Background: To respond to the pandemic, many societies, including the American Society for Radiation Therapy (ASTRO), the United Kingdom’s National Institute for Health and Care Excellence (NICE), and the Philippine Radiation Oncology Society (PROS), recommended guidelines to allow for continued safe delivery of oncologic services. Yet, the delivery of radiotherapy during the COVID-19 pandemic remains a challenge. Objective: To describe the situation of radiotherapy delivery in Metro Manila (NCR) during the COVID-19-related quarantine. Specifically, the objectives were to determine: (1) how the radiotherapy providers implemented the recommended changes, (2) if these implemented changes allowed the hospitals to operate with pre-COVID capacities, and (3) the causative factors of treatment interruptions if these were present. Additionally, in the face of treatment interruptions, the authors sought to put forth recommendations to decrease treatment interruptions. Methods: Investigators gathered data on the prevailing situation of RT services in their respective institutions during the strictest period of quarantine — Enhanced Community Quarantine (ECQ). Patients aged 18-70 years old who missed at least one fraction during the ECQ from March 16 – April 15, 2020, were invited to participate in a phone survey to determine factors contributing to treatment interruptions. Results: All the institutions implemented global recommendations to adapt to the pandemic, including infection control measures, telemedicine, and modification of RT plans. Despite this, most institutions had increased treatment interruptions during ECQ. The percentage of patients with interruptions was also much higher during the ECQ (66.37%) than during the pre-COVID month (30.56%). Among 142 patients unable to continue treatment, there were no significant differences in demographic variable and oncologic profile rates. The majority were more worried about getting COVID-19 than missing RT. The most common factor for treatment interruptions was transportation, followed by fear of getting COVID-19. Conclusion Compliance with global recommendations is not enough to ensure that the patients who require radiotherapy will receive it. Based on institutional and patient results, the causative factors of interruptions included suspension of services, lack of transportation, and anxiety of patients and staff. Especially in low-resource settings, recommendations are to use available resources as efficiently as possible by having an organized referral system, providing transportation or nearby accommodation for patients and staff, and communicating effectively to reassure patients that radiotherapy can be continued safely.
radiotherapy ; radiation therapy ; radiation oncology

Biomedical Research ; Humans ; Mouth ; radiation effects ; Radiation Injuries ; therapy

Radiation proctitis denotes the radiation damage of rectum caused by radiotherapy to pelvic malignancy. The clinical practices of radiation proctitis should be fully considered from diagnosis, treatment and prevention. In order to determine appropriate treatment strategies, the diagnosis of radiation proctitis should be based on clinical symptoms, endoscopic findings, imaging and histopathology to assess severity of symptoms and stage of disease. In terms of treatment decisions, non-surgical interventions are generally applied to relieve major symptoms and avoid serious complications. Diverting colostomy and restorative resection are the main surgical treatments for patients with recurrent symptoms. In terms of prevention, radiation proctitis should be prevented by improvement of radiotherapy technology, physical protection and prophylactic medication. This guide aims to provide guidance for the clinical practices of radiation proctitis in China.
China ; Consensus ; Humans ; Proctitis ; diagnosis ; therapy ; Radiation Injuries ; diagnosis ; prevention & control ; therapy ; Rectum ; pathology ; radiation effects

INTRODUCTIONRadiation-induced optic neuropathy (RON) is an infrequent but devastating consequence of radiation exposure to the visual pathways, usually following months to years after the treatment of paranasal or intracranial tumours. Hyperbaric oxygen (HBO) therapy is one of several therapies that have been tried for this condition. The purpose of this review is to describe the clinical characteristics of RON, the rationale for the use of HBO in this condition, and the available clinical data on its safety and efficacy.

METHODSMEDLINE searches were performed on radiation optic neuropathy, hyperbaric oxygen therapy, and similar terms, and selected references were reviewed. The results were combined with the experience at our own institution.

RESULTSRON typically follows a fulminant course with characteristic symptoms, examination findings, and imaging. The threshold for prior radiation exposure depends upon the delivery system used and patient characteristics. Therapy with anticoagulants or steroids has been unsuccessful. While there are case reports in the literature of successful treatment with HBO, therapy with HBO has to be initiated soon after the onset of vision loss, and even then yields variable results at best.

CONCLUSIONSThere is still no consistently successful treatment for RON. HBO may be attempted in selected cases, but the prognosis for preservation of vision remains grim.

OBJECTIVES

The aim of the study is to estimate the cost of breast cancer diagnosis, treatment, and management in the Philippines. Specifically, it aims to identify the resource requirements and interventions related to breast cancer diagnosis, treatment, and management, measure resource volumes (number of units), learn to value resource items (unit costs), and determine the total cost of treatment per disease stage.

The study covered nine tertiary hospitals, seven of which were government hospitals and two were private hospitals, with all tertiary hospitals providing breast cancer services and accredited by Philippine Health Insurance Corporation (PHIC or PhilHealth) for the Z-Benefit Package. Interventions and services related to breast cancer included radiographic procedures, laboratory and imaging tests, chemotherapy drugs and medications, medical and surgical supplies, surgical rates (for breast surgery), accommodation, staff time and salary/professional fees, and other procedure fees. The study conducted in 2022, examined cost prices of breast cancer interventions and services from stage 1–3B.

Purposive and convenience sampling were used based on PhilHealth accreditation and willingness of hospitals to participate in the study. The study conducted a focus group discussion with oncologists, radiologists, anesthesiologists, and other health care providers to validate the clinical guideline used and to solicit inputs to the costing design, analysis framework, and tools for data collection. Data collection of financial cost information (charge price) was conducted using a set of costing matrices filled out by the various departments of the hospitals. Costs and median rates were calculated across hospitals on diagnostics and imaging tests, surgery costs of both public and private facilities, medical treatment, and radiotherapy.

Breast MRI, Breast Panel, and Chest CT Scan are the top 3 most expensive diagnostic procedures ranging from PhP 8,102.00 to PhP 9,800.00 per procedure. Surgical procedures for breast cancer at private hospitals and public hospitals showed huge differences in costs. The cost of a cycle of chemotherapy ranges from PhP 596.70 to PhP 3,700.00 per session, while the cost of targeted therapy can cost up to PhP 46,394.21 per session. A year of hormone therapy ranges from PhP 3,276.00 with the use of Tamoxifen, and up to PhP 68,284.00 with Goserelin. Aromatase inhibitors such as Anastrozole and Letrozole cost from PhP 18,000 to PhP 36,000, respectively. Multiple cycles depending on the diagnosis are prescribed per patient and used in combination with other chemotherapy medications or other therapies such as targeted therapy and hormone therapy are usually taken daily up to 5 to 10 years. Conventional radiotherapy can cost up to PhP 88,150.00 covering 28 sessions, CT simulation, and CT planning.

This cost study provides relevant information and better perspective on benefit development for the PHIC, policy development for Department of Health on where and how to focus their support for the patient’s financial preparedness to address medical and f inancial catastrophes.

PhilHealth needs to guide the health care providers of their costing method and to develop their own integrated, interoperable, and comprehensive cost data library.

It recommends that the government allocate budget and cover for screening and assessment for earlier stage diagnosis of patients and lower health expenditure costs on cancer treatment.

Humans ; Radiation Injuries ; drug therapy ; prevention & control ; Radiation, Nonionizing ; Radiation-Protective Agents ; therapeutic use ; Radioactive Hazard Release ; prevention & control

Observations from clinical trials have frequently demonstrated that light therapy can be an effective therapy for seasonal and non-seasonal major depression. Despite the fact that light therapy is known to have several advantages over antidepressant drugs like a low cost, minimal side-effects, and fast onset of therapeutic effect, the mechanism underlying light therapy remains unclear. So far, it is known that light therapy modulates mood states and cognitive functions, involving circadian and non-circadian pathways from retinas into brain. In this review, we discuss the therapeutic effect of light on major depression and its relationship to direct retinal projections in the brain. We finally emphasize the function of the retino-raphe projection in modulating serotonin activity, which probably underlies the antidepressant effect of light therapy for depression.
Animals ; Brain ; radiation effects ; Depressive Disorder, Major ; therapy ; Humans ; Phototherapy ; methods ; Retina ; radiation effects ; Visual Pathways ; radiation effects

It is a difficult problem in high intensity focused ultrasound (HIFU) therapeutic dosimetry that how to use a BFR to ablate a mass in tissue and to determine the energy-efficiency relation, that is, the scale of biological effects of HIFU. A mass lesion was realized in this study according to a treatment principle of damaging tissue from BFRs to fascicle lesions, slice lesions and a mass lesion. A 1.6 MHz transducer, 150 mm in diameter and with a focal length of 120 mm, was used. The focal intensities (I(SATA)) were 0-27 000 W/cm2 and the scanning speeds were 1-4 mm/s. The distance between every fascicle lesion was 5-10 mm and the distance between two slice lesions was 10-20 mm. Different irradiation depths of fascicle slice and mass lesion were observed after HIFU procedures in this study. The dosage of HIFU required for tissue coagulated necrosis was evaluated with energy of HIFU (J) per cubic millimeter (mm3), i.e., J/mm3 which was defined as energy-efficiency factor (EEF). Results showed that EEF needed for producing fascicle lesions increased with the increase of irradiation depth. EEF required for inducing various lesions in biological tissue was different. Generally, it followed the law: EEF(mase)< EEF(slice) Animals ; Cattle ; In Vitro Techniques ; Liver ; pathology ; radiation effects ; Radiation Dosage ; Time Factors ; Ultrasonic Therapy ; methods

This study was aimed at exploring the high intensity focused ultrasound(HIFU) therapeutic dosimetry and its biologic effect. In-vitro, bovine liver was immersed into 0.9% NS and degassed for application. The JC Model-focused ultrasound tumor therapeutic system was used in the experiment. The HIFU parameters were: frequency 1.6 MHz, depth 20 mm, acoustic power from 16.44 W to 196.32 W. Under each power, at radiating times from is to 20 s, bioptic specimens were obtained from all samples. The results showed when the acoustic power was equal to or higher than 179.96 W, only is of radiating is adequate to induce coagulative necrosis, and when the acoustic power was lower than 65.44 W, the radiating time to produce coagulative necrosis was about 7 s. In the range of 65.44-179.96 W, at each time when the acoustic power was set up with an increment of 16.36 W, the time to produce coagulative necrosis was 1-2 s shorter. The form of biological focal region (BFR) varied with the acoustic power and HIFU irradiation time. The size of BFR increased with the increase of HIFU irradiation dosage (acoustic power x exposure time). There is positive correlation between the size of BFR and the dosage of HIFU irradiation (y = 0.0164x(1.05591), R5 = 0.9238, P < 0.05).
Animals ; Cattle ; In Vitro Techniques ; Liver ; pathology ; radiation effects ; Radiation Dosage ; Ultrasonic Therapy ; instrumentation ; Ultrasonics

Combined radiation-burn injuries mainly occur under the circumstances of nuclear explosion, nuclear accident, nuclear terrorism, depleted uranium attack, as well as secondary injuries following attack on nuclear installation. Combination of burn and radiation injuries bring along more serious whole body damage, more complicated pathological mechanism and much more difficult management. Research progress on the pathological mechanism and medical management of several key links of combined injury were discussed in this paper. (1) Enhancement of early first aid and prevention of early death of wounded. (2) Damage and restoration of hemopoietic function. (3) Disturbance of immune function and prevention and treatment of infection (mainly on the intestinal mucosa immunity and enterological infection). (4) Management of burn wound. (5) The role of several important measures in the comprehensive treatment.
Animals ; Burns ; therapy ; Combined Modality Therapy ; Dogs ; Humans ; Multiple Trauma ; therapy ; Radiation Injuries ; therapy ; Rats