Prognostic Factors in Patients with Non-small Cell Lung Carcinoma and Brain Metastases: a Malaysian Perspective

Tang, Weng Heng,Alip, Adlinda,Saad, Marniza,Phua, Vincent Chee Ee,Chandran, Hari,Tan, Yi Hang,Tan, Yan Yin,Kua, Voon Fong,Wahid, Mohamed Ibrahim,Tho, Lye Mun Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.5

Background: Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (${\leq}2$ vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or $SRS/SRT{\pm}WBRT$ vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ${\leq}2$, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.

Treatment Outcome for Head and Neck Squamous Cell Carcinoma in a Developing Country: University Malaya Medical Centre, Malaysia from 2003-2010

Wong, Yoke Fui,Yusof, Mastura Md,Ishak, Wan Zamaniah Wan,Alip, Adlinda,Phua, Vincent Chee Ee Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.7

Background: Head and neck cancer (HNC) is the eighth most common cancer as estimated from worldwide data. The incidence of HNC in Peninsular Malaysia was reported as 8.5 per 100,000 population. This study was aimed to determine the treatment outcomes for HNC patients treated in the Oncology Unit of University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with squamous cell carcinoma of head and neck (HNSCC) referred for treatment to the Oncology Unit at UMMC from 2003-2010 were retrospectively analyzed. Treatment outcomes were 5-year overall survival (OS), cause specific survival (CSS), loco-regional control (LRC) and radiotherapy (RT) related side effects. Kaplan-Meier and log rank analyses were used to determine survival outcomes, stratified according to American Joint Committee on Cancer (AJCC) stage. Results: A total of 130 cases were analysed. Most cases (81.5%) were at late stage (AJCC III-IVB) at presentation. The 5-year OS for the whole study population was 34.4% with a median follow up of 24 months. The 5-year OS according to AJCC stage was 100%, 48.2%, 41.4% and 22.0% for stage I, II, III and IVA-B, respectively. The 5-year overall CSS and LCR were 45.4% and 55.4%, respectively. Late effects of RT were documented in 41.4% of patients. The most common late effect was xerostomia. Conclusions: The treatment outcome of HNSCC at our centre is lagging behind those of developed nations. Efforts to increase the number of patients presenting in earlier stages, increase in the use of combined modality treatment, especially concurrent chemoradiotherapy and implementation of intensity modulated radiotherapy, may lead to better outcomes for our HNC patients.

Evaluation of high nutrient diets on litter performance of heat-stressed lactating sows

Choi, Yohan,Hosseindoust, Abdolreza,Shim, YoungHo,Kim, Minju,Kumar, Alip,Oh, Seungmin,Kim, YoungHwa,Chae, Byung-Jo Asian Australasian Association of Animal Productio 2017 Animal Bioscience Vol.30 No.11

Objective: The present study investigated the litter performance of multiparous sows fed 3% and 6% densified diets at farrowing to weaning during summer with mean maximum room temperature of $30.5^{\circ}C$. Methods: A total of 60 crossbred multiparous sows were allotted to one of three treatments based on body weight according to a completely randomized design. Three different nutrient levels based on NRC were applied as standard diet (ST; metabolizable energy, 3,300 kcal/kg), high nutrient level 1 (HE1; ST+3% higher energy and 16.59% protein) and high nutrient level 2 (HE2; ST+6% higher energy and 17.04% protein). Results: There was no variation in the body weight change. However, backfat thickness change tended to reduce in HE1 in comparison to ST treatment. Dietary treatments had no effects on feed intake, daily energy intake and weaning-to-estrus interval in lactating sows. Litter size, litter weight at weaning and average daily gain of piglets were significantly greater in sows in HE1 compared with ST, however, no difference was observed between HE2 and ST. Increasing the nutrient levels had no effects on the blood urea nitrogen, glucose, triglyceride, and creatinine at post-farrowing and weaning time. The concentration of follicle stimulating hormone, cortisol and insulin were not affected by dietary treatments either in post-farrowing or weaning time. The concentration of blood luteinizing hormone of sows in ST treatment was numerically less than sows in HE2 treatment at weaning. Milk and colostrum compositions such as protein, fat and lactose were not affected by the treatments. Conclusion: An energy level of 3,400 kcal/kg (14.23 MJ/kg) with 166 g/kg crude protein is suggested as the optimal level of dietary nutrients for heat stressed lactating sows with significant beneficial effects on litter size.

Risk of Treatment Related Death and Febrile Neutropaenia with First Line Palliative Chemotherapy for De Novo Metastatic Breast Cancer in Clinical Practice in a Middle Resource Country

Phua, Chee Ee,Tang, Weng Heng,Yusof, Mastura Md.,Saad, Marniza,Alip, Adlinda,See, Mee Hoong,Taib, Nur Aishah Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.23

Background: The risk of febrile neutropaenia (FN) and treatment related death (TRD) with first line palliative chemotherapy for de novo metastatic breast cancer (MBC) remains unknown outside of a clinical trial setting despite its widespread usage. This study aimed to determine rates in a large cohort of patients treated in the University of Malaya Medical Centre (UMMC). Materials and Methods: Patients who were treated with first line palliative chemotherapy for de novo MBC from 2002-2011 in UMMC were identified from the UMMC Breast Cancer Registry. Information collected included patient demographics, histopathological features, treatment received, including the different chemotherapy regimens, and presence of FN and TRD. FN was defined as an oral temperature > $38.5^{\circ}C$ or two consecutive readings of > $38.0^{\circ}C$ for 2 hours and an absolute neutrophil count < $0.5{\times}10^9/L$, or expected to fall below $0.5{\times}10^9/L$ (de Naurois et al, 2010). TRD was defined as death occurring during or within 30 days of the last chemotherapy treatment, as a consequence of the chemotherapy treatment. Statistical analysis was performed using the SPSS version 18.0 software. Survival probabilities were estimated using the Kaplan-Meier method and differences in survival compared using log-rank test. Results: Between $1^{st}$ January 2002 and $31^{st}$ December 2011, 424 patients with MBC were treated in UMMC. A total of 186 out of 221 patients with de novo MBC who received first line palliative chemotherapy were analyzed. The mean age of patients in this study was 49.5 years (range 24 to 74 years). Biologically, ER status was negative in 54.4% of patients and Her-2 status was positive in 31.1%. A 5-flourouracil, epirubicin and cyclophosphamide (FEC) chemotherapy regimen was chosen for 86.6% of the cases. Most patients had multiple metastatic sites (58.6%). The main result of this study showed a FN rate of 5.9% and TRD rate of 3.2%. The median survival (MS) for the entire cohort was 19 months. For those with multiple metastatic sites, liver only, lung only, bone only and brain only metastatic sites, the MS was 18, 24, 19, 24 and 8 months respectively (p-value= 0.319). Conclusions: In conclusion, we surmise that FEC is a safe regimen with acceptable FN and TRD rates for de novo MBC.

Interpretation of deformation microstructures in syntectonic granite: insights from Phulad granite, Rajasthan, NW India

Ayan Kumar Sarkar,Anirban Manna,Sadhana M. Chatterjee,Alip Roy 한국지질과학협의회 2023 Geosciences Journal Vol.27 No.6

Previous work reveals a syn-tectonic granite named Phulad granite, which is emplaced (~820 Ma) in the western part of the South Delhi Fold Belt (SDFB) along and across the Phulad Shear Zone (PSZ). There is a lack of information about the detailed microstructural study, differential stress and strain rate variation from this granite body. These pieces of information are crucial in developing deformational history associated with the shear zone deformation. The granite preserves a variety of dynamic recrystallization from grain boundary bulging (BLG) to sub-grain rotation (SGR) to grain boundary migration (GBM). There is a variation in the fractal dimension (D) in the granite, such as higher D at the shear zone, and with increasing distance from the shear zone, D values are low. Strain rates (10−7.52 s−1–10−7.99 s−1) are much higher than the geological strain rates in the natural systems. The strain rates indicate that the method to calculate strain rate using the D value (1.007 ± 0.017 to 1.031 ± 0.022) is to some extent erroneous or fails to give geologically reasonable value for high-temperature syn-tectonic granite such as Phulad granite. Based on the quartz piezometer, our findings reveal variation in flow stress with distance from the shear zone, which depends on the grain size. Volume gain and mass balance calculations indicate that fluid incorporation at the shear zone reduces deformation temperature, which also validates the findings from the microstructural study. These microstructures and grain size calculations are discussed to interpret the deformation mechanism, various stress-strain pattern and evolution of the Phulad granite throughout the area.

Capecitabine Pattern of Usage, Rate of Febrile Neutropaenia and Treatment Related Death in Asian Cancer Patients in Clinical Practice

Phua, Vincent Chee Ee,Wong, Wei Quan,Tan, Pei Lin,Bustam, Anita Zarina,Saad, Marniza,Alip, Adlinda,Ishak, Wan Zamaniah Wan Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.4

Background: Oral capecitabine is increasingly replacing intravenous 5-fluorouracil in many chemotherapy regimens. However, data on the risk of febrile neutropaenia (FN) and treatment related death (TRD) with the drug remain sparse outside of clinical trial settings despite its widespread usage. This study aimed to determine these rates in a large cohort of patients treated in the University of Malaya Medical Centre (UMMC). Materials and Methods: We reviewed the clinical notes of all patients prescribed with oral capecitabine chemotherapy for any tumour sites in University Malaya Medical Centre (UMMC) from $1^{st}$ January 2009 till $31^{st}$ June 2010. Information collected included patient demographics, histopathological features, treatment received including the different chemotherapy regimens and intent of treatment whether the chemotherapy was given for neoadjuvant, concurrent with radiation, adjuvant or palliative intent. The aim of this study is to establish the pattern of usage, FN and TRD rates with capecitabine in clinical practice outside of clinical trial setting. FN is defined as an oral temperature > $38.5^{\circ}C$ or two consecutive readings of > $38.0^{\circ}C$ for 2 hours and an absolute neutrophil count < $0.5{\times}10^9/L$, or expected to fall below $0.5{\times}10^9/L$ (de Naurois et al., 2010). Treatment related death was defined as death occurring during or within 30 days of last chemotherapy treatment. Results: Between $1^{st}$ January 2009 and $30^{th}$ June 2010, 274 patients were treated with capecitabine chemotherapy in UMMC. The mean age was 58 years (range 22 to 82 years). Capecitabine was used in 14 different tumour sites with the colorectal site predominating with a total of 128 cases (46.7%), followed by breast cancer (35.8%). Capecitabine was most commonly used in the palliative setting accounting for 63.9% of the cases, followed by the adjuvant setting (19.7%). The most common regimen was single agent capecitabine with 129 cases (47.1%). The other common regimens were XELOX (21.5%) and ECX (10.2%). The main result of this study showed an overall FN rate of 2.2% (6/274). The overall TRD rate was 5.1% (14/274). The FN rate for the single agent capecitabine regimen was 1.6% (2/129) and the TRD rate was 5.4% (7/129). All the TRDs were with single agent capecitabine regimen were used for palliative intent. Conclusions: Oral capecitabine is used widely in clinical practice in a myriad of tumour sites and bears a low risk of febrile neutropaenia. However, capecitabine like any other intravenous chemotherapeutic agent carries a significant risk of treatment related death.

nvestigating Meat Quality of Broiler Chickens Fed on Heat Processed Diets Containing Corn Distillers Dried Grains with Solubles

YoungHo Shim,JinSoo Kim,Abdolreza Hosseindoust,YoHan Choi,MinJu Kim,SeungMin Oh,HyungBin Ham,Alip Kumar,KwangYeol Kim,Aera Jang,ByungJo Chae 한국축산식품학회 2018 한국축산식품학회지 Vol.38 No.3

The present study investigated the effects of feed form and distiller’s dried grain with solubles (DDGS) on meat quality and fatty acids profile of broiler chickens. A total of 720 broilers (Ross 308; average BW [body weight] 541±5.7 g) were randomly allotted to six treatments. Birds were fed three different feed forms (mash; SP, simple pellet; EP, expanded pellet) and DDGS (0 or 200 g kg-1) in a 3×2 factorial arrangement. The addition of DDGS and EP to the diet resulted in increased shear force of breast meat. Moreover, DDGS inclusion in the diet reduced the concentration of stearic acid and behenic acid in thigh meat. Pelleting (SP and EP) of the diets increased palmitic acid content in the thigh, whereas the linolenic acid content decreased. The breast mass was higher with EP and SP diets than with the mash diet. Feed processing led to increased pectoralis muscle and drum mass compared to mash-fed chickens. In conclusion, our results demonstrated that EP decreased thigh linolenic acid and meat shear force. In addition, DDGS supplementation in broiler hampers meat quality by increasing the shear force.