN is crucial for the safety and treatment success of breast cancer patients. We conducted a retrospective study from January 2020 to December 2022 at Surin Hospital Cancer Center, focusing on breast cancer patients treated with anthracycline-based chemotherapy. Our objective was to identify incidents and contributing factors to severe neutropenia and FN following chemotherapy. Prognostic factors were analyzed using a flexible parametric regression model in both univariate and multivariate analyses. The result showed that among the 174 eligible breast cancer patients included in the study, severe neutropenia (defined as ANC <100 cells/mm³) occurred in 2.9% of cases, while 4% developed FN, resulting in two deaths. Univariate analysis revealed associations between FN and severe neutropenia with age over 65, higher ECOG performance status scores, and comorbidities. However, in multivariate analysis, only an initial absolute neutrophil count below 3,000 cells/mm³ emerged as an independent predictor of FN (OR 8.449; 95% CI 1.165–61.290; P=0.035). Notably, the severity of neutropenia did not significantly vary based on patients’ nutritional statuses. In conclusion, the study highlights FN as a significant complication of anthracycline-based chemotherapy in breast cancer patients. The identification of baseline neutrophil count as a predictive factor emphasizes the importance of pre-chemotherapy screening and proactive management strategies to mitigate FN risk and improve patient outcomes.

Application of a Digital Spirit Water Level to Measure and Determine The Slope of The Chest Surface in Radiotherapy Positioning of Breast Cancer Patients.

Khanthong Chaimongkhol — 2024-11-04

This research is to study the efficiency and accuracy of the application of using the laser system with the digital spirit water level (DSL) compared to using a laser system, which is a standard method. The study examined and assessed the errors, which could be caused by many factors, such as the use of fixation devices, the expertise of the radiotechnologist, and the patient. In the positioning of breast cancer patients before radiation therapy, using the Three Dimension Conformal Radiotherapy (3DCRT) techniques, Intensity Modulated Radiotherapy (IMRT) techniques, Volumetric Arc radiotherapy (VMAT) techniques. In ELEKTA Infinity^TH and Accuray TomoH radiation machines of totaling 34 cases by selecting according to the inclusion and exclusion criteria, which assessed the error in 3 dimensions: left-right (X-axis), head-foot (Y-axis), and front-back (Z-axis) from X-rays in kV-kV-imaging mode and Cone Beam Computed Tomography (CBCT) mode. Compared with computed tomography simulation image. The results were the group of breast cancer patients who received pre-irradiation positioning using only the laser system had mean error in the X-axis, Y-axis, and Z-axis of -0.23±2.67 mm, -0.09±2.02 mm, and 3.09±2.84 mm, respectively. The groups using the laser and DSL systems had mean error in the X-axis, Y-axis, and Z-axis of -1.01±1.54 mm, -0.38±2.05 mm, and -0.26±1.68 mm, respectively. When analyzed by the independent t-tests to compare the mean error between the 2 systems, it was found that the mean in the X-axis and Y-axis was not significantly different (P=0.305 and P=0.689 respectively), while the mean in the Z-axis was significantly different (P=0.003). The study of the average time for patient positioning found that the positioning using the Laser system average of 40±21.87 minutes, while using the Laser system and DSL average of 7.94±6.13 minutes, which was statistically significantly different (P<0.001). In addition, the average number of repeated imaging sessions between the laser system and the laser system and DSL were compared and found to be 8.00±4.37 times and 1.58±1.23 times, respectively, which were statistically significantly different (P<0.001). The Total Vector Error (TVE) of the device using the laser system and the device using the Laser and DSL system were 3.12 and 1.11 mm, respectively. The average error of the planning target volume margin (PTV margin) in the X-axis, Y-axis, and Z-axis of the device using the laser system and the device using the Laser and DSL system were 11.34, 12.49, 17.48 and 8.85, 8.92, 7.56 mm, respectively. In summary, the comparison of the use of two systems, the standard laser system and the laser system combined with DSL, found that the positioning error values in breast cancer patients were not significantly different in the X-axis and Y-axis, except in the Z-axis. Therefore, the use of the laser system and DSL helped increase the accuracy of patient positioning, especially in the Z-axis, reduce the overall mean error (TVE), reduce the PTV margin error, and reduce the time for patient positioning, as well as reduce the number of re-imaging. There are resulting in patients not receiving unnecessary additional radiation doses according to the principles of safety and radiation hazard prevention.