OBJECTIVE

To report a case of lacrimal gland adenoid cystic carcinoma in a 37-year-old female managed with globe-sparing surgery and adjuvant radiotherapy.

This is a case report.

This report details a 37-year-old Filipino female who presented with a 4-month history of right eye pain and non-axial proptosis. Computed tomography (CT) scan showed a right heterogenous extraconal mass with orbital roof remodeling. Lateral orbitotomy with excision biopsy was performed. Final histopathologic diagnosis of adenoid cystic carcinoma of the lacrimal gland was made based on the classic morphology and distinct arrangement of the neoplastic cells. Systemic surveillance revealed absence of metastases. Patient completed adjuvant radiotherapy four months post-operatively. Vision was preserved at 20/20 without signs of tumor recurrence five months post-operatively.

Adenoid cystic carcinoma is an aggressive lacrimal gland malignancy; hence, meticulous examination and high index of suspicion cannot be over-emphasized. Globe-sparing surgery with adjuvant radiotherapy could significantly preserve quality of life.

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.

PURPOSE

To report the technical details and outcomes of a case of cervical cancer in pregnancy treated with reduced standard radiation volume via Intensity Modulated Radiation Therapy (IMRT).

A 33-year-old G4P3 (3003) was diagnosed with cervical squamous cell carcinoma at 17 weeks of gestation. She had a 5-year history of intermittent post-coital bleeding and an incidental finding of a cervical mass during prenatal ultrasound. Internal examination revealed a 6-cm mass with no extension to the upper vagina and pliable bilateral parametria, leading to a staging of IB3. A multidisciplinary meeting with a gynecologic oncologist, radiation oncologist, medical ethicist and the patient was held wherein different treatment options were discussed. She consented to definitive external beam radiation therapy (EBRT) with concurrent cisplatin and was administered during 19-25 weeks of gestation using IMRT. A prescribed dose of 45 Gy in 25 fractions was delivered to the entire cervix with a 1-cm geometric expansion covering the lower uterus, and upper vagina as well as the pelvic lymph nodes, followed by four fractions of brachytherapy.

The patient tolerated treatment with only grade 1 gastrointestinal and genitourinary adverse effects. After completion of concurrent chemoradiation, she underwent induction of labor and delivered a nonviable fetus. Three months post-treatment, MRI found no evidence of disease. At 15 months follow-up, she remains asymptomatic with no palpable disease.

This report demonstrates that treating only the involved uterus may be considered in cases wherein giving the full radiation dose to the whole uterus may lead to significant toxicities and eventual treatment interruption.

Cervical cancer during pregnancy poses a rare and complex clinical and ethical challenge, particularly in low- and middle-income countries such as the Philippines. The dual obligation to preserve maternal life while protecting fetal viability requires a nuanced balance between medical science, ethics, and cultural values.This commentary explores the ethical implications of treating cervical cancer in pregnancy using Intensity Modulated Radiation Therapy (IMRT) at reduced standard radiation volumes, highlighting how medical innovation intersects with the principles of biomedical ethics.

OBJECTIVE

This is a case report of a 60-year-old woman with a juxtapapillary choroidal melanoma who underwent globe-sparing treatment using linear-accelerator (LINAC)-based hypofractionated stereotactic radiotherapy (FSRT).

Clinical data, ophthalmologic findings, and imaging results were obtained through retrospective chart review.

At three months and nine months post-treatment, tumor thickness decreased by 20.5% (from 13.00 mm to 10.34 mm) and 33.2% (to 8.69 mm), respectively. Partial resolution of subretinal fluid and vitreous hemorrhage was confirmed clinically and by B-scan. No metastatic spread was detected on liver ultrasound and chest radiography. Best-corrected visual acuity in the treated eye remained stable at hand motion. Radiation-induced dry eye was managed effectively with preservative-free sodium hyaluronate eye drops.

LINAC-based hypofractionated FSRT achieved marked local control and tumor regression in this case of a medium-large, juxtapapillary choroidal melanoma, while preserving the globe and the baseline vision. In regions without access to plaque brachytherapy, this technique offers a practical, cost-efficient, and multidisciplinary approach to eye-conserving therapy.

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.

High-Grade B-Cell Lymphoma (HGBCL) with gene rearrangements in MYC and BCL2 and/or BCL6 is an aggressive malignancy usually presenting in advanced stages. Current recommendations suggest the use of regimens more intensive than R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone), which are based on retrospective studies and single-arm prospective trials that included patients who are mostly in the advanced stage, and did not receive consolidation radiotherapy.

The optimal approach and treatment of HGBCL, whether limited-stage (LS) or advanced-stage, remains to be determined. Here we describe the promising outcomes of three patients with LS and low IPI HGBCL with the use of R-CHOP as induction chemotherapy regimen, which was followed by consolidation radiotherapy.

Three women, 54-, 60-, and 64-years of age diagnosed to have HGBCL with MYC, and BCL2 and/or BCL6 rearrangements, with Ann Arbor stages I-IIE were included in this case series. All three patients had complete metabolic response to 6 cycles of R-CHOP and was subsequently treated with consolidation involved site radiotherapy (ISRT; total dose 30-36 Gy). Chemotherapy and radiotherapy were tolerated very well. All patients remain to be in remission, with the longest being at 23 months.

Outcomes of patients with HGBCL generally remain to be poor, but this may not be the case for patients with limited-stage disease and favorable clinicopathologic risk profile. Nevertheless, the treatment of HGBCL is currently evolving and more studies are needed to determine the ideal approach and preferred chemotherapy regimen. Also, more studies are needed to elucidate the potential role of consolidation radiotherapy in patients with limited-stage HGBCL to improve survival outcomes. Findings of this case series suggest that patients with LS HGBCL may still derive benefit from R-CHOP followed by consolidation ISRT, but prospective trials are needed to confirm this.

Tianhe procedure^® is a functional sphincter-preserving surgical approach developed for rectal cancer patients following radiotherapy. This technique involves extended proximal resection of the colon beyond the pelvic cavity, followed by anastomosis of the non-irradiated proximal colon to the distal rectum or anal canal. This strategy aims to reduce the incidence of anastomotic complications and postoperative bowel dysfunction. However, there is currently a lack of standardized practice guideline for implementing Tianhe procedure^® in China. Therefore, the Chinese Radiation Intestinal Injury Research Group, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, the Anorectal Branch of Chinese Medical Doctor Association, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, and the Colorectal Cancer Committee of China Anti-cancer Association, and the Gastrointestinal Surgical Branch of Guangdong Medical Doctor Association, have jointly convened a panel of national experts to discuss and establish this standardized surgical procedure. This standard, based on the latest evidence from literature, research advancements, and expert experience, focuses on key aspects of the Tianhe procedure^®, including its precise definition, indications, critical procedural steps, postoperative complications, and functional rehabilitation strategies. It aims to promote standardized implementation and broader clinical adoption of this innovative surgical technique.
Humans ; Rectal Neoplasms/radiotherapy* ; Anal Canal/surgery* ; Anastomosis, Surgical/methods* ; Organ Sparing Treatments/methods* ; Rectum/surgery* ; Postoperative Complications/prevention & control* ; Digestive System Surgical Procedures/methods*

OBJECTIVE: To lay a foundation for formulating clinical evaluation and regulatory policies regarding radiotherapy equipment in China. METHODS: Comprehensive retrieval and comparison of the regulatory requirements for radiotherapy equipment from regulatory agencies in the United States, the European Union, and China are conducted, and their similarities and differences are analyzed. RESULTS: For mature radiotherapy systems in the European and American regions, the comparison of performance parameters serves as an important basis for determining whether a product can be marketed. Both the European Union and China regard the clinical evaluation report as a crucial part of the medical device review and submission process. CONCLUSION Identifying clear state of the art standards, performance parameters, and clinical indicator parameters, and establishing relevant technical guidelines are important directions for promoting the standardized development of radiotherapy equipment supervision.
Radiotherapy/standards* ; United States ; China ; European Union

At present, the C-arm structure accelerators commonly used in radiotherapy equipment are complex in operation and have potential safety hazards when realizing non-coplanar treatment. By combining with medical robotic arm technology, a spherical radiotherapy accelerator motion system is designed. The beam module is clamped by the medical robotic arm structure to achieve three-dimensional multi-angle irradiation treatment within the non-coplanar angle range. Firstly, the rotating mechanism, beam module, and MLC module of the spherical radiotherapy equipment are designed. Then, the double-plane counterweight method is used to calculate the dynamic balance of the equipment, ensuring that the beam center point does not rotate during the treatment process. Finally, the strength check and reliability analysis of the transmission component gear are conducted. The results show that the designed spherical radiotherapy accelerator motion system can meet the requirements of stable, accurate, and fast precision radiotherapy, which is conducive to improving the treatment efficiency.
Particle Accelerators/instrumentation* ; Equipment Design ; Reproducibility of Results ; Radiotherapy/instrumentation*