Thai cancer journal

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 — Tue, 08 Oct 2024 00:00:00 +0700

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.

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

Yuthapong Suwannapong — Wed, 09 Oct 2024 00:00:00 +0700

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

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

Mon, 04 Nov 2024 00:00:00 +0700

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.

Comparison of Interpretations of Chest Radiographs: Case of Interpretation by Radiologist and Artificial Intelligence Technology, Kalasin Hospital

Roongnapa Anupongpipat — Wed, 11 Dec 2024 00:00:00 +0700

The amount of chest radiograph (CXR) is continuously increasing, resulting increase the workload of radiologist. Artificial intelligence (AI) technology has been to assist in the interpretation of CXR for reduce steps and increase work efficiency. AI technology is continuously being develop to achieve higher accuracy. Objective: To study the comparison of CXR interpretation by AI technology and radiologist. Methods: Retrospective descriptive study, a samples of 2,207 CXR images in Kalasin hospital with interpreting by AI technology and by radiologist. Comparative analysis of the interpreting of CXR by AI technology and radiologists. Results: The interpreting by AI technology and radiologists is mostly highly consistent with a Kappa of 0.67 to 1.0, and the sensitivity and specificity are similar. Some pathologies such as nodules and calcified nodules have lower sensitivity and consistency. As for fracture bone, it is not indicated by AI technology, but indicate by radiologist. There were inconsistencies in some lesions such as infiltration, nodule and some locations such as both lower lungs, hilar and retrocardiac regions. Conclusions: The interpretation of CXR by AI technology and radiologists had a high to very high level of consistency. Although fracture bone was not indicated by AI interpretation which was different from the interpretation by radiologists. The interpretation by AI technology will have lower sensitivity such as nodule or calcified nodule and some locations such as hilar and retrocardiac regions that require caution ininterpretation. However AI technology can be applied to the interpretation of CXR images to reduces work steps and waiting times

Synchronous double primary cancers of adenocarcinoma of the rectum and hepatocellular carcinoma

Wed, 11 Dec 2024 00:00:00 +0700

Synchronous double primary cancers of the rectum and another have been hardly reported worldwide, so far. So, we additionally presented one patient who concurrently developed synchronous double cancers of the rectum and the hepatocellular carcinoma. He was a 65-year-old Thai who presented with hematochezia for a few days without fever or weight loss. His physical examination did not reveal any significant abnormality. The coloscopy found a rectal mass and multiple colonic polyps. The computerized tomography of the whole abdomen confirmed the rectal mass and also another mass in the liver with mild cirrhosis. His blood tests showed Hct 37.7%, elevated carcinoembryonic antigen (CEA), 22.04 ng/ml and normal alpha-fetoprotein (AFP) level, positive hepatitis B virus antigen, albumin 3.1 g%, globulin 3.6 g%. He underwent low anterior resection of the rectal mass, multiple colonic polypectomy, segmentectomy of the liver mass and colostomy and was further treated with radiation and adjuvant chemotherapy consisting of 5-fluoro uracil and leucovorin. The pathology of the rectal mass was adenocarcinoma whereas the liver mass was hepatocellular carcinoma. Nine months after treatment, the serum level of CEA appeared normal and the CT of the abdomen showed no recurrence of the liver or bowel wall carcinoma. He could still survive up to three years when this report was written. Although the primary colorectal cancer with liver metastasis is much more common than the synchronous double primary cancers of the colorectum and the liver, the liver mass biopsy must not be ignored even though the serum AFP level is not elevated, otherwise the double cancers can be overlooked and the appropriate management of the liver carcinoma will have never been accessed. The association between both cancers will be further discussed in detail.

The Role of Nurses in Caring for Patients with Dermatologic Side Effects from EGFR Inhibitors

Akradach Bamrungnam — Wed, 11 Dec 2024 00:00:00 +0700

EGFR Inhibitors are used in the treatment of lung cancer patients with EGFR gene mutations. These drugs exhibit highly specific effects, leading to enhanced treatment efficacy. However, they also cause side effects in various systems, particularly the skin. These side effects can lead to a loss of self-image, discomfort, and reduced quality of life for patients. Therefore, Nurses, who play a crucial role in caring for these patients, must have the necessary knowledge and apply evidence-based practices to their caregiving roles. This article discusses the pathophysiology and dermatologic side effects of EGFR inhibitors, guidelines for prevention and treatment, as well as the nurse’s role in assessing and advising patients on self-care regarding these dermatologic side effects.