Warren Bacorro

Background/Objectives: Squamous cell carcinoma of the nasal vestibule (SCCNV) represents a rare malignancy traditionally managed by radical surgical resection, frequently at the cost of substantial functional impairment and disfiguring aesthetic consequences. This study investigates an organ-preserving therapeutic strategy integrating high-dose-rate interventional radiotherapy (HDR-IRT; brachytherapy) with organ-preserving surgery. Material and Methods: A retrospective analysis of patients with primary SCCNV treated using HDR-IRT between 2008 and 2022, excluding recurrent disease and cutaneous squamous cell carcinomas. Interstitial HDR-IRT catheters were implanted intraoperatively, with radiation delivered twice daily to a target volume encompassing the tumor and a 10–15 mm safety margin. Results: Fifty-one patients were included, with a median age of 71 years. The median total dose was 40 Gy. Gross total resection was performed in 7 patients, and subtotal resection in 44. The median follow-up was 35 months. The 5-year nose preservation rate was 90%, with local control at 84%, regional failure-free survival at 94%, and overall survival at 82%. In total, 49 acute toxicity events were documented, including two grade 3 events, while 35 chronic toxicity events were reported, including one grade 3 event. At 3 years, 84.3% of cosmetic outcomes were rated as satisfactory, 9.8% as acceptable, and 5.9% as unsatisfactory. Conclusions: The OSIRIS approach, combining HDR-IRT with organ-preserving surgery, is an effective treatment for SCCNV, offering high organ preservation and favorable long-term disease control, with manageable toxicity and positive cosmetic outcomes.

Background: In cervical cancer, adding chemotherapy to radiotherapy improves survival but increases toxicity. In patients with contraindications, cisplatin or its substitute may decrease radiotherapy compliance due to toxicity. We evaluated the effectiveness and utility of a previously validated patient decision aid (PtDA) for chemotherapy or its exclusion in patients the cisplatin-intolerant patients with locally advanced cervical cancer. Methods: A block-randomized controlled trial was conducted to evaluate the effectiveness of the PtDA (intervention) in reducing decisional conflict (primary outcome) as measured by the Decisional Conflict Scale (DCS) and its utility (secondary outcome) as measured by the Preparation for Decision Making Scale (PDMS), when added to standard counseling (control); providers of standard counseling were blinded. Age, education, socioeconomic status, and decision self-efficacy as measured by the Decision Self-Efficacy Scale (DSES), were studied as determinants of effectiveness and utility. Minimum sample sizes of 16 and 24 for the control and experimental groups were required, accepting a two-sided alpha error of 0.10 and a power of 0.90. Results: From February 2023 to August 2024, 8 and 10 participants were recruited into the control and experimental groups. Interim analysis showed a futility index of 0.99, pertaining to the primary study objective (difference in proportions with low post-intervention DCS); hence early study closure. However, mean post-intervention DCS was lower in the experimental than in the control group (11.6 versus 19.3, P=0.07); 80% of the PtDA users reported a PDMS of ≥3.5, indicating utility in preparation for decision-making. Among the studied variables, only decision self-efficacy was a strong determinant for post-intervention DCS (r=−0.879, P2=0.392, P2=0.146, P=0.02) were independent determinants of post-intervention DCS. Conclusions: The CECIL reduces mean decisional conflict scores by 8 points on the DCS scale and is utile in preparation for decision-making. Decision self-efficacy is a strong determinant for post-intervention decisional conflict and PtDA utility. These findings are based on a defined clinical setting and a small sample and must be validated in other clinical settings and bigger studies. A multidisciplinary approach and shared decision-making culture must be in place when integrating the decision aid in the workflow. The DSES tool may identify patients who may require other decision support intervention such as active coaching. Trial Registration: ClinicalTrials.gov Identifier: NCT05701735.

Shared decision‐making is ethically imperative, and is a key component in cost‐effective, efficient and equitable cancer care. We review the recent advances in resources, training, tool development, and health policy, supporting the implementation of shared decision‐making, and how the Philippines is primed for it.

Purpose: Wilms tumor (WT) management has evolved into a multimodality paradigm that includes radiotherapy (RT), usually as an adjuvant or consolidative modality. Protocols are refined to maximize cure and compliance while minimizing acute toxicity and long-term effects. RT technique and timing are two factors that could improve these outcomes. We reviewed the evidence on survival and toxicity outcomes among WT patients with conventional versus advanced RT techniques and early versus delayed RT to inform a Department of Health (DOH) commissioned guideline. Materials and Methods: We systematically searched PubMed, EuropePMC, EBSCOHost, HERDIN, systematic review and clinical trial registries and official websites of scientific societies for relevant publications and grey literature. Eligibility screening, risk-of-bias assessment and data extraction were performed using a single-reviewer approach. Given the study and data heterogeneity, only a qualitative synthesis was performed. Certainty of evidence assessment was done using the GRADE approach. Results: We screened 314 studies and included seven in the review, including a phase 1/2 trial and six retrospective studies, all from first-world countries (US, France, Netherlands), except one from a newly industrialized country (Brazil). The certainty of evidence on the survival and toxicity outcomes with advanced RT techniques was very low. Moderate-certainty evidence supports that giving RT >14 days after surgery leads to increased mortality. Conclusion: Current evidence does not support the routine use of advanced RT techniques; proper contextualization is necessary. Tertiary centers managing WT should strive to administer RT within 14 days after surgery whenever possible. Keywords: Wilms tumor, nephroblastoma, radiotherapy, intensity-modulated radiotherapy, survival, toxicity

Objectives: The expanded prostate index composite (EPIC) is a widely used and well-validated quality of life (QOL) tool for prostate cancer patients. We developed a filipino version (EPIC-F) and tested its psychometric properties. Material and Methods: The EPIC-F and validated filipino versions of the international prostate symptoms score (IPSS), international index of erectile function-5 (IIEF-5), and european organisation for research and treatment of cancer (EORTC) prostate cancer module (PR-25) were administered to patients with nonmetastatic prostate cancer at baseline, 10–14 days later and after ≥15 radiotherapy (RT) sessions. Cronbach’s α, pearson correlation, and linear regression were used for reliability, validity, and sensitivity analyses. Alpha was set at p < 0.05. Results: The validation cohort comprised 52 patients aged 54–86 years (70.10 ± 6.9), with stage I (21%), II (27%), III (33%), or IVA (19%) disease. At enrolment, 38% had prior surgery; 19% had prior RT and 81% were to undergo RT; and 31% were on hormonotherapy. Internal consistency was good to very good for all domains (Cronbach’s α, 0.783–0.866). Test-retest reliability was moderate for all domains (Pearson’s r, 0.509–0.688), except for the hormonal domain (low r, 0.369). Interscale correlation was moderate to high between each domain and its corresponding reference scale (r, 0.551–0.834), except between the bowel domain and the PR-25 bowel (low r, 0.457). Sensitivity testing showed a strong r² (0.311) for the bowel domain, but weak for the rest. Conclusion: The EPIC-F is a reliable, valid, and sensitive tool for assessing the QOL of filipino prostate cancer patients.

Background. Peri-operative interventional radiotherapy (POIRT) entails tumor resection, catheter implantation in the same surgery, and irradiation within the peri-operative period. It allows for maximal tumor burden reduction, better tumor bed identification, more flexible implant geometry, highly conformal irradiation, and treatment delay minimization. We reviewed the published local control, survival, toxicity, and quality of life (QOL) outcomes with POIRT for head and neck cancers (HNCs) in primary and re-irradiation settings. Materials and Methods. A systematic search of PubMed, Scopus, Science Direct, and other databases, supplemented by bibliography scanning and hand-searching, yielded 107 titles. Fifteen unique articles were eligible, five of which were merged with more updated studies. Of the ten remaining studies, four reported on primary POIRT, and seven reported on reirradiation POIRT. Given data heterogeneity, only qualitative synthesis was performed. Results. Primary POIRT in early tongue cancer results in 6-year recurrence-free (RFS) and overall survival (OS) of 92% for both; in advanced HNCs, the 9-year RFS and OS rates are 52% and 55%. Grade 1–2 toxicity is very common; grade 3–4 toxicity is rare, but grade 5 toxicity has been reported. POIRT re-irradiation for recurrent HNCs results in 5y RFS and OS rates of 37–55% and 17–50%; better outcomes are achieved with gross total resection (GTR). QOL data are lacking. Conclusions. Primary POIRT is safe and effective in early tongue cancers; its use in other HNC sites, especially in advanced disease, requires careful consideration. Re-irradiation POIRT is most effective and safe when combined with GTR; toxicity is significant and may be limited by careful case selection, implant planning and execution, use of smaller fraction sizes, and adherence to homogeneity constraints. Study Registration Number. PROSPERO Registry Number CRD42024548294.

PURPOSE: Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. METHODS: We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. RESULTS: Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. CONCLUSION: Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.