30 Years of Radiotherapy Service in Southern Thailand: Workload vs Resources

Phungrassami, Temsak,Funsian, Amporn,Sriplung, Hutcha Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.12

Background: To study the pattern of patient load, personnel and equipment resources from 30-years experience in Southern Thailand. Materials and Methods: This retrospective study collected secondary data from the Division of Therapeutic Radiology and Oncology and the Songklanagarind Hospital Tumor Registry database, Faculty of Medicine, Prince of Songkla University, during the period of 1982-2012. Results: The number of new patients who had radiation treatment gradually increased from 121 in 1982 to 2,178 in 2011. Shortages of all kinds of personnel were demonstrated as compared to the recommendations, especially in radiotherapy technicians. In 2011, Southern Thailand, with two radiotherapy centers, had 0.44 megavoltage radiotherapy machines (cobalt or linear accelerator) per million of population. This number is suboptimal, but could be managed cost-effectively by prolonging machine operating times during personnel shortages. Conclusions: This study identified a discrepancy between workload and resources in one medical school radiotherapy center in Southern Thailand. This information is crucial for future strategic planning both regionally and nationally.

Radiotherapy for Brain Metastases in Southern Thailand: Workload, Treatment Pattern and Survival

Phungrassami, Temsak,Sriplung, Hutcha Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.4

Purpose: To study the patient load, treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy. Materials and Methods: Data for patients with brain metastases treated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital information system database, and a population-based tumor registry database until death or at least 5 years after treatment and retrospectively reviewed. Results: The number of treatments for brain metastases gradually increased from 48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated with whole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overall median survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy was as follows: 52% at 3 months, 18% at 1 year and 3% at 5 years in males; and 66% at 3 months, 26% at 1 year and 7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalities had a better prognosis. Poor prognostic factors included primary cancer from the lung or gastrointestinal tract, emergency or urgent consultation, poor performance status (ECOG 3-4), and a hemoglobin level before treatment of less than 10 g/dl. Conclusions: This study identified an increasing trend of patient load with brain metastases. Possible over-treatment and under-treatment were demonstrated with a wide range of survival results. Practical prognostic scoring systems to assist in decision-making for optimal treatment of different patient groups is absolutely necessary; it is a key strategy for balancing good quality of care and patient load.

시간 개념을 고려한 전과정평가 방법

H. Phungrassami,박정건(Jeoung Gun Park),이건모(Kun Mo Lee) 大韓環境工學會 2007 대한환경공학회지 Vol.29 No.6

전과정평가(Life Cycle Assessment: LCA)는 전과정에 걸친 투입과 산출을 정량화하고, 잠재적인 환경 영향을 평가하는 도구이다. 기존 LCA 방법은 시간을 명확하게 고려하지 않는다는 결함이 있다. 또한 정규화(normalization)단계에서도 시간 경계에 관한 문제가 존재한다. 본 연구의 목적은 시간이 고려된 새로운 LCA 방법을 제안하는 것이다. 본 연구에서 제안하는 새로운 LCA 방법론인 ``시간 부하 LCA``는 각각의 전과정단계에서 발생하는 환경 부하를 해당 전과정단계에서 소요되는 시간으로 나누는 것이다. 전과정평가에서 시간 고려를 명확히 함으로써 제품 시스템의 환경 영향에 대한 새로운 관점을 제공할 수 있을 뿐만 아니라 정규화 단계의 시간 단위 불일치를 보완할 수 있다. 시간-부하 LCA의 기본 전제는 같은 양의 환경 부하라 하더라도 짧은 시간 동안 발생하는 환경부하가 긴 시간 동안 발생하는 환경 영향보다 더 튼 환경 영향을 미칠 수 있다는 것이다. 그러므로 목록 파라미터가 환경에 미치는 영향을 평가할 때 시간 당 부하를 고려할 필요가 있다. Life Cycle Assessment(LCA) is a tool that quantifies the inputs and outputs, and evaluates the potential environmental impacts during the entire life cycle of a product, material and/or service. Inputs and outputs encompass the consumption of natural resources and emission of pollutants to the environment. One of the deficiencies of the conventional LCA methodology is that it does not consider time explicitly. In addition, there are problems associated with the temporal boundary in the normalization step of LCA. The objective of this study is to propose a new life cycle assessment method that considers time in LCA as called ``Time Load LCA``. Basically Time Load LCA is a method that divides environmental load in each life cycle stage by time duration in each life cycle stage. Time consideration in the proposed method indicated that the new LCA method not only renders new perspective on the environmental impacts of a product system but also rectifies inconsistency in temporal dimension of the normalization step. Basic premise of the time load LCA method is that same amount of load over a shorter time period would affect more seriously on the environment than over a longer time period. therefore, load per time is necessary for the assessment of an impact of the inventory parameters on the environment.

시간-부하(Time-Load) LCA에서 시간 산출을 위한 방법론

H. Phungrassami,박정건(Jeoung Gun Park),천윤영(Youn Young Chun),이건모(Kun Mo Lee) 大韓環境工學會 2007 대한환경공학회지 Vol.29 No.4

Comparison of Treatment Compliance and Nutritional Outcomes among Patients with Nasopharyngeal Carcinoma with and without Percutaneous Endoscopic Gastrostomy during Chemoradiation

Peerawong, Thanarpan,Phungrassami, Temsak,Pruegsanusak, Kovit,Sangthong, Rassamee Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.11

Aims: The study aimed to compare treatment compliance and nutritional outcomes in nasopharyngeal carcinoma (NPC) patients during chemoradiation. Methods: Clinical information of patients with NPC that underwent chemoradiation during 2004-2009 were retrieved from the hospital database and retrospectively reviewed. Patients were categorised into a prophylactic percutaneous endoscopic gastrostomy (PPEG) group and a non-PPEG group. Clinical information including treatment compliance, weight, haematological and renal toxicity was compared. Results: A total of 219 patients were reviewed and categorised into PPEG (n=77) and non-PPEG (n=142). Significant differences in absolute percentage weight loss between groups were found from the $3^{rd}$ cycle of chemotherapy. There were 24.2, 20.3 and 24.8% in the third, the fourth and the fifth cycles of chemotherapy, respectively. Migration of grade 2 to grade 3 weight loss was obviously seen in the $3^{rd}$ cycle as well. A significant difference of grade 3 or more hypokalemia was found with values of 14.3% and 50% in the PPEG and non-PPEG groups, respectively. Other toxicity parameters and treatment compliance were not different between the groups. Conclusions: Use of PPEG resulted in decreased severe weight loss, reduced migration from grade 2 to grade 3 weight loss and reduced hypokalaemia. However, benefits in treatment compliance could not be detected. So consideration of PPEG in NPC patients requires care.

Survival and Prognostic Factors of Different Sites of Head and Neck Cancer: An Analysis from Thailand

Pruegsanusak, Kowit,Peeravut, Sumet,Leelamanit, Vitoon,Sinkijcharoenchai, Wattana,Jongsatitpaiboon, Jaturong,Phungrassami, Temsak,Chuchart, Kanyarat,Thongsuksai, Paramee Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.3

Background: Head and neck cancers are prevalent in Thailand, in particular in the southern region of the country. However, survival with a large data set has not been reported. The purpose of the present study was to evaluate the survival figures and the prognostic factors in a cohort of patients treated in a university hospital located in the south of Thailand. Patients and Methods: Consecutive new cases of primary carcinoma of the oral cavity, oropharyx, hypopharynx and larynx, treated at Songklanagarind Hospital during 2002 to 2004, were analyzed. The 5-year overall survival rates were obtained by the Kaplan-Meier method. Prognostic factors were identified through multivariate Cox regression analysis. Results: A total 1,186 cases were analyzed. Two-thirds (66.6%) of the cases were at advanced stage (stage III & IV) at presentation. The five-year overall survivals for the whole cohort, oral cavity, oropharynx, hypopharynx and larynx were 24.1%, 25.91%, 19.2%, 13.4%, 38.0% respectively. Stage and treatment type were strong prognostic factors for all sites. An age ${\geq}$ 80 years was associated with poor survival in oral cavity and larynx cancer. Conclusions: The results revealed remarkably poor outcomes of the patients in the series, indicating a strong need to increase the proportion of early stage presentations and maximize the treatment efficacy to improving outcomes. Very old patients are of particular concern for treatment care of oral cavity and larynx cancer.