Final Pcioc 2019 E-Book

New Frontiers in Cancer Combat
August 8-9, 2019

Centara Grand & Bangkok Convention Centre at CentralWorld
Bangkok, Thailand
PROGRAM & ABSTRACT BOOK 1

“With commitment to carrying on His Majesty King Bhumibol Adulyadej’s dedication to
improving the well-being of his subjects, I have founded Chulabhorn Royal Academy as one
of the leading learning and research centers in the fields of medicine, science, public health
and environment management. Therefore, the graduates and the trained personnel from
this non-profit institute will be equipped with not only knowledge but also a code of ethics.
With the aim of providing medical services to the society, their selfless devotion will be widely
recognized. In addition, Chulabhorn Royal Academy provides internationally standardized
medical services for all, in particular, the poor and the underprivileged, in honor of His Majesty
King Bhumibol Adulyadej’s dedication.”
Her Royal Highness Princess Chulabhorn Krom Phra Srisavangavadhana

Chancellor of Chulabhorn Royal Academy
Content
Page
Welcome Messages 4
Board of Directors 10
Scientific Program 12
- Program at a Glance 13
- Pre-Congress Sessions 14
- Main Scientific Program 20
Speakers 22
Speakers’ Synopses 27
- Synopses of Day-1 Presentations 28
- Synopses of Day-2 Presentations 52
Abstracts 84
- Oral Presentations 85
- Poster Presentations 93
Committees 126
Index 139
3
Welcome Messages
4
Welcome Message
With the royal grace of Her Royal Highness Princess Chulabhorn Krom Phra Srisavangavadhana,
the quality of life of thousands of cancer patients has been improving. Not only because
of the progress in advanced patient care, but also because of the progress in research on
the basic science and clinical research in the field of oncology.
Cancer has been one of the two most common causes of death among Thai people for decade.
The diagnosis of new case of cancer is 2 in every 1,000 population per year, whereas the
mortality is 1 in every 1,000 population. These figures have been uprising. Parallelly, the
knowledge and health technologies in cancer patient care have been rapidly developed.
Princess Chulabhorn International Oncology Conference 2019 (PCIOC 2019) with the theme
of “New Frontiers in Cancer Combat” will be a platform for knowledge and experience
sharing between clinicians, researchers, experts in the area of oncology from the three top
rank medical schools in the country (i.e. Faculty of Medicine, Chulalongkorn University;
Faculty of Medicine Ramathibodi Hospital; and Faculty of Medicine Siriraj Hospital, Mahidol
University) and HRH Princess Chulabhorn College of Medical Science. Lectures, symposia,
panel discussions, and other academic programs will provide participants up-to-date know-
ledge, opinions, and different views on several aspects of oncology, including the basic
science (biology of tumor cells – e.g. genetic and poly-omic information), clinical features,
new diagnostic procedures, advance in patient care (e.g. precision medicine), and the future
trends.
With the joint commitment of the four institutions to provide better quality of life to cancer
patients, the scientific program of PCIOC 2019, likewise the speakers and panelists, are
deliberately designed and invited. I do belief the PCIOC 2019 will be a very successful conference,
and subsequently improve the cancer patient care.
Professor Prasit Watanapa

Dean and Professor of Surgery
Faculty of Medicine Siriraj Hospital, Mahidol University
5
PCIOC 2019
Welcome Message
To the great honor of Her Royal Highness Princess Chulabhorn Krom Prasrisavangavadhana,
the four distinguish institutions of Faculty of Medicine; namely the Faculty of Medicine
Siriraj Hospital, Mahidol University, Faculty of Medicine, Chulalongkorn University,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, and Faculty of Medicine and
Public Health, Chulabhorn Royal Academy have jointly organized the Princess Chulabhorn
International Oncology Conference 2019.
This book was also jointly written by four distinguish institutions with the objective to
disseminate medical knowledge, innovative diagnostic tests as well as novel treatments,
particularly oncology. On behalf of the executive committee, we are extremely grateful for
the valuable time and dedication the editors and authors have graciously given, in writing
up these wonderful synopses. They are well summarized topics on most updated medical
knowledge of oncology.
We believe that this information can help guide the physicians and will be applicable in
clinical practice; therefore, achieving the goal of the conference and synopses of providing
useful oncology information to the physicians and professional health care personnel.
Professor Suttipong Wacharasindhu

Dean, Faculty of Medicine
Chulalongkorn University
6
Welcome Message
It is my pleasure to welcome all of you to the Princess Chulabhorn International Oncology

Conference 2019. This event marks a key milestone in Thailand’s oncological society as four
leading academies - the Faculty of Medicine Ramathibodi Hospital, Mahidol University,
Faculty of Medicine Siriraj Hospital, Mahidol University, Chulabhorn Royal Academy, and
Faculty of Medicine, Chulalongkorn University - join hand in hand to push boundaries and
open the “New Frontiers in Cancer Combat”. At the conference, international and domestic
delegates will have opportunities to explore multidisciplinary and holistic approaches to
manage cancer; such as surgery, medication, radiation, nursing, home chemotherapy,
nutrition, pain management, alternative medicine, and so forth. The highlights include the
Opening Ceremony by Her Royal Highness Princess Chulabhorn, the Plenary Session by the
2008 Nobel Laureate in Physiology or Medicine - Professor Emeritus Harald zur Hausen with
his specialization on oncovirus and cervical cancer, and sessions on many other challenging
topics in cancer management, such as genome personalized medicine, artificial intelligence
(AI), and the use of cannabis in treating cancer.
As dean of the Faculty of Medicine Ramathibodi Hospital, I do hope that this prestigious
conference will serve as an academic arena for the medical communities which include
students, medical personnel, public health experts, scholars, and other stakeholders from
various institutions to partake in in-depth discussions, sharing knowledge and experiences
regarding cancer management. Apart from cultivating technical evidences on oncology,
it is also my aspiration to see this conference as a catalytic agent for public awareness and
the empowerment of people living with cancer, which in the end will lead toward the
advancement in fighting cancer.
I sincerely hope all of you enjoy and receive full academic benefits and networks from the
Princess Chulabhorn International Oncology Conference 2019 which will take place on
August 8 – 9, 2019 at the Centara Grand Hotel at CentralWorld Bangkok, Thailand.
Professor Piyamitr Sritara, M.D., FRCPT, FACP, FRCP

Dean, Faculty of Medicine Ramathibodi Hospital
Mahidol University
7
PCIOC 2019
Welcome Message
With Her Royal Highness’s determination to help underprivileged, especially patients

suffering from cancer, the number one cause of death in Thailand, this conference on
“Princess Chulabhorn International Oncology Conference 2019” is organized to honor the
greatest wisdom and dedication of HRH Princess Chulabhorn Krom Prasrisavangavadhana
in the field of cancer medicine. Contributions of Her Royal Highness to the advanced
knowledge in environmental toxicology, molecular oncogenesis, and clinical oncology have
been well recognized with many prestigious awards from the international organizations
and communities, particularly Her Royal Highness’ strong determination to provide the
best cancer care to Thai patients as well as to improve the quality of life of Thai people as
a whole. This conference will provide an excellent venue for sharing knowledge and
experiences among experts in various fields of oncology-related medical and health sciences.
Particularly, colleagues in the fields of medical and health sciences will be able to meet and
collaborate to broaden their scopes of research and practices which would fulfil Her Royal
Highness’ aspiration to alleviate suffering of overall cancer patients through research and
development of science and technology.
Professor Chirayu Auewarakul

Dean, Faculty of Medicine and Public Health
HRH Princess Chulabhorn Royal College of Medical Science
Chulabhorn Royal Academy
8
Welcome Message
During the long reign of the late HM King Bhumibol Adulyadej, one of the main concerns
for his people during his dedicated hard work is public health issue and he believed that
these matters should be adjusted. It is HRH Princess Chulabhorn Krom Prasrisavangavadhana‘s
graciousness to carry out the late King Bhumibol Adulyadej’s wishes that all individuals in
Thailand will have an improved health and better quality of life. Her Royal Highness follows
the footsteps of the late King Bhumibol Adulyadej and has regularly visited her people in
various provinces particularly those in the rural areas with poor sanitation ever since she
was young. Her Royal Highness realizes the distresses and difficulties her people are facing,
especially health related problems, and is thus determined to help the underprivileged
which includes patients suffering from cancer. With this conference, we would like to
cordially invite and welcome everyone to exchange knowledge and experiences to honor
HRH Princess Chulabhorn Krom Prasrisavangavadhana for her dedication in the field of
cancer. The conference will provide insights for innovation and research in cancer as well
as a great opportunity for potential networks and connections worldwide for the
advancement of cancer research and innovation towards better quality of life and treatment
outcome of cancer patients both Thai and global.
Professor Nithi Mahanonda

Secretary General, Chulabhorn Royal Academy
9
Board of Directors
10
Board of Directors

Prasit Watanapa Co-Chairman
Manee Rattanachaiyanont Committee
Visit Vamvanij Committee
Ubolrat Santawat Committee
Naris Kitnarong Committee
Gulapar Srisawasdi Committee
Faculty of Medicine, Chulalongkorn University

Suttipong Wacharasindhu Co-Chairman
Buranee Kanchanatawan Committee
Chanchai Sittipunt Committee
Nijasri Charnnarong Committee
Ankanee Chanakul Committee
Faculty of Medicine Ramathibodi Hospital, Mahidol University

Piyamitr Sritara Co-Chairman
Sarikapan Wilailak Committee
Ronnachai Kongsakon Committee
Somkiat Leelasithorn Committee
Suradej Hongeng Committee
Faculty of Medicine and Public Health, Chulabhorn Royal Academy

Nithi Mahanonda Chairman
Chirayu Auewarakul Committee and Secretary
Jiraporn Laothamatas Committee
Nuttavut Kantathavorn Committee and Assistant Secretary
Danupon Nantajit Committee and Assistant Secretary
Arpaporn Arnamwong Assistant Secretary
11
Scientific Program
12
Program at a Glance
Legend:
Nobel Laureate
Pre-Congress Sessions Prince Mahidol Award Session Research Highlight Speciality Session Paralleled Symposia Social Functions
Session
August 5, August 6,
August 7, 2019 Day 1 (August 8, 2019) Day 2 (August 9, 2019)
2019 2019
Convention Hall A Lotus 1-2 Lotus 3-4 Lotus 5-6 Lotus 7 Convention Hall A Lotus 1-2 Lotus 3-4 Lotus 5-6 Lotus 7
8.00-8.30 Registration
Registration Speciality Session
8.30-9.00
(Data Science)
Nobel Laureate Speciality Session

9.00-9.30
Session (Robotic Surgery)
9.30-09.45
UHC for Cancer
Japan-Thailand
9.30-10.00 Education and Research
9.45-10.00
Cooperation
Universal Coverage
Policy and Cancer
10.00-10.30 Break Break
10.30-10.50
Dean’s Session
Speciality Session
10.30-11.00 10.50-11.10
10.50-11.10 (Canabis Oil)
Speciality Session 10.30-11.30
13
Speciality Session
(Alternative Research Highlights

(Oncology)
and Robotic Urological Cancer Surgery

Medicine) (General/Trainee) 10.30-11.45
Public and Press
10.50-12.00
and Management
11.10-11.40 10.50-11.10 Speciality Session Seminar
Speciality Session
11.00-11.30 Speciality Session Paralleled Symposium (Unknown Primary
11.10-12.00 (Oncology)
(Oncology) Research Highlights Cancer)
(Genomics, Proteomics
11.40-12.00 and Metabolomics) Paralleled Paralleled
Pre-Congress Session 3: Semi-Live Surgical Techniques of Challenging Laparoscopic

11.30-12.00
Speciality Session (AI) Symposium Symposium
Pre-Congress Session 2: Advanced Cancer Investigation

12.00-12.30
Lunch Lunch
Pre-Congress Session 4: Demonstration of Cancer Bioinformatics

12.30-13.00
13.00-13.30 13.00-14.15
13.00-14.15 13.00-14.15 13.00-14.15 13.00-14.15
Preparation for
Paralleled Symposium Paralleled Symposium Paralleled Symposium Paralleled Symposium Paralleled Paralleled Paralleled Paralleled Paralleled
13.30-14.00 Opening Ceremony
MassARRAY, and StripAssay Technology platforms in Research and Clinical Applications

Symposium Symposium Symposium Symposium Symposium
Pre-Congress Session 1: International Conference on Cancer Immunotherapy

Pre-Congress Session 4: Laboratories and Lecture Demonstrations Next Generation Sequencing,
14.00-14.30 14.15-14.45 Break
14.30-15.00 Break
14.45-16.00 14.45-16.00 14.45-16.00 14.45-16.00
15.00-15.30 Paralleled Symposium Paralleled Symposium Paralleled Symposium Paralleled Symposium
14.45-17.00
Paralleled Paralleled Paralleled Paralleled Paralleled
15.30-16.00 Preparation for
Symposium Symposium Symposium Symposium Symposium
Opening Ceremony
16.00-16.30
16.30-17.00 Closing Remarks

Royal Opening
17.00
Ceremony
Nobel Laureate
Session
PCIOC 2019
Pre-Congress Session: Faculty of Medicine Siriraj Hospital, Mahidol University
International Conference on Cancer Immunotherapy

Date: August 5, 2019
Time: 08.30-17.35
Venue: Room 101, Siriraj Medical Research (SiMR) Center, Faculty of Medicine Siriraj Hospital, Mahidol University
Available seats: 60 pax
Registration fee: No
Pre-Congress Session: Faculty of Medicine, Chulalongkorn University
Advanced Cancer Investigation and Management
Time: 08.30-15.00
Venue: Abdul Rahim Bldg, 2nd floor, Faculty of Medicine, Chulalongkorn University King Chulalongkorn Memorial Hospital
Pre-Congress 3: Faculty of Medicine Ramathibodi Hospital, Mahidol University
Semi-Live Surgical Techniques of Challenging Laparoscopic and Robotic Urological Cancer Surgery
(VDO base surgical technique discussion)
Time: 08.30-12.00
Venue: Meeting room 623, Lecture Hall Building, Ramathibodi Hospital
Pre-Congress 4: Faculty of Medicine Ramathibodi Hospital, Mahidol University and Chulabhorn Royal Academy
2-Day Pre Congress Programs (August 6-7, 2019)
“Cancer Genomics 101” from Sample – to – Answer: Integrated NGS Sequencing, Genotyping, Data Analysis,
and Interpretation for the Screening, Monitoring and Treatment of Cancer
Demonstration Workshop
Topic: Next Generation Sequencing, MassARRAY, and StripAssay Technology Platforms
in Research and Clinical Applications
Day 1: August 6, 2019
Time: 08.30-16.30
Venue: Center for Medical Genomics (CMG), Faculty of Medicine Ramathibodi Hospital, Mahidol University
Topic: Demonstration of Cancer Bioinformatics
Time: 09.00-15.00
Venue: Meeting room, 4th floor, Chulabhorn Hospital
14
Pre-Congress Session:
International Conference on Cancer Immunotherapy 2019
Meeting Room 101, Siriraj Medical Research (SiMR) Center,
August 5, 2019: 08.30-17.30
Time Activity/Presentation Speakers
8:30-9.00 Registration
9:00-9.15 Opening & Taking Photograph Prof. Prasit Wattanapa
9:15-9.45 Opening & Overview Prof. Pa-thai Yenchitsomanus
9:45-10.15 To be announced Assoc. Prof. Yongyut Sirivatanauksorn

10:15-10:35 Coffee Break
10:35-11.05 To be announced Dr. Doonyapat Sa-nguanraksa
11:05-11.35 To be announced Dr. Naravat Poungvarin

11:35-12.05 Dependency of Cholangiocarcinoma on Cyclin Dr. Siwanon Jirawatnotai
D-Dependent Kinase Activity
12:05-13:00 Lunch
13:00-13.30 Haploidentical NK cell therapy in high risk AML Dr. Koramit Suppipat
13:30-14.00 CAR-modified Immune Cells Against Neuroblastoma Asst. Prof. Usanarat Anurathapan
14:00-14.30 To be announced Assoc. Prof. Chanitra Thuwajit

14:30-14.55 Specific T Cell Production for Potential Use in Dr. Mutita Junking
Cholangiocarcinoma
14:55-15.20 Self-differentiated Dendritic cells and CAR-NK Dr. Aussara Panya
Cells: An Update and Future Perspectives
15:20-15.45 Cellular Immunotherapy for Hepatocellular Dr. Thaweesak Chieochansin
Carcinoma

16:05-16.35 CAR T Cell Therapy: Potential Strategies for Solid Asst Prof. Supannikar Tawinwung
Tumors
16:35-17.00 CAR T Cell Therapy for Childhood Cancers Dr. Jatuporn Sujjitjoon
17:00-17.25 Immunogenic Cells Death in Breast Cancer Dr. Sasiprapa Khunchai
17:25 Conclusion and Closing Prof. Pa-thai Yenchitsomanus
15
PCIOC 2019
Advanced Cancer Investigation and Management
Abdul Rahim Building, 2nd floor, King Chulalongkorn Memorial Hospital
August 7, 2019: 08.30-15.00
8:30-9.00 Registration
9:00-10.00 New Era of Immunotherapy in Cancer
Management
New Concept Prof. Nattiya Hirankarn
From Research to Practice Dr. Koramit Suppipat

10:20-11.00 Radiology Aspect in Cancer Management Dr. Sasitorn Sirisalipoch
Role of PET-CT in Diagnosis, Staging, and
Monitoring
11:00-12.00 Stereotactic Body Radiotherapy (SBRT) Assoc. Prof. Kanjana Shotelersuk
12:00-13:00 Lunch
13:00-15.00 Interventional Bronchoscopy for Lung Cancer Dr. Thitiwat Sriprasart
Lectures and Case Demonstration Dr. Nophol Leelayuwatanakul
(Location: Santiwan Respiratory Center, Dr. Vorawut Thanthitaweewat
Bhumisiri Mangkhalanusorn, Bldg., 10th floor)
16
Semi-Live Surgical Technique of Challenging Laparoscopic and
Robotic Urological Cancer Surgery
(VDO base surgical technique discussion)
Meeting Room 623, Lecture Hall Building, Faculty of Medicine Ramathibodi Hospital,
Mahidol University
August 7, 2019: 09.00-12.00
8:00-9:00 Registration
9:00-9.10 Welcoming Message Asst. Prof. Wit Viseshsindh
9:10-9.30 Technique of Laparoscopic Radical Dr. Kamol Panumatrassamee

Nephrectomy Assoc. Prof. Kittinut Kijvikai
Moderator: Asst. Prof. Premsant Sangkum
9:30-10.00 Techniques of Laparoscopic and Robotic Assoc. Prof. Kittinut Kijvikai

Partial Nephrectomy Moderator: Asst. Prof. Premsant Sangku
- Vessel Controlling
- Cutting the Tumor
- Suturing Technique
- Laparoscopic Renal Hypothermia
10:00-10.20 Techniques of Laparoscopic and Assoc. Prof. Kittinut Kijvikai

Robotic Radical Cystectomy Moderator: Asst. Prof. Premsant Sangkum

10:40-11.00 Techniques of Laparoscopic and Robotic Assoc. Prof. Kittinut Kijvikai
Nephroureterctomy with Bladder Cuff Moderator: Asst. Prof. Premsant Sangku
Excision
11:00-11.50 Techniques of Laparoscopic and Robotic Assoc. Prof. Wisoot Kongcharoensombat

Prostatectomy Assoc. Prof. Kittinut Kijvikai
- Bladder Neck Dissection Dr. Kamol Panumatrassamee
- Apex Dissection Asst. Prof. Premsant Sangkum
- Nerve Sparing Technique Dr. Varat Woranisarakul
- Anastomosis Technique Moderator: Chinnaket Katesuwan
- Lymph Node Dissection
11:50 Q&A
17
PCIOC 2019
Pre-Congress Session: Cancer Genomics 101

From Sample-to-answer: Integrated NGS Sequencing, Genotyping,
Data Analysis, and Interpretation for the Screening, Monitoring
and Treatment of Cancer
Faculty of Medicine Ramathibodi Hospital, Mahidol University and Chulabhorn Royal Academy
August 6-7, 2019
Day 1: August 6, 2019, 08:30-16:30

Laboratories and Lecture Demonstrations Next Generation Sequencing, MassARRAY, and StripAssay
Technology platforms in Research and Clinical Applications
Location: Center for Medical Genomics (CMG), Ramathibodi Hospital, Mahidol University
Map: http//:bit.ly/genomecenter

08:30 Registration
9:00-9.30 Opening Prof. Dr. Wasun Chantratita
Center for Medical Genomics, Ramathibodi Hospital,
the Game Changer in Yothi Medical Innovation
District: YMID
9:30-10.00 Circulating Tumor Cell (CTCs) and Cell-free DNA CMG Staffs & CellMax Life
(cfDNA) in Liquid Biopsy
10:00-10.30 Advancing Tumor and Plasma Testing by MassARRAY CMG Staffs & Agena Bioscience
11:00-11.30 Short Read, Long Read, Linked Read, and Single Cell Dr Darat Lauhakirti
Genomics Sequencing (RI Technologies)
11:30-12.00 Adaptive Focused AcousticsTM (AFA): Enabling CMG Staffs & Covaris
Sample Preparation Simplification and Standardization
for Genomic Research
12:00-13:00 Lunch
13:00-14.00 NGS Laboratory and Demonstration CMG Staffs
14:00-14.30 Whole Genome and Whole Exome Sequencing in CMG Staffs & NovogeneAIT
Cancer and Variety of Diseases
14:30-15.00 BRCA Mutations: Cancer Risk and Genetic Testing CMG Staffs & Qiagen
(AstraZeneca-BRCA Testing)
15:00-15.30 Targeted Sequencing in Cancer (Target Hotspots, CMG Staffs & Thermofisher
SNVs, Indels, CNVs, and Gene Fusions from DNA and
RNA in a Single Workflow)
16:00-16.25 Identification of Oncogene Mutations Using CMG Staffs & ViennaLab
StripAssay Technology Diagnostics GmbH
16:25 Closing Prof. Wasun Chantratita
18
Day 2: August 7, 2019, 09:00-15:00

Demonstration of Cancer Bioinformatics
Location: Meeting Room, 4th floor, Chulabhorn Hospital

9:00-10.30 Introduction to Next Generation Sequencing in Cancer Dr. Gnana Prakash
Genomics Balasubramanian

11:00-12.30 Clinical – Translational Bioinformatics as applied to Dr. Gnana Prakash
Oncology (Interactive session) Balasubramanian
12:30-13:30 Lunch
13:30-15.00 Practical Exercises: Clinical Translation in Oncology Dr. Gnana Prakash
Balasubramanian
19
Main Scientific Program
Legend:
Nobel Laureate Session Prince Mahidol Award Session Research Highlight Speciality Session Symposia Social Functions
Convention Hall A Lotus 1-2 Lotus 3-4 Lotus 5-6 Lotus 7

Prevention of Cancers Linked to Infections

Prof. Herald zur Hausen (Germany)
9.00-9.30
Moderator:
Prof. Sarikapan Wilailak (Rama)
Japan-Thailand Education and

Research Cooperation
9.30-10.00 Prof. Yasuyuki Yoshizawa (Japan)
Moderator:
Prof. Dr. Prasit Watanapa (SI)
10.00-10.30 Break
Highlights in Oncology Research

Prof. Dr. Prasit Watanapa (SI)
Prof. Suttipong Wacharasindhu (CU)
10.30-10.50 Prof. Piyamitr Sritara (Rama)
Prof. Dr. Chirayu Auewarakul (CRA)
Moderator:
Dr. Vitoon Chinswangwatanakul (SI)
Whole Genome Sequencing: the Game Changer

A Guided Tour to PET in Oncology New Frontiers in Lung Cancer
10.50-11.10 in Cancer Precision Medicine
Assist. Prof. Wichana Chamroonrat (Rama) 1. Cancer Treatment by TCM in China Speakers:
Prof. Wasun Chantratita (Rama)
Prof. Hu Zhen, Wenshou Medical University, (China) 1. Assoc. Prof. Kanjana Shotelersuk (CU)
Oncology Fertility Basic Science Research (Genomics, 2. Learning Something from Traditional Chinese 2. Asst. Prof. Punnarerk Thongcharoen (SI)
11.10-11.40 Proteomics and Metabolomics) Medicine (TCM) 3. Asst. Prof. Thanyanan Reungwetwattana (Rama)
Prof. Nao Suzuki (Japan)
20
1. Prof. Dr. M.R.Jisnuson Svasti (CRA) Prof. Guo Qiang Lin, Shanghai University 4. Dr. Wisut Lamlertthon (CRA)
2. Prof. Manop Pithukpakorn (SI) of Traditional Chinese Medicine Moderator:
AI (Artificial Intelligence) in Cancer Treatment 3. Asst. Prof. Natini Jinawath (Rama) Assoc. Prof. Virote Sriuranpong (CU)
11.40-12.00
Assoc. Prof. Tiranee Achalakul (Thailand) 4. Dr. Trairak Pisitkun (CU)
12.00-13.00 Lunch Lunch Symposium by GE Healthcare Lunch Symposium by BDMS Lunch Lunch Symposium by Berlin
Current Concept in Management of Current and Future Perspectives of Breast Cancer Management: Novel Therapies Panel Discussion on Case-based Approach
High Risk Prostate Cancer Rectal Cancer Management and Future Trends for Hepatocellular Carcinoma (HCC) Treatment
Speakers: Speakers: Speakers: Speakers:
1. Asst. Prof. Choosak Pripatnanont (CRA) 1. Assoc. Prof. Atthaphorn Trakarnsanga (SI) 1. Dr. Archara Supavavej (CRA) 1. Asst. Prof. Natthaporn Tanpowpong (CU)
13.00-14.15 Preparation for Opening Ceremony 2. Dr. Julin Opanurak (CU) 2. Dr. Bunchorn Siripongpreeda (CRA) 2. Dr. Kitwadee Saksornchai (CU) 2. Dr. Sasikorn Feinggumloon (CRA)
3. Assoc. Prof. Kittinut Kijvikai (Rama) 3. Dr. Keeratikarn Boonyawan (Rama) 3. Dr. Kampanart Nimpoonsri (SI) 3. Asst. Prof. Krittiya Korphaisarn (SI)
4. Assoc. Prof. Tawatchai Taweemonkongsap (SI) 4. Asst. Prof. Surbpong Tanasanvimon (CU) 4. Asst. Prof. Thitiya (Sirisinha) Dejthevaporn (Rama) 4. Asst. Prof. Paramin Muangkaew (RA)
Moderator: Moderator: Moderator: Moderator:
Asst. Prof. Choosak Pripatnanont (CRA) Asst. Prof. Charuwan Akewanlop (SI) Assoc. Prof. Suebwong Chuthapisith (SI) Dr. Teerapat Ungtrakul (CRA)
14.15-14.45 Break
Integrating Palliative Care into Specialized Cares: Frontiers in Diagnosis and Treatment of Gliomas
Cancer Pain Management
When, Why and How? Speakers: Multidisciplinary Approach for Gastric Cancer
Speakers:
Speakers: 1. Dr. Iyavut Thaipisuttikul (CU) Speakers:
1. Assoc. Prof. Chuthamanee Suthisisang (Thailand)
1. Dr. Chusana Khaiman (CU) 2. Prof. Jiraporn Laothamatas (CRA) 1. Asst. Prof. Suppa-ut Pungpapong (CU)
2. Asst. Prof. Koravee Pasutharnchat (Rama)
14.45-16.00 2. Dr. Burapen Boonchoo (CRA) 3. Assoc. Prof. Mantana Dhanachai (Rama) 2. Dr. Thammawat Parakonthun (SI)
Preparation for Opening Ceremony 3. Dr. Patt Pannangpetch (CU)
3. Asst. Prof. Kittiphon Nagaviroj (RAMA) 4. Asst. Prof. Sarun nunta-aree (SI) Moderators:
4. Asst. Prof. Sasikarn Chamchod (CRA)
4. Dr. Pratamaporn Chanthong (SI) 5. Prof. Shanop Shuangshoti (CU) 1 .Assoc. Prof. Dr. Asada Methasate (SI)
Moderator:
Moderator: Moderator: 2. Assoc. Prof. Chadin Tharavej (CU)
Asst. Prof. Pranee Rushatamukayanunt (SI)
Asst. Prof. Kittiphon Nagaviroj (RAMA) Assoc. Prof. Sith sathornsumetee (SI)
16.00-17.00 Preparation for Opening Ceremony
Royal Opening Ceremony
17:00 Link of Nutritional Infections to

Common Human Cancers
PCIOC 2019
Prof. Herald zur Hausen (Germany)

Main Scientific Program
Legend:
Nobel Laureate Session Prince Mahidol Award Session Research Highlight Speciality Session Symposia Social Functions
Convention Hall A Lotus 1-2 Lotus 3-4 Lotus 5-6 Lotus 7
8.30-9.00 Genomic Data for Precision Medicine

Dr. Gnana Prakash Balasubramanian
(German Cancer Research Center (DKFZ), Germany)
9.00-9.30 Update in Robotic Cancer Surgery

Prof. KH Rha (Korea)
9.30-09.45 Health Promotion Activities and UHC for
Cancer Prevention and Control in Japan
Speaker:
Dr. Munehito Machida (Japan)
09.45-10.00 Universal Coverage Policy and Cancer
Speaker:
Dr. Worachai Aungaphina (Thailand)
10.00-10.30 Break
10.30-11.00 Medical Cannabis: What Is the Evidence? Public and Press: Seminar on Cancer Combat and Declaration
Prof. David Currow (AUS) of the Joint Commitment on Cancer Combat (Thai Language)
11:00 - 11:30 Cancer of Unknown Primary Research Highlights 10.30 – 12.00 น.
Speaker: (General/Trainee) การเสวนายุทธการต้านมะเร็ง
Dr. Malee Warnnissorn (SI) ผู้ร่วมเสวนา
Moderator: ภาควิชาการ: ผศ.รอ.นพ.เอกภพ สิระชัยนันท์ (นายกมะเร็งวิทยาสมาคมแห่ง
Asst. Prof. Suwanit Therasakvichya (SI) ประเทศไทย)
ภาครัฐ: นพ.จเด็จ ธรรมธัชอารี (รองเลขาธิการ สปสช.)
11.30-12.00 Cancer Prevention and Screening Cancer in Adolescents and Young Adults (AYAs) ภาครัฐ: นพ.วีรวุฒิ อิ่มส�ำราญ (ผอ.สถาบันมะเร็งแห่งชาติ)
Speakers: Speakers:
21
ภาคประชาชน: คุณไอรีล ไตรสารศรี
1. Dr. Bunchorn Siripongpreeda (CRA) 1. Assoc. Prof. Kleebsabai Sanpakit (SI) ผู้ด�ำเนินรายการ คุณณัฎฐา โกมลวาทิน
2. Dr. Nuttavut Kantathavorn (CRA) 2. Dr. Piti Techawichit (CU)
3. Dr. Teerapat Ungtrakul (CRA) 3. Assoc. Prof. Preeda Vanichsetakul (CRA) 12.00 – 12.15 น.
Moderator: 4. Assoc.Prof. Samart Pakakasama (Rama) การลงนามพันธะสัญญาความร่วมมือเพื่อพิชิตมะเร็งในประเทศไทย
Prof. Dr. Chirayu Auewarakul (CRA) Moderator: ระหว่างคณะแพทยศาสตร์ 4 สถาบัน กระทรวงสาธารณสุข
Prof. Suradej Hongeng (Rama) และส�ำนักงานหลักประกันสุขภาพแห่งชาติ (สปสช.)
12.00-13.00 Lunch
13.00-14.30 New Frontier in Combatting Cervical Cancer Immunotherapy in Lymphoid Malignancies Head & Neck Cancer Nursing Intervention Program for Patients Practical Points in Cancer Management for GP
Speakers: Speakers: Speakers: with Cancer Symptoms Speaker: TBA
1. Asst. Prof. Chomporn Sitathanee (Rama) 1. Dr. Archrob Khuhapinant (SI) 1. Dr. Chanida Vinayanuwattikun (CU) Speakers: Moderators:
2. Assoc. Prof. Irene Ruengkhacharm (SI) 2. Asst. Prof. Udomsak Bunworasate (CU) 2. Dr. Nuttapong Ngamphaiboon (Rama) 1. Asst. Prof. Dr. Autchareeya Patoomwan (Rama) Mr.Kasidis Kaipattanapng (Rama)
3. Dr. Nuttavut Kantathavorn (CRA) 3. Asst. Prof. Usanarat Anurathapan (Rama) 3. Dr. Poompis Pattaranutaporn (Rama) 2. Mrs. Penprapa Piriyajittrakornkij (CU) Mr.Kittithat Chairatana (CRA)
4. Assoc. Prof. Wichai Termrungruanglert (CU) Moderator: 4. Asst. Prof. Warut Pongsapich (SI) 3. Mrs. Ploenpit Thamnipa (SI) Mr.Nattapat Anuduang (CU)
Moderator: Prof. Suradej Hongeng (Rama) Moderator: 4. Miss Rasarudee Sriwisai (CRA) Mr.Theerajate phongsuphan (SI)
Assoc. Prof. Arbaroon Lertkhachonsuk (Rama) Dr. Nuttapong Ngamphaiboon (Rama) Moderator:
Miss Kingtip Tamthong (CU)
14.30-15.00 Break
15.00-16.30 Updates in Skin Cancer Updates in Ophthalmic Oncology Management of Bone Metastasis in Extremities Palliative Care for Patients with Cancer 15.00-15.45
Speakers: Speakers: Speakers: Speakers: Holistic Care for Cancer Patients
1. Dermoscopic Diagnosis of Skin Cancer 1. Dr. Duangnate Rojanaporn (Rama) 1. Dr. Chandhanarat Chandhanayingyong (SI) 1. Dr. Nongluck Ananta-ard (CU) Speaker:
Asst. Prof Sasima Eimpunth (SI) 2. Prof. La-ongsri Atchaneeyasakul (SI) 2. Dr. Chris Charoenlap (CU) 2. Mrs. Thitaree Boonchaue (CRA) Asst. Prof. Thitiya (Sirisinha) Dejthevaporn (Rama)
2. Skin Cancer Mobile Apps: Do they work? 3. Dr. Pornpattana Vichitvejpaisal (CRA) 3. Dr. Prakrit Suwanpramote (Rama) 3. Miss. Thochaporn Tesasil (SI) Moderators:
Dr. Pamela Chayavichitsilp (Rama) 4. Prof. Wasee Tulvatana (CU) 4. Asst. Prof. Sasikarn Chamchod (CRA) 4. Asst. Prof. Dr. Tiraporn Junda (Rama) Mr.Kasidis Kaipattanapng (Rama)
3. Liquid Biopsy: A Nouveau Monitoring Moderator: Moderator: Moderator: Mr.Kittithat Chairatana (CRA)
Technique in Melanoma Patients Prof. Suradej Hongeng (Rama) Dr. Thanapon Chobpenthai (CRA) Miss Kingtip Tamthong (CU) Mr.Nattapat Anuduang (CU)
Dr. Rasthawathana Desomchoke (CRA) Mr.Theerajate phongsuphan (SI)
4. Basal Cell Carcinoma and the Need of
Mohs Micrographic Surgery 15.45-16.30
Asst. Prof. Marisa Pongprutthipan (CU) Inspirations for Oncology Research
Moderator: Speaker: TBA
Dr. Pamela Chayavichitsilp (Rama) Moderators:
Mr.Kasidis Kaipattanapng (Rama)
Mr.Kittithat Chairatana (CRA)
Mr.Nattapat Anuduang (CU)
Mr.Theerajate phongsuphan (SI)
16:30 Closing Remarks
Speakers
22
Speakers
First Name Last Name Country
David Currow Australia
Kasidis Kaipattanapng Thailand
Tiranee Achalakul Thailand
Charuwan Akewanlop Thailand
Nongluck Ananta-ard Thailand
Nattapat Anuduang Thailand
Usanarat Anurathapan Thailand
La-ongsri Atchaneeyasakul Thailand
Chirayu Auewarakul Thailand
Worachai Aungaphina Thailand
Gnana Prakash Balasubramanian Germany
Thitaree Boonchaue Thailand
Burapen Boonchoo Thailand
Keeratikarn Boonyawan Thailand
Udomsak Bunworasate Thailand
Kittithat Chairatana Thailand
Sasikarn Chamchod Thailand
Wichana Chamroonrat Thailand
Chandhanarat Chandhanayingyong Thailand
Pratamaporn Chanthong Thailand
Wasun Chantratita Thailand
Chris Charoenlap Thailand
Pamela Chayavichitsilp Thailand
Vitoon Chinswangwatanakul Thailand
Thanapon Chobpenthai Thailand
Suebwong Chuthapisith Thailand
Thitiya (Sirisinha) Dejthevaporn Thailand
Rasthawathana Desomchoke Thailand
23
PCIOC 2019
Mantana Dhanachai Thailand

Sasima Eimpunth Thailand
Sasikorn Feinggumloon Thailand
Suradej Hongeng Thailand
Weerawut Imsamran Thailand
Natini Jinawath Thailand
Tiraporn Junda Thailand
Nuttavut Kantathavorn Thailand
Chusana khaiman Thailand
Archrob Khuhapinant Thailand
Kittinut Kijvikai Thailand
Nattha Komolvadhin Thailand
Krittiya Korphaisarn Thailand
Wisut Lamlertthon Thailand
Jiraporn Laothamatas Thailand
Arbaroon Lertkhachonsuk Thailand
Guo Qiang Lin China
Munehito Machida Japan
Asada Methasate Thailand
Paramin Muangkaew Thailand
Kittiphon Nagaviroj Thailand
Nuttapong Ngamphaiboon Thailand
Kampanart Nimpoonsri Thailand
Sarun Nunta-aree Thailand
Julin Opanurak Thailand
Samart Pakakasama Thailand
Patt Pannangpetch Thailand
Thammawat Parakonthun Thailand
Koravee Pasutharnchat Thailand
Autchareeya Patoomwan Thailand
24
Poompis Pattaranutaporn Thailand

Theerajate Phongsuphan Thailand
Penprapa Piriyajittrakornkij Thailand
Trairak Pisitkun Thailand
Manop Pithukpakorn Thailand
Marisa Pongprutthipan Thailand
Warut Pongsapich Thailand
Choosak Pripatnanont Thailand
Suppa-ut Pungpapong Thailand
Thanyanan Reungwetwattana Thailand
KH Rha Korea
Duangnate Rojanaporn Thailand
Irene Ruengkhacharm Thailand
Pranee Rushatamukayanunt Thailand
Kitwadee Saksornchai Thailand
Kleebsabai Sanpakit Thailand
Sith Sathornsumetee Thailand
Kanjana Shotelersuk Thailand
Shanop Shuangshoti Thailand
Ekaphop Sirachainan Thailand
Bunchorn Siripongpreeda Thailand
Chomporn Sitathanee Thailand
Piyamitr Sritara Thailand
Virote Sriuranpong Thailand
Rasarudee Sriwisai Thailand
Archara Supavavej Thailand
Chuthamanee Suthisisang Thailand
Prakrit Suwanpramote Thailand
Nao Suzuki Japan
Jisnuson Svasti Thailand
25
PCIOC 2019
Kingtip Tamthong Thailand

Surbpong Tanasanvimon Thailand
Natthaporn Tanpowpong Thailand
Thawatchai Taweemonkongsap Thailand
Piti Techawichit Thailand
Wichai Termrungruanglert Thailand
Thochaporn Tesasil Thailand
Iyavut Thaipisuttikul Thailand
Jadej Thammatacharee Thailand
Ploenpit Thamnipa Thailand
Chadin Tharavej Thailand
Suwanit Therasakvichya Thailand
Punnarerk Thongcharoen Thailand
Ireal Traisarnsri Thailand
Atthaphorn Trakarnsanga Thailand
Wasee Tulvatana Thailand
Teerapat Ungtrakul Thailand
Preeda Vanichsetakul Thailand
Pornpattana Vichitvejpaisal Thailand
Chanida Vinayanuwattikun Thailand
Suttipong Wacharasindhu Thailand
Malee Warnnissorn Thailand
Prasit Watanapa Thailand
Sarikapan Wilailak Thailand
Yasuyuki Yoshizawa Japan
Hu Zhen China
Harald zur Hausen Germany
26
Speakers’ Synopses
27
PCIOC 2019
Synopses of Day-1 Presentations

WHOLE GENOME SEQUENCING: THE GAME CHANGER IN CANCER PRECISION MEDICINE
Chantratita W
A GUIDED TOUR TO PET IN ONCOLOGY

Chamroonrat W
BASIC SCIENCE RESEARCH (GENOMICS, PROTEOMICS AND METABOLOMICS):

PERSONALIZED NEOANTIGEN-BASED CANCER IMMUNOTHERAPY
Pisitkun T
NEW FRONTIER IN LUNG CANCER

Reungwetwattana T
NEW FRONTIER IN MANAGEMENT OF LUNG CANCER: RADIOTHERAPY ASPECT

Shotelersuk K
CURRENT CONCEPT IN MANAGEMENT OF HIGH-RISK PROSTATE CANCER

Pripatnanont C, Opanurak J, Kijvikai K, Taweemonkongsap T
COLORECTAL CANCER PREVENTION AND SCREENING

Siripongpreeda B
CURRENT AND FUTURE PROSPECTIVES OF RECTAL CANCER MANAGEMENT:

RADIOTHERAPY ASPECT
Boonyawan K
NEW TRENDS OF TARGETED THERAPY AND IMMUNOTHERAPY IN BREAST CANCER

Supavavej A
ADVANCES IN BREAST CANCER RADIOTHERAPY

Saksornchai K
RECENT ADVANCE AND FUTURE TRENDS IN THERAPY FOR HORMONE RECEPTOR POSITIVE
BREAST CANCER
Dejthevaporn T
28
PANEL DISCUSSION ON CASE-BASED APPROACH FOR HEPATOCELLULAR CARCINOMA

Muangkaew P
INTEGRATING PALLIATIVE CARE INTO SPECIALIZED CARES: WHEN, WHY AND HOW? -PEDIATRIC
PALLIATIVE CARE
Khaiman C
INTEGRATING PALLIATIVE CARE INTO SPECIALIZED CARES: WHEN, WHY AND HOW?
Nagaviroj K
INTEGRATING PALLIATIVE CARE INTO SPECILIZED CARE, WHEN, WHY AND HOW?
Chanthong P
ROLE OF SYSTEMIC THERAPY IN GLIOMA MANAGEMENT

Thaipisuttikul I
PATHOLOGICAL DIAGNOSIS OF GLIOMAS

Shuangshoti S
CANCER PAIN MANAGEMENT IN RADIATION THERAPY

Chamchod S
29
PCIOC 2019
WHOLE GENOME SEQUENCING: THE GAME CHANGER

IN CANCER PRECISION MEDICINE
Wasun Chantratita, PhD

Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Disruptive technologies of next generation genomics and computational analyses have enabled
exploration of somatic protein-altered mutations in most cancer types, with coding mutation data.
However, there is limited information on somatic mutations in non-coding regions, including
introns, regulatory elements and non-coding RNA. Structural variants and pathogen in cancer
genomes remain widely unexplored.
Until recently, as sequencing costs reduce drastically to $US1,000 or even lower per whole human
genome, and the tools to effectively analyse complex and big-scale data improve, the ability to
effectively characterize whole genomes at scale in a clinically relevant turnaround time is now
being started.
Cancer whole genome sequencing detecting copy number alterations (CNA) and structural variants
(SV), and epigenomic alterations with and without some hereditability (germline variants) often
combined with RNA-Seq, immuno-genomic and clinic-pathological information have been used
to understand cancer like never before. We now have an ability to see tumors with big data cre-
ated by disruptive sequencing technologies. Recently, efforts are very focused on cell free tumor
DNA/RNA, targeted genes. Currently, single-cell approaches in which tumor cells are analysed
separately or individually from enormous normal cells, and which has the power to detect rare
cells with genomic features capable of powering re-initiation of the disease even after treatment.
Certainly, the need of more sophisticated analysis tools and higher computing/processing capacity,
along with cheaper storage and faster and more efficient big data transfer that must be overcome
before precision medicine in cancer treatment finally becomes a reality.
Centre for Medical Genomics, Ramathibodi Hospital, teams up with Faculty of Science and
Faculty of Pharmacy, Mahidol University utilizing these next generation genomics for characterization
of both germline mutations in white blood cell and somatic mutations in cell free DNA/RNA,
circulating tumor cells, exosomes, including epigenomics, which will lead us to understand
why this tumor from the patient keeps coming back and how can we go from 50% response rate
to 90-100% response rate of antitumor for cancer patients to live longer. Some cancers though
never have a cure, but certainly we are going treat them to become a chronic disease.
30
A GUIDED TOUR TO PET IN ONCOLOGY
Wichana Chamroonrat, MD
Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology,
Positron Emission Tomography (PET) without suitable positron emitting radiotracers (PET tracers)
is considered as camera without light. Currently, most clinically used PET tracers in oncology could
be described into 3 groups according to their behaviors as parts of glucose metabolism (Fluoro-
DeoxyGlucose: FDG), folate metabolism (Prostate-Specific Membrane Antigen: PSMA/folate
hydrolase/glutamate carboxypeptidase) and somatostatin receptor. The exact PET tracers in each
group may vary upon availability. In Thailand, they are F-18 FDG, Ga-68/F-18 PSMA and Ga-68
DOTATATE (Figure).
F-18 FDG, glucose analog, is a longstanding, most used PET tracer in most cancer types for more
than 2 decades. At the beginning, it adds view of functioning cancer to its volume. It helps evaluate
malignant mass not only size assessment but also malignant viability. It would continue to solely
occupy oncologist’s heart as a single broad-spectrum oncologic PET tracer if other tracers could
not prove themselves in the past recent years.
PSMA PET tracers are recently popular and fast-growing used, particularly for prostate cancer as
emphasized on its name (Prostate-Specific Membrane Antigen). Oncologist’s interest does not
end at the diagnosis yield because it could give additional radio-therapeutic option once found
positive PSMA PET or PSMA-avid lesion(s). This method is known as theranostic approach (diagnosis
plus therapy) or PSMA RadioLigand Therapy (PRLT) for prostate cancer, using, for example, Lu-177
PSMA etc.
Ga-68 DOTA-TATE is one of several PET tracers which target somatostatin (SST) receptors.
Neuroendrocrine neoplasm (NEN) is a rare disease which majorly expresses these SST receptors.
Radiolabeled SST analogs have been used prior PSMA radiopharmaceuticals; however, they seem
to be less utilized, likely due to lower disease-specific incidence. The theranostic agent for SST
receptors is called Peptide Receptor Radionuclide Therapy (PRRT), using, for example, Lu-177
DOTA-TATE etc.
31
PCIOC 2019
Figure1
32
BASIC SCIENCE RESEARCH (GENOMICS, PROTEOMICS AND METABOLOMICS):

PERSONALIZED NEOANTIGEN-BASED CANCER IMMUNOTHERAPY
Trairak Pisitkun, MD
Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Although advanced cancer therapeutics have already existed in recent years, the high failure and
low survival rate are still existent. The primary reason for the disappointment of those treatments
is possibly from the high heterogeneity of genetic background in different types of cancer as well
as in different individual patients. So, the unmet need for new treatment options that can be
tailored for each person is urgently required. Cancer immunotherapy has come to be a robust
approach for several types of cancer because it exploits our immune systems to attack cancer
cells, so it is a promising strategy to eliminate cancer. To develop personalized cancer immuno-
therapy such as cancer vaccine, it is essential to characterize the specific targets which can be
selectively recognized by the immune system. Cancer cells classically contain a high number of
somatic mutations that do not emerge in normal cells. Those mutated peptides can be presented
on the tumor cell surface in complex with human leukocyte antigen (HLA) class I protein; this
HLA-mutated-peptide complex could potentially be immunogenic and recognized by T cells as a
neoantigen. Therefore, identification of neoantigens is an essential step to improve the development
of cancer vaccine approach and help in the prediction of patient response to checkpoint inhibitors.
Here we discuss our progress in the development of personalized neoantigen-based cancer
immunotherapy.
33
PCIOC 2019
NEW FRONTIER IN LUNG CANCER
Thanyanan Reungwetwattana, MD, MSc

Department of Medicine, Faculty of Medicine Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
Even though, currently we have several novel and emerging therapies in lung cancer which improve
the survival and quality of life for patients, but we also have a lot of unanswered questions that
we need the global network research to explore the new knowledge. EGFR-TKI is the first effective
targeted drug for treatment in EGFR-positive patients. The prevalence of EGFR mutation in NSCLC
patients is higher in Asian population compared to the other population (55% vs. <20%). Currently,
there are 3 generations of EGFR-TKI approved in the market for treating EGFR-positive patients
specifically with sensitive mutation (exon19 deletion and exon21 L858R mutation) with the over-
all response rate of 60-70%. The acquired resistance could be occurred after 9-13 months of
treatment. The majority of this group of patients (50-60%) develops T790M as the mechanism of
resistance which is now we have the third-generation EGFR-TKI for overcoming this resistance.
The second approved targeted drugs for lung cancer is ALK inhibitors, which the history of
development is similar to EGFR TKIs. Nowadays we do have 5 ALK inhibitors in the market to treat
NSCLC with ALK fusion gene. The third and the forth targeted drugs are ROS inhibitor and BRAF
inhibitors which are already approved for NSCLC patients with ROS fusion gene and with BRAF
V600E mutation. Recently, larotrectinib was approved for treating NTRK fusion gene in solid tumor
including lung cancer. Moreover, the other oncogenic driven mutation (MET amplification, HER2,
PIK3CA mutation, RET, NTRK, FGFR fusion etc.) could be the target of treatment in NSCLC as well
as EGFR gene. Currently, the potential targeted drugs for inhibiting these oncogenic driven muta-
tions are developing in the early phase clinical studies.
Each region of the world has the different in prevalence of oncogenic driven mutations in lung
cancer. Our institute found the unique molecular profile in Thai lung cancer patients, which have
the high prevalence of BRAF V600E mutation (10%) and METexon14 splice site (9%). In this study,
we also found 68% (113/166) of EGFR mutation, 32.5% (54/166) of KRAS mutation, 4.8% (8/166)
AKT mutation (E17K), 2.4% (4/166) of ROS1 mutation, 0.6% (1/166) of PIK3CA mutation (H1047R),
and 0.6% (1/166) of PTEN mutation. We further validated the positive results by Real-Time PCR.
Immunotherapy is currently approved for treatment in NSCLC both in adenocarcinoma and
squamous cell carcinoma either with 1st or 2nd line treatment. The cost of the drug is one of the
key issues together with the other important problem that we have not known the true predictive
biomarkers for the immunotherapy. This is the urge of conducting the research to explore the real
predictive and prognostic biomarkers.
In summary, the journey of personalized treatment in lung cancer is the good prototype for the
cancer drugs development. I do believe that there will be the other effective emerging treatments
for lung cancer approved in the near future which would improve the long term survival and QOL
for patients.
34
NEW FRONTIER IN MANAGEMENT OF LUNG CANCER: RADIOTHERAPY ASPECT
Kanjana Shotelersuk, MD
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
Lung cancer is the leading cause of cancer death worldwide. Non-Small Cell Lung Cancer (NSCLC)
is approximately 80% of all lung cancer cases. Surgery has been considered standard treatment
in early stage NSCLC. However, radiation therapy is increasingly used, especially Stereotactic Body
Radiotherapy (SBRT) or Stereotactic Ablative Radiotherapy (SABR). It is an advanced radiotherapy
technique to precisely deliver high dose radiation per fraction in small number, usually 1-5, of
fractions. This technique has a radiobiological advantage in killing tumor cell. However, the suitable
condition, which is a tumor of a small size (4 cms or less) and located in peripheral lung, is required.
Several nonrandomized studies revealed good outcome of SBRT in early stage NSCLC. Local control
at 2-3 years ranged from 40-80% and 3-year overall survival is around 50-60%. Therefore, SBRT is
considered a standard of care for early stage medically inoperable NSCLC (T1-2, N0M0). Randomized
studies, STARS, ROSEL and ACOSOG trials are attempted in operable NSCLC to compare between
surgery and SBRT. Although there were not many patients recruited in these trials, the outcome
was encouraging. Pool analysis of STARS and ROSEL studies reported that 3-year Relapse Free
Survival and Overall Survival in SBRT arm was 86% and 95%, respectively. (1)
SBRT may be used cautiously in the tumor centrally located, 2 cms around the proximal bronchial
tree, because of higher risk of treatment-related toxicity to critical mediastinal structures. RTOG
0813 has recently published the outcome of dose escalating study of five fractions SBRT schedule
for centrally located NSCLC. The study revealed that radiation dose 50-60 Gy in 5 fractions is safely
delivered with high rate of tumor control. (2)
In locally advanced NSCLC, concurrent chemoradiation has been considered standard treatment.
However, the long term survival is not satisfied due to uncontrolled primary tumor in the lung and
distant metastasis. Recently, PACIFIC study, showed promising outcome of adjuvant systemic
immunotherapy after concurrent chemoradiation in locally advanced NSCLC. In the meantime,
advanced radiotherapy techniques trying to improve treatment outcome has also been studied.
Because radiation treatment target volume in locally advanced cases is quite large, delivering high
dose radiation could increase radiation toxicities to adjacent normal tissues including heart, normal
lung, spinal cord and esophagus. Advanced radiotherapy techniques including 3-Dimensional
Conformal Radiotherapy, Intensity Modulated Radiation Therapy (IMRT) and recently Proton
Therapy improve radiation dose delivery to the tumor. The physical property of proton, which is
a type of particle beam, has significant dosimetric advantages comparing to photon therapy or
X-ray beam. This results in decreasing radiation dose to critical normal structures. Since dose-
escalating trial of photon therapy from 60 to 74 Gy, RTOG 0617, showed disappointing outcome,
35
PCIOC 2019
using proton therapy to increase radiation dose to tumor while maintain radiation dose to normal
tissue might be beneficial in these patients. Favorable outcome of proton therapy has been
reported in early and locally advanced stage NSCLC. Recently, retrospective study from National
cancer Database Analysis of Proton therapy in NSCLC revealed better survival comparing with
photon therapy. (3)
In conclusion, new and advanced radiation techniques have become available. Ongoing and future
studies are required to determine their optimal use.
References:
1. Chang JY, Senan S, Paul MA, et al. Stereotactic Ablative Radiotherapy versus Lobectomy for Operable Stage I
Non-Small-Cell Lung Cancer: A Pool Analysis of Two Randomized Trials. Lancet Oncol. 2015: 630-7.
2. Bezjak A, Paulus R, Gaspar LE, et al. Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy
Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/ RTOG 0813 Trial. J Clin Oncol. 2019:
1316-25.
3. Higgins KA, O’Connell K, Liu Y, et al. National cancer database analysi of proton versus photon radiation therapy
in non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2017: 128-37.
36
CURRENT CONCEPT IN MANAGEMENT OF HIGH-RISK PROSTATE CANCER
Choosak Pripatnanont, MD1,

Julin Opanurak, MD2,
Kittinut Kijvikai, MD3,
Thawatchai Taweemonkongsap, MD4
1
Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
2
3
4
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
The definition of high-risk prostate cancer is still heterogeneous, but it is most commonly defined
as men having one or more of these features: initial PSA >20 ng/ml, biopsy Gleason score >7, and
clinical stage T≥2c. High-risk prostate cancer is clearly the most concerning form of localized
disease with 35.5% cumulative mortality at 15 years. For many years an aggressive local therapy,
either by external beam radiotherapy (EBRT) or surgery, was offered as principal or sole therapy
for high-risk PC patients. The field is now in evolution, with more promising results from multi-
modal therapies next to EBRT or RP. This session will review in detail of treatment based on current
guideline and practice including case discussion.
37
PCIOC 2019
COLORECTAL CANCER PREVENTION AND SCREENING
Bunchorn Siripongpreeda, MD
Department of Surgery, Chulabhorn Royal Academy, Bangkok, Thailand
Colorectal cancer was one of the five most common cancers found in many countries included
Thailand, and it also was the leading cause of cancer deaths for years. Accumulating knowledge in
carcinogenesis of this cancer afforded progression in management to control disease. There were
several modalities for detection of known steps in carcinogenesis. Each screening modality had
more benefit than others by its character and aspect. If approach in precancerous stage with further
additional proper management such as colonoscopy with polyp removal had been done, this
would prevent formation of new colorectal cancer cases. Detection of earlier staged cancer added
more survival benefit to patients. Some developed countries with high disease incidence applied
some interventions for colorectal cancer screening as national policy and seemed to success in
decrease incidence and mortality of this disease. So colorectal cancer appeared to be one of the
preventable cancers in health care management. Unfortunately, the intervention with high yield
that needed to be handled for control colorectal cancer was invasive, resumed numerous resource
and skills. Many people refused the offered uncomfortable and fearfully presumed intervention
and more were inaccessible status or unaffordable health service, the incidence of this disease
continued showing increment or not obvious decrease in many countries. Challenges in development
of better screening method and strategy for colorectal cancer control were gradually invaded by
flood of multidisciplinary related data.
38
CURRENT AND FUTURE PROSPECTIVES OF RECTAL CANCER MANAGEMENT:

RADIOTHERAPY ASPECT
Keeratikarn Boonyawan, MD
Department of Therapeutic and Diagnostic Radiology, Faculty of Medicine Ramathibodi Hospital,
The management of rectal cancer has been changed continually either surgery or concurrent chemo-
radiation (CCRT). According to the phase III randomized control trial from Germany1 demonstrated
the superior outcomes of pre-operative CCRT including local control, sphincter preservation and
toxicity when compared with post-operative CCRT. Pre-operative CCRT is the standard treatment
of patients with stage II and III rectal cancer; however, the benefit of pre-operative CCRT for those
patients who have favourable features such as T1-2N1, T3N0 and upper rectal cancer remains
controversial. Moreover, many unclear issues needed further investigation such as the use of
chemotherapy, role of surgery for patients who achieve pathological complete response and the
use of particle beam.
Reference:
1. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemo-
radiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III
trial after a median follow-up of 11 years. J Clin Oncol. 2012;30:1926-33.
39
PCIOC 2019
NEW TRENDS OF TARGETED THERAPY AND IMMUNOTHERAPY

IN BREAST CANCER
Archara Supavavej
Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science,
Chulabhorn Royal Academy, Bangkok, Thailand
Her2 positive breast cancer is the first example of targeted therapy in breast cancer treatment. In
1998, Trastuzumab, a humanized monoclonal antibody targeted at the extracellular domain of
the transmembrane receptor Her2, was first approved for treatment of Her2 positive metastatic
breast cancer. Her2 and Her3 dimerization was the second target for Her2 positive breast cancer.
Pertuzumab combined with Trastuzumab was the comprehensive Her2 dual blockade. Cleopatra
study reported significantly improved both progression free survival and overall survival with
Pertuzumab plus Trastuzumab plus Docetaxel compared with Trastuzumab plus Docetaxel.
Consequently, Pertuzumab in combination with trastuzumab and Docetaxel became the standard
of care for the first line for recurrent/metastatic Her2 positive breast cancer since 2012.
Lapatinib, reversible EGFR (Her1) and Her2 dual Tyrosine kinase inhibitor, in combination with
capecitabine was superior to capecitabine alone in Her2 positive advanced breast cancer that
progressed after anthracycline, taxanes and trastuzumab as EGF104900. Six year later, Trastuzumab
emtansine-1 (T-DM-1), Anti-Her2 Antibody (Trastuzumab) drug conjugated with Emtansine
classified as tubulin inhibitors, could improve both the progression free survival and the overall
survival to lapatinib plus capecitabine as EMILIA study in 2013. To date, T-DM-1 was approved for
the second line for Her2 positive recurrent/metastasis breast cancer.
In setting of adjuvant therapy, Hera study was published in 2006. One year after adjuvant Trastu-
zumab was approved for treatment of Her2 positive early breast cancer. In 2011, concurrent
Trastuzumab with chemotherapy became the standard of care for Her2 positive in early breast
cancer as Joint analysis data of NCCTG N-9831 and NSABP B-31. Pertuzumab and trastuzumab
improved disease free survival above trastuzumab alone in APHINITY trial. T-DM-1 was also
approved for residual Her2 positive early breast cancer after neoadjuvant chemotherapy plus
anti-Her2 drug and surgery as Katharine study in 2019. Neratinib, an irreversible Pan Her (EGFR,
Her2 and Her 4) receptor tyrosine kinase inhibitor, demonstrated benefit of extended 1 year of
adjuvant Neratinib after completion of adjuvant trastuzumab for 1 year with moderate adverse
effects.
Triple negative breast cancer (TNBC) is another subtype of breast cancer that never has targeted
treatment in the last two decades. Until now there have been three novel targets for TNBC. To
begin with PARP (Poly ADP Ribose Polymerase) inhibitor, the second is androgen receptor blockade
and the last is immune checkpoint inhibitors.
PARP inhibitor has an activity in BRCA gene related cancer such as ovarian cancer or breast cancer.
Most common subtype of BRCA1/2 related breast cancer was triple negative breast cancer. Loss
of function of BRCA gene resulted in defective homologous recombination. Synthetic lethality can
40
be achieved when using PARP inhibitors in this setting. Concurrent tumor intrinsic BRCA loss of
function and pharmacologic PARP inhibition effects tumor cell death with high therapeutic index.
Olympiad is the first phase III study of Olaparib in advanced Her2 negative breast cancer with
BRCA gene mutation with prior two chemotherapy regimens and was presented in ASCO 2017.
Olaparib improved progression free survival significantly compared to standard of care chemotherapy.
Subgroup of triple negative breast cancer had more significantly benefit above Hormone positive
Her2 negative breast cancer. Talazoparib is the second drug approved in advanced Her2 negative
breast cancer with BRCA gene mutation as the result of EMBRACA study in 2018. Both studies
provided the undistinguishable results.
Androgen receptor blockade is the second target of TNBC treatment. Luminal androgen receptor
subtype was identified in TNBC from gene expression microarray based studies; there is a high
expression of androgen receptor messenger RNA in addition to downstream androgen receptor
targets and co-activators. Androgen receptor inhibition was postulated for antitumor activity.
Abiraterone and Enzalutamide were studied in phase II clinical trials. Both provided impressive
results with 6 months clinical benefit rate of 20% and 29%, respectively. The ENDEAR study, Phase
III clinical trial of Enzalutamide was initiated in 2016.
Immune checkpoint inhibitor was mentioned in TNBC due to twenty percent of triple negative
breast cancer has immunomodulatory subtype which expressed genes that involved in immune
systems. Early stage Triple negative breast cancer has high levels of tumor infiltrating lymphocytes
(TILs) which represented better prognosis. TILs significantly contribute gene expression profile
and present immune checkpoint gene such as Program cell Death 1 (PD-1) and Program cell Death
Ligand 1 (PD-L1). T-cell checkpoint inhibitor promotes antitumor immune response and has an
impressive efficacy data across many tumor types including TNBC.
Pembrolizumab, anti-PD-1 checkpoint inhibitor, monotherapy has an overall response rate of

18.5% in multicohort phase 1B study for PD-L1 positive metastatic TNBC. Phase II study (Keynote
086) preliminary reported Pembrolizumab as the first line treatment of metastatic TNBC provided
the overall response rate 23% with three patients achieved complete response. Phase III study of
Pembrolizumab monotherapy in previously treated metastatic TNBC (Keynote 119) was completely
recruited by the end of 2017. Atezolizumab, anti-PD-L1 checkpoint inhibitor, as a single agent
in phase IA showed efficacy in metastatic TNBC with an overall response rate of 33%.
Combination of chemotherapy and immunotherapy may be promising in TNBC. Chemotherapy

can enhance immune response to cancer and synergize with immunotherapy. Phase I B study of
Atezolizumab plus Nab paclitaxel showed promising data in the first line metastatic TNBC with
71% of overall response rate. Phase III study of Atezolizumab and Nab Paclitaxel (Impassion 130)
showed significantly improved progression free survival in all TNBC and PD-L1 positive groups.
So it was approved as the first line treatment of metastatic TNBC.
The Future trends of targeted therapy and immunotherapy still have many ongoing clinical
studies. Immune checkpoint inhibitor can change the paradigm of TNBC treatment in the next few
years.
41
PCIOC 2019
ADVANCES IN BREAST CANCER RADIOTHERAPY
Kitwadee Saksornchai, MD
Division of Therapeutic Radiology and Oncology, Department of Radiology,
In the early era of the breast cancer radiotherapy, the radiotherapy was done by a fluoroscopic
simulator in two dimensional images (X-ray) using bony outline that’s difficult to verify the location
of the tumor and the exact radiation dose to nearby organ tissue. Many years later, the computed
tomography (CT) imaging had been developed and implemented in the radiotherapy. With CT
planning, we are able to identify the location of tumors and organs at risk. We can assure the
target coverage and dose distribution.
The novel techniques such as intensity modulated radiotherapy (IMRT) or volumetric modulated
radiotherapy (VMAT) have been approved in terms of conformality achievement to the target
volume and dose reduction to normal nearby organs such as lungs and heart in the breast cancer
radiotherapy.
The late toxicity from breast irradiation such as cardiotoxicity has been becoming a concern. A
study from Darby showed that the risk of major coronary events increased 7.4% per 1 gray of the
median heart dose. Many techniques have been applied to reduce the heart dose. For example,
prone position has been favored in patients with pendulous breasts and provided significantly
lower in the lung and heart doses. Deep inspiration breath hold (DIBH) allowed the large distance
between the chest wall and the heart and associated with significant improvement in heart dose.
However, this technique could be used in patients who are able to hold their breathing during the
treatment.
Furthermore, the shortening time of treatment has also been proposed in terms of time reduction
and breast tumor biology. ASTRO guideline 2018 has recommended that hypofractionation can
be used in the whole breast irradiation both in ductal carcinoma in situ and invasive cancer. Partial
breast irradiation is an alternative treatment for selected low risk patients.
Finally, the proton therapy which is a particle beam therapy in breast irradiation is feasible without
excessive toxicities and significantly improves lung and cardiac dose, especially in left sided patients.
In conclusion, the radiation technique in breast irradiation has immensely progressed over the
years. All of those techniques are personalized tumor dose distribution with lowest normal organ.
42
RECENT ADVANCE AND FUTURE TRENDS IN THERAPY

FOR HORMONE RECEPTOR POSITIVE BREAST CANCER
Thitiya Dejthevaporn, MD
Medical Oncology Unit, Department of Internal Medicine, Faculty of Medicine
Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Approximately two-thirds of breast cancers are hormone receptor (HR) positive. Although many
patients diagnosed with early stage disease are cured, HR positive tumors are notorious for a
lifelong relapse risk that is unpredictable. Once recurrence occurs, it is unlikely to be cured. En-
docrine therapy has been the mainstay of treatment and it plays a crucial role of maintaining
disease control, delaying the need for chemotherapy, and preserving quality of life. In general, in
the absence of a visceral crisis, two to four lines of endocrine therapy (ET) may be attempted
before resorting to cytotoxic chemotherapy. Historically, median survival of patients with HR
positive MBC has been reported to range between 16 and 26 months. Both de novo and acquired
resistance to initial ET lead to endocrine resistance. Several mechanisms of resistance have been
identified such as ESR 1 mutation, upregulation of the growth and survival pathway, phosphoino-
sitide 3-kinase (PI3K)/Akt/mTOR, cyclin D1 overexpression, and HER2 overexpression. Recently,
a changing concept of treatment from sequential single agent therapy to combination therapy is
evident based on an improvement in understanding of pathway activation and treatment resis-
tance. However, optimal sequencing of these therapies is evolving. Although each of these com-
binations improves progression-free survival, none with the exception of anastrazole plus fulves-
trant have demonstrated improved overall survival. Moreover, they are associated with an increased
risk of potentially serious and early‐onset class‐specific toxicities which would require closer
monitoring and patient education.
Improved biomarkers to better identify and eventually be able to individually select patients for
given treatments on the basis of accurate prediction of response and resistance are important
subjects of current and future research efforts.
In conclusion, tremendous efforts to understand the biological mechanisms of hormone therapy

resistance, with the ultimate goal of implementing new therapeutic strategies to improve the current
treatments for ER positive breast cancer are ongoing. Novel drugs and combination therapy have
proven benefit but more researches are needed to further optimize patients’ outcome.
43
PCIOC 2019
PANEL DISCUSSION ON CASE-BASED APPROACH

FOR HEPATOCELLULAR CARCINOMA
Paramin Muangkaew, MD
Hepato-Pancreato-Biliary Division, Department of Surgery,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
Hepatocellular carcinoma (HCC) is the common cancer of Thai population. The treatment of HCC
has been continuingly developed and surgery is still an important treatment of HCC. Due to many
presentations of HCCs, multifocal lesion, large single lesion or HCC with extensive invasion, the
surgical techniques and adjunctive treatment should be discussed in multidisciplinary team.
44
INTEGRATING PALLIATIVE CARE INTO SPECIALIZED CARES:

WHEN, WHY AND HOW? -PEDIATRIC PALLIATIVE CARE
Chusana Khaiman, MD
Cheewabhibaln Palliative Care Center, King Chulalongkorn Memorial Hospital,
Bangkok, Thailand
Pediatric palliative care service in King Chulalongkorn Memorial Hospital has been established and
served approximately 70 patients per year with advanced illness. The majority of our patients
were diagnosed with pediatric cancers. We provided great benefits for children and bereaved
families. They could take the advantages from multidisciplinary team approach to receive the
information of clinical outcome, disease trajectory and their lives as a whole. Comprehensive
palliative care service in wards, outpatient clinics, home visit programs could provide continuity
of care and support the family distress. We tried to fulfil their wishes as much as possible. Even
for patients in the terminal phase who desired to pass away at their homes or nearby hospitals,
we contacted community-based health care service. This helped the families to build-up their
relationship early and provided the important information to the primary care team.
The key of success was the dedication of team. We made a lot of effort to follow up patients
regularly especially in-home care setting to assess clinical/psychosocial needs at homes. For patients
who needed to be admitted to primary hospital, we tried to contact with the local team to visit
our patients. This could support the families, non-abandon care. The patients’ symptoms would
be effectively controlled by palliative care specialist recommendation. We also empowered the
local teams to increase their potentials in palliative care. This is the important factors that provide
end-of-life care at community-based setting seamlessly with tertiary hospital.
However, there are some barriers about integration pediatric palliative care service in our institute.
From our experience, active total care that aims for quality of life usually is performed very late
at the terminal stage of diseases due to limited resources (e.g. lack of educational medical staffs,
assessment tools and budget). Therefore, we design the project that can reduce barriers and
effectively integrate palliative care service parallel with the disease modifying treatment.
The methodology will run step by step.
Step 1 for health care professionals: we will raise awareness, promote them to understand
philosophy of palliative care and be able to identify early palliative care needs in all children with
advanced illness. We plan to provide palliative care workshop, regular educational activities and
practical tools/materials.
Step 2 for patients: we plan to set up child life, psychosocial service for children with advanced
illness to early integrate quality of life care by promoting child life/psychosocial professional train-
ing in year 1 and build-up team consultation service in year 2.
45
PCIOC 2019
Step 3 for parents: we plan to initiate novel activities for parent (e.g. education class, parent
support group) that will improve quality of care to their beloved child, promote adaptation to the
child’s illness and practicing self-care.
We hope our program will bring better quality of life to our patients, fulfil their wishes earlier and
give them more happy time with their families. Beside intra organizational benefits, this will serve
as a role model to many hospitals in Thailand.
46
INTEGRATING PALLIATIVE CARE INTO SPECIALIZED CARES:

WHEN, WHY AND HOW?
Kittiphon Nagaviroj, MD
Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital,
Palliative care is specialized medical care for people with serious illnesses. According to the WHO,
the main purpose is to improve the quality of life of patients and their families, through the pre-
vention and relief of suffering by means of early identification and impeccable assessment and treat-
ment of pain and other problems, including physical, psychosocial and spiritual issues. Palliative
care is appropriate at any age and at any stage in a serious illness, and can be provided together
with curative treatment. Patients with cancer make up a significant portion of those people who
have a high symptom burden and/or with advanced illness. Of all patients with metastatic cancer,
nearly half have incurable diseases but they can live for years after initial diagnosis. Palliative
management focuses on the care of patients with advanced illness or a significant symptom bur-
den by emphasizing medically appropriate goal setting, honest and open communication with
patients and families.
The Faculty of Medicine Ramathibodi Hospital, Mahidol University, has had a project on the
development of palliative care for people in the Bangkok metropolitan area beginning in 2010.
The project is aimed at the integration of palliative care services into mainstream medicine by
providing a variety of services, including inpatient consultation, palliative care clinic, telephone
consultation, a 6-bed palliative care unit as well as providing home-based palliative care. In 2018,
around 1,100 patients and their families participated in our program. During this session, we will
demonstrate how we align palliative care service with oncology care and address the key success
factors as well as challenges for future direction.
47
PCIOC 2019
INTEGRATING PALLIATIVE CARE INTO SPECILIZED CARE,

WHEN, WHY AND HOW?
Pratamaporn Chanthong, MD
Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
WHO defines palliative care as “An approach that improves the quality of life of patients and their
families facing the problems associated with life-threatening illness, through the prevention and
relief of suffering by means of early identification and impeccable assessment and treatment of
pain and other problems, physical, psychosocial, and spiritual”. Palliative care services include
establishing goal of care, symptom control, and psychosocial, spiritual and bereavement support.
Palliative care is an interdisciplinary approach; assist patients and families control over their care
plans and in receiving care in the setting most appropriate to their needs and resources by coor-
dinating care throughout the illness. Many studies have shown that palliative care services improve
patients’ symptoms and quality of life, allow patients to be cared at home, avoid hospitalization
and improve coping skills of patients and family through the end of life.
It is now recognized that the principles of palliative care are applicable earlier in the course of
serious illness and palliative care should be provided alongside the disease treatment. The American
Society of Clinical Oncology published the integration of palliative care into standard oncology
care guideline recommended that “inpatients and outpatients with advanced cancer should receive
dedicated palliative care services concurrently with active treatment in the early course of disease”.
Palliative care approach for patients with advanced cancer should therefore occur as early as
possible, rather than be reserved until the last days of life.
Palliative care services can be provided in the hospital, ambulatory setting, and community-based
services. Models of hospital-based palliative care services include palliative care consult services,
dedicated palliative care units and integrated palliative care models in the services. Communi-
ty-based services include the continuity care of patients who were discharged from hospital,
coordination of home care needs, including housing, transportation, and equipment. These services
can be provided within the home and coordinate within an outpatient clinic. The optimal palliative
care model for an individual institution is determined by several factors and resources.
48
ROLE OF SYSTEMIC THERAPY IN GLIOMA MANAGEMENT
Iyavut Thaipisuttikul, MD
Chulalongkorn Comprehensive Cancer Center, King Chulalongkorn Memorial Hospital,
Bangkok, Thailand
Diffuse gliomas are a group of primary brain tumors which consists of infiltrative astrocytic and
oligodendroglial tumors. Surgical management, radiotherapy (RT) and systemic therapy are the
mainstay for glioma treatment. The role of systemic therapy for gliomas has become significant
since the publish of the landmark Stupp’s trial (EORTC 26981–22981/NCIC CE3) in 2005. Despite
advances in the understanding of glioma biology, the current standard therapy for glioblastoma
still consists of maximal surgical resection followed by concomitant radio-chemotherapy and ad-
juvant therapy with temozolomide (TMZ). The result of this approach, however, is still far from
optimal. The new glioma classification which integrates molecular diagnostics into routine histo-
pathological method plays important role in tumor management under various circumstances.
Treatment decision for glioblastoma in elderly may depend on the result of MGMT promoter
methylation testing. The addition of adjuvant PCV chemotherapy to RT has become a standard of
care for IDH-mutant low-grade glioma and IDH-mutant/1p/19q-codeleted anaplastic oligodendro-
glioma in many regions of the world. There is evidence from CATNON trial to support the use of
12-cycle adjuvant temozolomide chemotherapy after RT for IDH-mutant, 1p/19q-non-codeleted
anaplastic astrocytoma. Whether treatment with TMZ as in Stupp’s regimen for glioblastoma can
be used for IDH-mutant/1p/19q-codeleted anaplastic oligodendroglioma is still pending the result
of modified CODEL trial.
There is no standard of care for treatment of recurrent gliomas. Treatment decisions depend on
tumor location, grading of tumor at recurrence, treatment received at initial diagnosis and per-
formance status. Systemic therapy is often the only available option for recurrent glioblastoma
due to the risk of retreatment with surgery and RT. Cytotoxic chemotherapy can be used such as
re-challenged TMZ, nitrosoureas, platinum, and oral etoposide. Bevacizumab, a monoclonal an-
tibody against the vascular endothelial growth factor receptor, was approved by U.S. FDA for use
in recurrent glioblastoma in 2009. The initial radiographic response and disease control are tran-
sient. Most patients develop tumor progression after a median of 3–5 months.
More recently, there is excitement that immunotherapy, such as immune checkpoint inhibitors,
peptide vaccines, DC vaccines and adoptive t cell therapy may be an effective option for glioma
patients. Benefits and adverse effects of are still being explored in clinical trials.
49
PCIOC 2019
PATHOLOGICAL DIAGNOSIS OF GLIOMAS
Shanop Shuangshoti, MD
Department of Pathology and Chulalongkorn GenePRO Center, Faculty of Medicine,
Since the recent World Health Organization (WHO) classification of tumors of the central nervous
system (CNS) issued in 2016, molecular parameters have been incorporated into the classification
and routine diagnosis of gliomas. In adults, IDH mutation has linked diffuse astrocytomas to oli-
godendrogliomas, and separated them from other astrocytic tumors e.g. pilocytic astrocytoma.
IDH mutation test by immunostain and/or molecular assay is now required for diagnosis of diffuse
gliomas. 1p/19q co-deletion and IDH mutation are now needed to establish the diagnosis of oli-
godendroglial tumors. With ancillary tests, most of the cases previously diagnosed as mixed glio-
mas (oligoastrocytoma and anaplastic oligoastrocytoma) could be re-classified into either oligo-
dendroglial or astrocytic linage. Thus, the diagnosis of “mixed glioma” is discourage. Epithelioid
glioblastoma has been shown to carry BRAF 600E mutation in about haft of the cases. Diffuse
midline glioma, H3 K27M-mutant (WHO grade IV) with various morphological features from low-
to high-grade, and RELA fusion–positive ependymoma, have been proposed. More recently,
cIMPACT-NOW (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor
Taxonomy) has been established to provide a forum to evaluate and recommend proposed chang-
es to future CNS tumor classifications. The term “Diffuse astrocytic glioma, IDH-wildtype, with
molecular features of glioblastoma, WHO grade IV” has been introduced for diffuse and anaplas-
tic astrocytic gliomas without IDH mutation but demonstrate at least one of the following genetic
features: EGFR amplification, whole chromosome 7 gain and whole chromosome 10 loss (+7/-10),
and TERT promoter mutation. The term “diffuse midline glioma, H3 K27M–mutant” is now re-
stricted to tumors that are diffuse/infiltrating, midline gliomas, with H3 K27M-mutant, and should
not be applied to other tumors (e.g., ependymomas) that carry H3 K27M mutation. Several other
genetic features are being evaluated in gliomas, and more molecular tests will be required for
diagnosis and classification of CNS tumors in the next WHO book. In Thailand, molecular diagno-
sis has largely been driven by drugs. Not infrequently, molecular signatures with impact on diag-
nosis and prognosis are ignored. Cost of tests and re-imbursement issue appear to be one of the
important factors.
50
CANCER PAIN MANAGEMENT IN RADIATION THERAPY
Sasikarn Chamchod, MD
Radiation Oncology Department, Faculty of Medicine and Public Health,
Two-thirds of patients with metastatic cancer experience pain. Pain can significantly decrease
quality of life in cancer patients. Pain may result from tissue damage caused by the tumor, such
as bone destruction by a metastasis or direct invasion. Radiotherapy is the most effective onco-
logical treatment of cancer pain. In the treatment of bone metastases, the pain-relieving efficacy
of both external radiotherapy and systemic radionuclide therapy is well documented. Radiotherapy
is also effective in treating pain caused by soft-tissue tumors, although only a limited number of
studies have investigated its efficacy in relieving pain caused by soft-tissue tumors. The mechanism
behind the pain-relieving effect of radiotherapy is incompletely understood. There is no direct
correlation between the effectiveness of radiotherapy and the radiosensitivity of the tumor or the
dose administered. Tumor shrinkage and inhibition of the release of chemical pain mediators seem
to be the main mechanisms by which radiotherapy acts. The rapid onset of pain relief is attributed
to the decrease of various chemical pain mediators, whereas tumor shrinkage and recalcification
of osteolytic bone lesions contribute to the long-lasting effect.
Single-fraction treatment (8 Gy) is as effective as a multifraction regimen with 20 Gy in 5 fractions

or 30 Gy in 10 fractions. There are no differences between single- and multifraction therapy in the
time to initial improvement in pain, time to complete pain relief, or time to first increase in pain
at any time up to 12 months from randomization, nor in the class of analgesics used. However,
time to treatment failure seems to be shorter after single-fraction treatment. There is no difference
in quality of life or side effects between the different fractionation schedules. Acute grade II–IV
toxicity seems to be more common among patients receiving fractionated radiotherapy; late tox-
icity of palliative radiotherapy is rare.
In a Cochrane analysis, radiotherapy produced complete pain relief in 25% of patients and at least
50% relief in 41% of patients at some time during the trials. The number-needed-to-treat (NNT)
to achieve complete relief in one patient at 1 month was 4.2 (95% CI 3.7–4.7).
51
PCIOC 2019
Synopses of Day-2 Presentations

CANCER OF UNKNOWN PRIMARY
Therasakvichya S
LONG-TERM EFFECTS FOR PEDIATRIC CANCER SURVIVORS

Sanpakit K
SOFT TISSUE SARCOMA IN ADOLESCENTS AND YOUNG ADULTS

Techavichit P
NEW FRONTIER IN RADIOTHERAPY FOR CERVICAL CANCER

Sitathanee C
IMMUNOSUPPRESSIVE THERAPY IN SUBCUTANEOUS PANNICULITIS-LIKE T-CELL LYMPHOMA

Bunworasate U
ENGINEERED T CELL EXPRESSING CHIMERIC ANTIGEN RECEPTOR AGAINST CD19

ON LYMPHOID MALIGNANCIES
Anurathapan U
MOVING TOWARDS PERSONALIZED TREATMENT IN HEAD AND NECK CANCER:

MEDICAL ONCOLOGY ASPECT
Vinaynauwattikun C
HEAD AND NECK CANCER (RADIOTHERAPY)

Pattaranutaporn P
HEAD AND NECK CANCER

Pongsapich W
SLEEP PROBLEMS IN CHILDREN WITH CANCER

Patoomwan A
THE BENEFIT OF SCALP COOLING FOR REDUCING HAIR LOSS IN BREAST CANCER
PATIENTS RECEIVING CHEMOTHERAPY
Piriyajittrakornkij P, Tamthong K
52
NURSING INTERVENTION PROGRAM FOR PATIENTS WITH CANCER SYMPTOMS

Thamnipa P, Thananowan N, Uppagan R, Viriyapak B
FACTORS INFLUENCING VENOUS PAIN IN PATIENTS WITH CANCER RECEIVING GEMCITABINE

Sriwisai R
SKIN CANCER UPDATES

Eimpunth S, Chayavichitsilp P, Desomchoke R, Pongprutthipan M
RETINOBLASTOMA IN THAILAND: PAST, PRESENT, AND FUTURE

Rojanaporn D
UPDATES ON TUMOR IN OPHTHALMOLOGY: RETINOBLASTOMA PATHOLOGY

Tulvatana W
MANAGEMENT OF BONE METASTASIS IN EXTREMITIES

Chandhanayingyong C

Charoenlap C
MANAGEMENT OF BONE METASTASES IN EXTREMITIES: BONE ANTIRESORPTIVE AGENTS

Suwanpramote P
RADIATION THERAPY OF BONE METASTASIS IN EXTREMITIES

Chamchod S
PALLIATIVE CARE FOR PATIENTS WITH CANCER

Ananta-ard N
CHULABHORN HOSPITAL’S PALLIATIVE CARE MODEL

Boonchaue T
THAI NURSES’ PALLIATIVE CARE COMPETENCIES AT A GLANCE

Junda T
53
PCIOC 2019
CANCER OF UNKNOWN PRIMARY
Suwanit Therasakvichya, MD
Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital,
Cancer of unknown primary origin (CUP) is a heterogeneous group of metastatic tumors which

primary tumor site remains unidentifiable despite of extensive diagnostic work-up. The diagnostic
code for CUP patients from ICD-O-3 is C80. It accounts for 2‐5% of all new cancer diagnoses.1
The initial histological and immunohistochemical evaluation by the pathologist is to establish

the type of malignancy into carcinoma, lymphoma, melanoma, germ cell tumor or sarcoma.
Most cases of CUP are carcinomas which are divided into well or moderately differentiated
adenocarcinoma (60%), poorly differentiated adenocarcinoma or undifferentiated carcinoma
(29%), squamous cell carcinoma (5%), undifferentiated neoplasm (5%), and neuroendocrine tumor
(1%). Immunohistochemistry is capable of identifying the site of origin in < 30% of all CUP, with
limitation in small biopsy specimens/malignant effusions, and tumor heterogeneity.2
Autopsy studies provided information on proportional distribution of CUP. In an analysis of 12

post-mortem cohort studies (1944-2000), primary tumor site was identified in 644 (73%) out of
884 patients [lung 27%; pancreas 24%; liver or bile duct 8%; kidney or adrenal 8%; colorectal 7%;
genital tract 7%; stomach 6%; unknown 27%].
The diagnostic process in patients with CUP consists of taking a complete medical history including
family history of neoplasms. The complete physical examination must be done focusing specially
on head and neck region, rectum, and testes for males, and also breast and pelvic organs for
females.
Laboratory and radiological examinations consist of complete blood count, liver and kidney function
test, electrolytes (including calcium), and lactate dehydrogenase (LDH), beta human chorionic
gonadotropin (β hCG), alpha-fetoprotein (AFP), prostate specific antigen (PSA), computer
tomography (CT), positron emission tomography (PET), mammography or magnetic resonance
imaging (MRI) of the breast.
Application of molecular profiling assays is an option of diagnostic attempt when immunohisto-

chemical stains are unable to predict the tissue of origin. Validation with samples of known tumor
type yielded accuracy rate of 82-97%.3 However, it is difficult to confirm the site of origin in most
cases. Clinical judgement is required to interpret the result and determine the optimal management.
Treatment should be individually tailored for each clinical pathological profile. Between 15-20%
of CUP are defined as favourable prognostic subsets and should be treated similarly to patients
with equivalent known primary site with metastatic dissemination. However, mostly CUP had poor
prognosis and median overall survival of 6 months.3
54
CUP without presumable primary site, by histological and immunohistochemical evaluation, is an

immense clinical challenge, as the primary site of cancer influences treatment choices, outcome,
and prognosis. Molecular testing may provide information facilitating targeted therapies for CUP.
However, more data is needed to evaluate the effectiveness of treating CUP patients according to
molecular study results.
References:
1. Siriraj Cancer Registry 2017
2. Econopoulou P, Mountzios G, Pavlidis N, Pentheroudakis G. Cancer of unknown primary origin in the genomic
era: elucidating the dark box of cancer. Cancer Treat Rev. 2015;41:598-604.
3. Losa F, Soler G, Casado A, Estival A, Fernandez S, Gimenez S, et al. SEOM clinical guideline on unknown primary
cancer (2017). Clin Transl Oncol. 2018;20:89-96.
55
PCIOC 2019
LONG-TERM EFFECTS FOR PEDIATRIC CANCER SURVIVORS
Kleebsabai Sanpakit, MD
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Incidence of newly diagnosed cancers in Thai children less than 15 years old is approximately
1,000-1,200 cases/year. Advances in cancer treatment improve outcomes of these patients and
as a consequence, the number of childhood cancer survivors continues to grow. From study of
Thai Pediatric Oncology Group, the 5-year overall survival of these patients is 54.9% (95%CI:
53.0-56.9%) for all cancers. These long-term survivors of childhood cancer are at increased risk
for therapy-related late effects and late mortality. The Childhood Cancer Survivor Study (CCSS); a
large North American cohort study, revealed that 60% of long-term survivors had more than 1
chronic medical problems and 30-40% of them had 2 or more chronic medical problems. Moreover,
30% of these survivors had a severe (grade 3) or life-threatening or disabling (grade 4) chronic
condition.
The most common organ specific late adverse effect is long-term neurological complication. Most
neurological toxicity is related to central nervous system (CNS) tumors or cranial radiation and/or
CNS-directed chemotherapy (intrathecal or high dose intravenous methotrexate or cytarabine).
Long-term complications can affect many organs such as hepatic, renal, endocrine, cardiology, and
pulmonary systems. Patients who are treated at younger age are more common and severe to
acquire toxicities. Other risk factors for long-term complications depend on type of primary
malignancy, modality of treatment, type and dose of chemotherapy, dose and field of radiation
treatment, site and extent of surgery. Long-term follow up of growth, puberty, and psychosocial
aspect is also important because these patients can have delay growth or puberty, problem at
school, and behavioral or psychological problem. Another issue of concerning is second malignancy
from chemotherapy or radiation which can occur many years after completion of treatment.
In summary, prevalence of late effects after treatment of childhood cancer is significant. A long-
term follow up program for survivors of childhood cancer is therefore needed.
56
SOFT TISSUE SARCOMA IN ADOLESCENTS AND YOUNG ADULTS
Piti Techavichit, MD
Division of Hematology and Oncology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
Soft tissue sarcoma is a group of rare cancers comprise for less than 1% of all malignancies but
account roughly 10% of all cancers among patients who diagnosed during adolescent and young
adult (AYA) ages. Importantly, over half of all soft tissue sarcoma diagnoses occur in the AYA age
group. Survival from soft tissue sarcoma among AYAs is inferior to younger patients even in the
same histology subtype. Soft tissue sarcoma-related survival is low compared with other malig-
nancies in AYAs, and AYAs diagnosed with late stage sarcomas have poorer survival.
Several studies have suggested that outcomes for soft tissue sarcoma are improved when treated
by pediatric inspired protocol with multidisciplinary team approach. Neoadjuvant and adjuvant
chemotherapy follow by surgery are wildly recommended for bone sarcoma and Ewing family
tumor. While radiation therapy is indicated for Ewing family tumor. Chemotherapy is considered
the standard care for rhabdomyosarcomas, synovial sarcoma, and desmoplastic small round cell
tumors, but is not standard for other nonrhabdomyosarcoma subtypes, which local control is the
mainstay.
57
PCIOC 2019
NEW FRONTIER IN RADIOTHERAPY FOR CERVICAL CANCER
Chomporn Sitathanee, MD
Department of Radiology, Faculty of Medicine Ramathibodi Hospital,
Cervical cancer is the second leading cancer in Thai women. Radiotherapy can be used as a curative
treatment (definitive, adjuvant/postoperative) or palliative treatment. Curative treatment consists
of external-beam radiation, brachytherapy, and most of the time, concurrent platinum-based
chemotherapy. New developments in both external-beam radiation and brachytherapy aim to
improve tumor control and reduce treatment complications. Advanced imaging techniques
including CT scan, MRI, and PET/CT, that help us better define initial disease extension, in combination
with intensity-modulated radiotherapy (IMRT) and image-guided adaptive brachytherapy
(intracavitary and interstitial insertion) have been shown to increase radiation dose to the targets
and reduce normal tissue toxicity. Intensification of concurrent or sequential systemic therapy is
under evaluation.
58
IMMUNOSUPPRESSIVE THERAPY IN SUBCUTANEOUS PANNICULITIS-LIKE

T-CELL LYMPHOMA
Udomsak Bunworasate, MD
Division of Hematology, Department of Medicine, King Chulalongkorn Memorial Hospital
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare subtype of peripheral T-cell

lymphoma affecting younger patients. It is more common in females than males. Patients usually
present with multifocal subcutaneous nodules commonly at the extremities and trunk. Systemic
symptoms are seen in up to 50% of patients. Pathological findings show infiltrates of neoplastic
pleomorphic T-cells (CD3+, CD4-, CD8+, CD56-, βF1+ phenotype) and reactive histiocytes. The
neoplastic T-cells locate exclusively within the subcutaneous tissue. The disease often runs an
indolent course, although some patients may have life-threatening hemophagocytic syndrome.
Autoimmune disease may play a role in some patients. Immunosuppressive therapy with
cyclosporine yields very good outcomes in SPTL, unlike other lymphomas, which require
chemotherapy. The molecular pathogenesis of SPTL is previously poorly understood. Recently,
our group suggests that SPTL is an inherited disease which is caused by bi-allelic germline mutations
in HAVCR2, encoding T-cell immunoglobulin mucin-3 (TIM-3). TIM-3 is a transmembrane protein
expressed on T and innate immune cells. TIM-3 acts as a negative immune checkpoint regulating
peripheral tolerance, anti-tumoral immunity, and innate immune responses. Loss of TIM-3
expression promotes uncontrolled immune activation and makes individual susceptible to SPTL.
The disease shows an autosomal recessive–inherited pattern. In addition to the germline mutations,
recurrent somatic mutations in the genes involved in epigenetic regulation and signal transduction
might be associated with clonal expansion of SPTL cells.
Reference
Polprasert C, et al. Frequent germline mutations of HAVCR2 in sporadic subcutaneous panniculitis-like T-cell
lymphoma. Blood Adv. 2019;3:588-95.
59
PCIOC 2019
ENGINEERED T CELL EXPRESSING CHIMERIC ANTIGEN RECEPTOR AGAINST

CD19 ON LYMPHOID MALIGNANCIES
Usanarat Anurathapan, MD
Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital,
Cancer is one of the leading causes of death worldwide. In Thailand, the incidence of childhood
malignant diseases was 74.9 cases per million. Leukemia and lymphoma were the most common
cancer in Thai children. Acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma expressing
a distinct antigen, CD19, are called B-cell lymphoid malignancies. More than a half of pediatric
patients with those diseases were cured and survived after standard treatments, including che-
motherapy and/or radiotherapy. Some of those patients have been successfully treated with
hematopoietic stem cell transplantation, either from allogeneic or autologous donors. However,
small number of patients, especially with relapsed or refractory B-cell lymphoid malignant diseases,
could not cured by any available standard treatments. Cellular immunotherapy is a promising
novel therapy for those patients. Interestingly, Chimeric antigen receptor (CAR)-modified
T lymphocyte has been recently FDA-approved for the treatment of ALL in children and diffuse
large B-cell lymphoma (DLBCL) in adults. We would like to establish the treatment for children
with ALL using CAR-modified T lymphocyte (CAR-T cell) against CD19-expressing leukemic cells.
We successfully generated a second generation of CAR-CD19 lentivirus, comprised of endodomains

of CD28 and CD3ζ as a co-stimulatory and a signalling domain, respectively. Furthermore, we use
a CH3 portion of an IgG2 as a hinge part to extend an antigen detection part, ScFV against CD19,
out of the surface of the engineered T lymphocyte. We assessed the expression of CAR-CD19
molecule in the modified T cells using Q-PCR; the transduction efficiency was averagely 41%. We
co-cultured our engineered T lymphocytes with CD19-expressing cancer cell lines, Raji, RS4 and
Sup-B15, which were specifically killed of 35-50%. Moreover, our modified T cells were expressed
high levels of interferon-gamma after co-cultured with those CD19-positive cell lines. We have
recently developed a phase1/2 clinical trial using our CAR-T cells in ALL pediatric patients who
receive stem cell transplantation from related donors. The CAR-CD19 T cells, generated from the
designated donors, have been produced in a GMP-compliant facility. Furthermore, those engineered
T lymphocytes have been evaluated according to the protocol, especially a release criteria including
viability, transduction efficiency, cytotoxicity and sterility, prior to administered to the volunteers.
Thus far, we generated the CAR-CD19 T cells for 6 enrolled volunteers, however we infused one
patient with a very low dose of our modified T lymphocyte. We have not found any adverse reactions
related to the CAR-CD19 T cell infusion in that patient.
In summary, we have generated a novel treatment for children with ALL using CAR-CD19 T cells.
We are exploring the safety and feasibility of this cellular immunotherapy in Thailand.
60
MOVING TOWARDS PERSONALIZED TREATMENT IN HEAD

AND NECK CANCER: MEDICAL ONCOLOGY ASPECT
Chanida Vinaynauwattikun, MD, PhD

Department of Medicine, Chulalongkorn University and
The King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Head and neck cancer is the sixth most common cancer, with high morbidity and mortality in
Thailand and worldwide. Multimodality treatment including surgery, radiation and chemotherapy
had been conducted for this deadly disease. Incorporate novel genetic testing, including
next-generation sequencing had been explored to elucidate molecular mechanisms that contributing
to oncogenesis, progression and metastasis. Most frequently mutated gene in head and neck
cancer squamous cell carcinoma (SqCA) included TP3 (67.5%), CDKN2A (16.7%), PIK3CA (16.5%),
NOTCH1 (8%), EGFR amplification. However, the genetic alterations that had been translated to
potential clinical impact was limited only integrated virus of HPV or EBV in viral-associated head
and neck cancer.
HPV-related oropharynx SqCA had diverse genomic pattern, biology, radiologic appearing and
outcome of treatment compare to HPV negative oropharynx. It had been stratified as difference
disease in latest 8th AJCC classification and represented favorable prognosis of disease outcome.
De-escalating treatment strategy had been explored in this selected population. However, latest
two phase III randomized control study in HPV-related locally advanced oropharynx SqCA; RTOG
1016 (1) and De-ESCALaTE trial (2) had been conducted to compare the efficacy of concurrence
cetuximab vs. high-dose cisplatin with radiation. The result of those 2 studies had consistent and
shown superiority of high-dose cisplatin in term of progression-free survival and overall survival.
However, further de-escalating strategy in early stage HPV-related SqCA has been currently con-
ducted.
Another effort to personized treatment is using plasma EBV viral load, the significant prognostic
biomarker in nasopharyngeal carcinoma (NPC). Detectable plasma EBV viral in locally advanced
NPC patient after complete radiation was explored to define benefit of adjuvant 6 cycle of
gemcitabine plus cisplatin compare to surveillance but did not demonstrate difference in relapse-free
survival (3). Various efforts of personalized treatment such as immunomodulatory agent and tar-
geted therapy guided by biomarker-driven might be novel treatment paradigm in head and neck
cancer.
References
1. Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, et al. Radiotherapy plus cetuximab or cis-
platin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised,
multicentre, non-inferiority trial. Lancet. 2019;393:40-50.
2. Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, et al. Radiotherapy plus cisplatin or cetux-
imab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label ran-
domised controlled phase 3 trial. Lancet. 2019;393:51-60.
3. Chan ATC, Hui EP, Ngan RKC, Tung SY, Cheng ACK, Ng WT, et al. Analysis of Plasma Epstein-Barr Virus DNA in
Nasopharyngeal Cancer After Chemoradiation to Identify High-Risk Patients for Adjuvant Chemotherapy: A
Randomized Controlled Trial. J Clin Oncol. 2018:JCO2018777847.
61
PCIOC 2019
HEAD AND NECK CANCER (RADIOTHERAPY)
Poompis Pattaranutaporn, MD
Department of Radiology, Faculty of Medicine Ramathibodi Hospital,
Radiotherapy has a significant role in head and neck cancer treatment both in early and locally
advanced stages. In the last decade, advanced radiation techniques with sophisticated individualized
planning such as IMRT or VMAT are accepted as standard of care, which could improve local control
and decrease long-term complications compared to conventional radiotherapy. Advance in
image-guidance system of radiotherapy machines make a significant improvement in accuracy
and precision of radiation delivery which allows radiation to be delivered in smaller margin and
more of normal tissue could be spared. However, radiation therapy with x-ray beam is almost
reached its physical properties limitation. Proton and other particles are now emerging, and size
and cost of the machine are reduced, making it more available in hospitals and cancer centers.
With its special property called Bragg’s Peak, it could deliver a higher dose of radiation to targets
while decreasing radiation dose to surrounding organs. Not only the machine but planning system
is also improved. Better tumor visualization with better oncologic imaging such as MRI and PET/CT
are more available and used in clinics. Biologic and physiologic imaging such as hypoxic imaging
with PET/CT are used to identify the area for dose escalation. There is more evidence coming to
prove the benefits of the advanced imaging.
Since head and neck cancer treatment is required multidisciplinary approach, there is no one best
treatment for all patients. The selection of modalities is now could be more individualized based
on information of biologic and genetic markers such as overexpression of p16 status. However,
these bio-molecular testing might not represent the behavior of the whole tumors. With the
advancement of imaging technologies, computer sciences and data sciences, there is emerging
approach called “Radiomics” which objectively measures the phenotypic expression of tumors by
extracting features from imaging studies. It is now in a beginning stage but the early results are
promising.
62
HEAD AND NECK CANCER
Warut Pongsapich, MD
Nowadays, robotic system becomes a novel device in operative frontier to combat against many
diseases including head and neck cancer. Although overall incidence of upper aero-digestive tract
tumors seem to be slightly decreased, that of oropharyngeal tumor seems rather to be increased.
The epidemiological pattern was explained by reduction of alcohol and smoking consumption but
an increase in HPV-related carcinoma.
According to data from the 1990s, chemoradiotherapy treatment of oropharyngeal cancer could
yield equivalent oncological outcomes, when compared to classical open surgery, with less
morbidity. Nevertheless, the disadvantages of non-operative treatments are severe mucositis,
gastrostomy and/or tracheostomy dependence.
Following FDA clearance of transoral robotic surgery (TORS) in 2009, the trend of T1/T2
oropharyngeal cancer feasibly returns to surgical resection. The primary aim of TORS is to provide
adequate local disease control with appropriate functional outcomes, good quality of life, and
cosmetic. The procedure may be an alternative to non-surgical modalities, particularly for patients
intolerable to drugs toxicity or morbidity associated treatments. Whilst, TORS is also an ideal for
salvage therapy in residual/recurrent diseases. Thus, robotic surgery in head and neck surgery is
much beneficially attributed to its minimally invasive nature, with lower rate of complications,
such as radiation-related mandibular necrosis, carotid exposure, and orocutaneous fistula.
Up until now, TORS has been operated in more than 40 patients in Siriraj Hospital. Most of the
patients were diagnosed with oropharyngeal or supraglottic cancer. Preliminary data showed one
serious surgical associated event which was delayed postoperative bleeding. No patient requires
additional tracheotomy after TORS, while only few of them need long term gastric feedings.
Moreover, the oncological outcomes were comparable to standard treatment protocols.
A number of publications confirm the critic role of TORS as a novel modality for surgical treatment
of head and neck cancer. Additionally, knowledge sharing, team training, and technology refinement
are essential for quality improvement of surgical outcomes. Hence, a comprehensive understanding
from both our own perspective and relating specialties is crucial for the multidisciplinary team
approach.
63
PCIOC 2019
SLEEP PROBLEMS IN CHILDREN WITH CANCER
Autchareeya Patoomwan, RN, PhD (Nursing)

Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital,
Sleep is a complex physiologic process which is vital for life. Although the basic function of sleep
remains unknown, most of the biologic controlling system of sleep involve central nervous system
components which are nuclei in the hypothalamus, brainstem, and basal forebrain.1 Thus, the
injury to these areas either directly from the cancer in the brain or indirectly from the cancer
therapy including chemotherapy or cranial radiation and neurosurgery might affect the normal
sleep/wake rhythms, causing a variety of sleep problems. Cancer and its therapy often disrupts
the circadian, homeostatic, neurologic, and psychiatric-behavioral processes that regulate normal
sleep. Sleep Disturbances in Pediatric Cancer Model proposes that many factors may contribute
to changes in sleep observed in children with cancer including cancer-related factors (diagnosis,
medication, treatment), mechanisms of altered sleep (psychosocial, environment and biological
processes), and child/family factors (child temperament, family sleep habits, child age, parenting
skills, etc.).2
Sleep problems are common in children with cancer during and after treatment, and in long-term
survivors. The exact prevalence of sleep problems in children with cancer is unknown. Moreover,
prevalence rates vary across studies because of the variability and validity of measurement. It can
be estimated ranging from 25% to 87%.2 However, what we know is that children with brain
tumors are at increased risk for poor sleep quality, excessive daytime sleepiness, and fatigue
compared to children with non-central nervous system malignancies and healthy children.3
Disrupted sleep can negatively affect the overall quality of life of children with cancer and the
healing process as well since sleep is essential for immune function. Thus, it is vital for nurses
who work with children with cancer to have an awareness on sleep problems and provide
anticipatory guidance to parents on the factors that can cause the child with cancer at risk for
sleep problems. An important role for pediatric oncology nurses is to manage sleep problems by
identifying risk factors and causes of sleep problems in order to design and provide individualized
intervention to promote sleep in this population.
References
1. Saper CB, Scammell TE & Lu J. Hypothalamic regulation of sleep and circadian rhythms. Nature 2005; 27: 1257-63.
2. Daniel LC, Schwarts, LA, Mindell, JA, Tucker, CA & Barakat, LP. Initial validation of the sleep disturbances in
pediatric cancer model. J Pediatr Psych. 2016; 41:588-99.
3. Graef DM, Crabtree VM, Srivastava DK, Li C, Pritchard M, Hinds PS, & Mandrell B. Sleep and mood during
hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma. Psycho-Oncol.
2018; 27:1847-53.
64
THE BENEFIT OF SCALP COOLING FOR REDUCING HAIR LOSS

IN BREAST CANCER PATIENTS RECEIVING CHEMOTHERAPY
Penprapa Piriyajittrakornkij, RN, BNS, Kingtip Tamthong, RN BNS, MA (Anthropology)

Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
The purpose of Surgical Oncology Day Care Unit, Vongvanij 8th floor, is to take care for patients
and ensure a high standard of treatment, safety and satisfaction. In our unit we provide service
for out-patients receiving chemotherapy. Breast cancer is the most common type of the top three
diseases of cancers among women. Regarding chemotherapy side effects, hair loss is viewed as
the most common adverse effect concerning body image among cancer patients.
The Queen Sirikit centre for breast cancer serves as medical services in particular new optional
treatments and high medical technology for breast cancer patients. As we know, chemotherapy-
induced alopecia has been viewed as a cause of distress to cancer patients undergoing chemo-
therapy treatment. Thus far, the breast center also provides scalp cooling for patients, which is
considered as one of new optional methods of preventing hair loss during chemotherapy
administration.
Additionally, when the oncologist suggests the scalp cooling to reduce hair loss for patients
receiving chemotherapy regimen, these patients will gain the counseling from the nurse counselor
having a great deal of experience at the breast cancer clinic on 2nd floor at Vongvanij building.
Also, during chemotherapy administration these patients will obtain chemotherapy regimen with
scalp cooling at the oncology day care unit, Vongvanij 8th floor as well as standard care. Therefore,
to raise awareness the essence of fostering psychological supportive care concerning body image
in cancer patients during chemotherapy treatment and administering holistic care are needed.
Treatment steps using scalp cooling
1. To assess the patient’s condition by taking the history of illness, treatment, allergies, general
appearance, and chemotherapy regimen.
2. To implement the scalp cooling process as following steps:

- To identify the patient by doing identification and assess the patient‘s physical and
psychological status, a history of treatment and allergies.
- To assess the ECOG Score (Eastern Cooperative Oncology Group performance status).
- To record vital signs, laboratory and chemotherapy protocols.
3. To show the scalp cooling process to patient through the photos and explanation.
4. To evaluate the hair and scalp using the Sinclair’s midline hair density scale and take the picture
for evaluation in order to compare the hair loss during the treatment.
5. To choose a gel and cover cap that fits for individual patient’s head.
65
PCIOC 2019
6. To make the hair wet all over the head. Then the middle hair combing is equally divided.
7. To put the gel and cover cap on the head with softness and apply a head band to reduce the
compression of the gel cap on the forehead
8. To attach the scalp with the machine and then start pre cooling time with pre medication 30
minutes before chemotherapy administration. Also, the infusion time of scalp cooling depends on
the chemotherapy regimen, and the machine will control the temperature at 17˚C.
9. To provide a specialized warming blanket and adjust the patient’s position for the greatest
comfort during the process.
10. To monitor vital signs and observe at all times whether the patient has discomfort. Also, to
evaluate for any negative symptoms during the process such as chills, dizziness, and headache
and monitor hypersensitivity, adverse reactions for early detection and effective nursing care.
11. When the chemotherapy is completed, the scalp cooling needs to be continued until the
completion of the time recommended, which is called the post infusion cooling time roughly
60 minutes.
12. After finishing the cooling time process, the nurse will provide a cool dryer for the patient and
advise the patient about hair care as follows:
- Using baby shampoo and employing gentle combing.
- Avoiding the drying hair on a hot setting.
13. During treatment, the nurse will administer health education to the patients. Additionally,
nurses will empower patients and offer options to enhance the image including hats, hair cover
scarf and wigs. Importantly, our goal is to provide the best quality of care for our patients.
14. To record data correctly as a nursing documentation.
Results summary of scalp cooling’s indicators on 1st Oct 2017 - 30th Sep 2018.
The chemotherapy regimen. Percent of patients used scalp Percent of patients used complete
cooling, level hair loss 1-3. cycle scalp cooling during
Goal > 50% chemotherapy treatment.
(no need use a wig) Goal > 60%
AC: Adriamycin, cyclophosphamide 56.1 68.29
AC-T 85.19 81.48

T: Taxane 77.78 88.89
TC: Taxane, carboplatin 50 92.86
CMF: Cyclophosphamide, 100 100

methotrexate, 5 FU
Other 50 100
Average 69.85 88.56
66
Adverse events from chemotherapy with scalp cooling
Regimen Adverse events Headache Cold Dizziness
AC: Adriamycin, cyclophosphamide 9.76% 14.63% 4.88%
AC-T 3.70% 7.41% 0
T: Taxane 0 11.11% 0
TC: Taxane, carboplatin 0 7.14% 0
CMF: Cyclophosphamide, methotrexate, 5 FU 0 0 0
Other 0 0 0
Average 2.24% 6.72% 0.81%
67
PCIOC 2019
NURSING INTERVENTION PROGRAM FOR PATIENTS WITH CANCER SYMPTOMS
Ploenpit Thamnipa, RN, MNS, Nanthana Thananowan, RN, PhD,

Rapepan Uppagan, RN, MNS, Boonlert Viriyapak, MD
Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Purpose: To examine the effects of exercise program on peripheral neuropathy and the quality of
life in patients with ovarian cancer receiving chemotherapy.
Design: A quasi-experimental design
Methods: Participants were 86 patients with ovarian cancer receiving chemotherapy at a

university hospital. They were divided into a control group and a treatment group, with 43 samples
for each group. Both groups received standardized care while the treatment group also received
the exercise program, including personal reviewing about hands and legs exercise with VDO for
practicing at home, knowledge about peripheral neuropathy and self-care manual, and the toolkit
for stimulating hands and legs sensation. The data were collected by using a demographic
questionnaire, FACT/GOG-NTX and FACT-G before the program implementation (T0) and after
receiving the program (T1 and T2). Data analyses included descriptive statistics, independent
t-tests, chi-square tests, and repeated measures ANOVA.
Main findings: There was no statistically significant difference of the mean scores on peripheral
neuropathy (F = 0.52, p = 0.473) and the quality of life (F = 0.93, p = 0.477) between the study
groups. However, for the intervention group, the time effects on peripheral neuropathy at T0 and
T1 (mean difference = 4.64, p = 0.002) and at T0 and T2 (mean difference = 6.28, p < 0.001) were
statistically significant.
Conclusion and recommendations: These findings imply that those patients in the intervention
group had a stable degree of peripheral neuropathy at each two time points. Further research is
needed to measure peripheral neuropathy at different times, i.e. every 3 weeks to help clarify the
impairment pattern. Results enhanced nurses to understand and develop interventions to prevent
peripheral neuropathy among patients receiving chemotherapy.
References:
1. Newton MJ. An exercise intervention for women undergoing chemotherapy for ovarian cancer: feasibility and
preliminary outcomes [master’s thesis]. Queensland: Queensland University of Technology; 2010. p.168.
2. Maryam A, Fazlollah A, Eesa M, Ebrahim H, Abbas VF. The effect of designed exercise programme on quality of
life in women with breast cancer receiving chemotherapy. Scand J Caring Sci. 2010;24:251-8.
3. Thamnipa P, Konsue P, Therasakvichya S. Perception of symptoms and symptom management of side effects in
ovarian cancer patients receiving chemotherapy. J Nursing Sci. 2014;32:28-38.
68
FACTORS INFLUENCING VENOUS PAIN IN PATIENTS

WITH CANCER RECEIVING GEMCITABINE
Rasarudee Sriwisai, RN
Chemotherapy Unit, Outpatient Department, Chulabhorn Hospital,
Gemcitabine is a cytotoxic agent of antimetabolite, which can be given alone or combined with
other anti-cancer drugs, such as Cisplatin, Carboplatin, Paclitaxel, and Docetaxel, depending on
the type of cancer. However, it is likely to cause venous pain during drug administration.
At Chemotherapy Unit, Chulabhorn Hospital, the incidence of venous pain between August and
October 2015 was 43 out of 117 times of drug administration (37%). Thus, this study aimed to
determine the contributing factors that influenced venous discomforts in cancer patients who
received Gemcitabine administration.
A retrospective study was conducted during January to October 2016 after the approval by Human
Research Ethics Committee of Chulabhorn Research Institute No.007/2559. Three hundred and
seventy-two sessions of 72 patients receiving Gemcitabine alone or in combination with other
cytotoxic drugs were extracted from Chulabhorn Hospital’s data system. Gender, age, type of
cancer, type of drug, regimen, dosage, solution, cycle, infusion time, puncture site, period of pain,
location of pain, and pain score were analysed. The ordinal logistic regression with cluster variation
analysis was performed by using STATA/SE version 12 (STATA Corp LP, College Station, TX, USA)
statistical software.
Results showed that patients with Gemcitabine administration experienced venous pain (37.4%),
including mild pain (32.3%) and moderate to severe pain (5.1%). The contributing factors that
influenced venous pain were gender, age, cycle of Gemcitabine and puncture site. There was a
statistical significance in female, aged 65 years and younger, with the 4th to the 9th cycle (p<0.05).
Whilst, the puncture site at Basillic vein significantly yielded less pain (p<0.05).
This study may benefit oncology nurses for the prediction of venous pain in patients receiving
Gemcitabine. Moreover, the management planning of puncture site to lessen venous complications
in those receiving chemotherapy should be administered as sensitive priority.
69
PCIOC 2019
SKIN CANCER UPDATES
Sasima Eimpunth, MD1, Pamela Chayavichitsilp, MD2,

Rasthawathana Desomchoke, MD3, Marisa Pongprutthipan, MD4
1
2
3
4
Skin cancer is a worldwide health issue and the incidence is on the rise globally. Skin cancer may
arise from any cell type within the skin such as keratinocytes (cells of the epidermis), melanocytes
(pigment-producing cells), or fibroblasts (fiber-producing cells). The 3 most common skin cancers
are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma (MM) with BCC
being the most common and MM being the most invasive type of skin cancer.(1)
Because the skin is an organ that is visible to the eye, screening is of paramount importance as it
enables early detection, early treatment and thereby higher cure rates. In the recent years, the
public has been made aware of skin cancer protection as well as self-detection due efforts by
several organizations in many countries. Our session aims to discuss updates in skin cancer from
diagnosis to management. Discussions will involve not only knowledge for physicians in providing
appropriate care, but also technological advancements in self-detection on the patient side. The
session includes 4 distinct topics as shown below:
Dermoscopic Diagnosis of Skin Cancer
The gold standard for skin cancer diagnosis is microscopic evaluation from the excised tissue.(1) If
there exists a suspicious lesion, the lesion should individually be biopsied and tissue sent for his-
topathological diagnosis in order to decide on an appropriate treatment. Unfortunately, not all
patients can tolerate undergoing a biopsy for every suspicious lesion. In cases with conditions such
as organ-transplants, chronic arsenicism or xeroderma pigmentosum, numerous skin cancers or
premalignant lesions are typical. Hence, any non-invasive method that can help differentiate benign
from malignant tumors, can be beneficial.
Dermoscopy, or dermatoscopy, is the use of a dermoscope, or a dermatoscope, which is an

instrument with a magnifying lens and a light source used to visualize skin lesions and determine
the type of lesions from the patterns observed. It cannot be used as a substitution for the gold
standard of biopsy with microscopic examination. However, patterns under dermoscopy can be
used to help rule out or rule in skin malignancies in many cases, thus avoiding unnecessary
biopsies.(2) The dermoscopic patterns in the diagnosis of skin cancers will be introduced and
discussed in this lecture.
Skin Cancer Mobile Apps: Do they work?

Screening for skin cancer has traditionally been performed by dermatologists. However, due to
70
the rise of incidence of skin cancer globally, public awareness has become more apparent. In the
age of smart phones, many providers are creating applications to help screen for skin cancers from
photographs. These applications are becoming more widely used in the general population,
particularly the younger generation that is familiar with using smart phone applications in their
daily routine. This talk will discuss the available applications and their accuracy in screening skin
cancers keeping in mind no apps will replace a thorough skin check by a board-certified
dermatologist.
Liquid biopsy: A Nouveau Monitoring Technique in Melanoma Patients

Recently, circulating tumor (ctDNA) detection has been used as a noveau biomarker for monitoring
disease status of patients with late stage cancer. In melanoma, ctDNA demonstrates a clinical
benefit as another option of tumor recognition for treatment analysis. Aged systemic agents have
been replaced by modern first-line therapies, such as anti-CTLA4 and anti-PD1as well as others
targeted therapies. Therefore, it is important for oncodermatologists to have predictable and
decisive tools for monitoring disease progression.
Localized and advanced stages of melanoma are known to produce circulating tumor cells and
tumor DNA (ctDNA) that can be identified and measured from peripheral blood specimens. This
“liquid biopsy” technique will help physicians decide on the precise treatment options, particularly
in the case of mutation-based targeted therapies. The use of this nouveau technique and its criteria
for the phenotypic analysis of circulating melanoma cells or their fragments as well as the instability
of ctDNA in blood will be discussed in this talk.
Basal Cell Carcinoma and the Need of Mohs Micrographic Surgery

Basal cell carcinoma (BCC) is the most common type of skin cancer. In Thailand, treatment of BCC
can be easily performed in an outpatient setting. This includes electrodessication and curettage,
cryotherapy and wide excision in early stages of disease. In aggressive variants of BCC such as
sclerosing, micronodular and those with perineural involvement, these modalities of treatment
may be inadequate since negative pathological margins may not translate to complete clearance
of the tumor.
Mohs micrographic surgery (MMS) is a staged excision with tissue margin examination and is now
considered the recommended treatment modality in BCC given its the lowest rate of recurrence
compared to other methods. Because of its high operating costs and time-consuming nature, less
than ten medical facilities perform MMS in Thailand. This lecture will discuss MMS and provide
the appropriate referral indications to optimize treatment outcomes as well as cost efficiency.
References
1. Ponten F, Lundeberg J, and Asplund A. Principles of tumor biology and pathogenesis of BCCs and SCCs. In: Callen
JP, et al, editors. Dermatology. 2nd ed. Spain: Mosby Elsevier; 2008. p. 1627-39.
2. Kittler H, et al. General principles. In: Kittler H, et al, editors. Dermatoscopy: An algorithmic method based on
pattern analysis. Australia: Facultas.wuv; 2011. p. 9-24.
71
PCIOC 2019
RETINOBLASTOMA IN THAILAND: PAST, PRESENT, AND FUTURE
Duangnate Rojanaporn, MD
Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital,
The current population of Thailand is approximately 69 million (United Nations estimates). According
to the nationwide multicenter population-based prospective study of the incidence and survival
rate of childhood cancer from Thai Pediatric Oncology Group (ThaiPOG), there were 97 cases of
retinoblastoma diagnosed during the year 2003-2005, placing retinoblastoma the 7th most common
childhood cancer in Thailand, with the incidence of 3.1 per million population with overall survival
probability at 5 years of 73%. The predicted incidence of retinoblastoma in Thailand, calculated
from 67 million population, is 41 children in 2013 and 2023. The treatment modalities and survival
rate of retinoblastoma in Thailand varies among each center and region of the country.
A multi-center study and national system of retinoblastoma registration are required to establish
a nationwide picture of this disease. Education of public and primary health care providers, along
with the implementation of a retinoblastoma screening program, should be promoted to enable
earlier detection of retinoblastoma. This would allow patients to gain better treatment outcomes.
In addition, proper retinoblastoma management necessitates multidisciplinary cooperation, by a
team that should include an ocular oncologist, pediatric oncologist, neurointerventionist, and
ocular pathologist. As such specialized providers are not available in many areas of the country,
comprehensive referral centers may present one solution toward better provision of retinoblastoma
care in Thailand.
72
UPDATES ON TUMOR IN OPHTHALMOLOGY: RETINOBLASTOMA PATHOLOGY
Wasee Tulvatana, MD, MSc

Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
Retinoblastoma is the most common primary intraocular malignancy in children worldwide.

The diagnosis mainly relies on pathology results. In this meeting session, we describe the basic
gross and microscopic pathology of this tumor. Recent pathology classification and advanced
techniques regarding the prognostic indicators of tumor local recurrence and distant metastasis
will be discussed.
73
PCIOC 2019
Chandhanarat Chandhanayingyong, MD
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery,
Bone metastases are a common manifestation of distant relapse from many types of solid cancers,
especially those arising in the lung, breast, and prostate. Bone is the third most common organ
affected by metastases, after the lung and liver. Bone metastases represent a prominent source
of morbidity. Skeletal-related events (SREs) that are due to bone metastases can include pain,
pathologic fracture, and hypercalcemia. In some cases, the extent of bone destruction is such that
a fracture is imminent but not complete (termed an impending fracture). To be considered a can-
didate for a surgical procedure, a patient with metastatic disease should have an expected length
of survival that is longer than the expected period of recovery from the procedure. Because of
the shortened expected life span of the patients with metastatic disease, one of the goals of
surgical fixation should be to achieve an immediately stable construct, which will allow full weight
bearing and normal function without delay.
Classic indication of an impending pathologic fracture included a limited number of criteria- for
example, fracture for the lessor trochanter, a lytic lesion involving more than 50% of the bone
width, a lytic lesion involving more than 2.5 cm of bone and pain that persists after radiotherapy.
Mirels’ Evaluation System has been published for prediction of lone bone fracture risk in a group
of patients with predominantly metastatic breast cancer treated with radiotherapy. This system
become most commonly used criteria for prediction of pathologic fractures. Four criteria are
equally weighted with potential assignment of 12 points. (Table 1) The risk of fracture increased
with a score of 7 points. A score of 8 points correlated with a fracture risk of 15% and warranted
consideration of prophylactic fixation.
Table 1. Mirels scoring system for prediction of impending pathologic fracture

Criteria 1 point 2 points 3 points
Site Upper extremity Lower extremity Peritrochanteric
Size <1/3 width of bone 1/3-2/3 >2/3
Type Blastic Mixed Lytic
Pain Minimal Moderate Functional
Three considerations must be weighted before considering prophylactic fixation: diagnosis, tumor
resection and preoperative embolization. For long bone lesions that are at risk for fracture and in
need for prophylactic fixation, locked intramedullary nail fixation is the preferred treatment, when
feasible. The need for supplemental bone cement in prophylactic stabilization has not been well
established. However, curetting and cementation larger lesions during prophylactic fixation should
be considered.
74
Chris Charoenlap, MD
Principle of bony metastasis from cancer is palliative treatment. It aims to reduce patient suffering
for the rest of their life. Holistic approach, which include body, mind, and social aspect, should be
used.
Reducing pain and severity of cancer spreading need combination of adequate pain management,
radiotherapy, chemotherapy and hormonal therapy. The bone with cancer metastasis should be
evaluate for potential of fracture. Fixation or reconstruction must be done in impending or already
fracture case, if patient is in good status for surgery. Patient with paraneoplastic disease such as
hypercalcemia may present with unspecific symptoms including depression, weakness, constipation
or severe condition like seizure, coma and arrythmia. Emergency treatment with intravenous
fluid and bisphosphonate should be administered to patient as quickly as possible when
hypercalcemia is detected.
The main objective of surgical treatment in bony metastasis case is to reduce pain and improve
patient function. Instrument of choice should withstand daily activities and also last long enough
to avoid revision surgery. Intramedullary nail gives a whole bone structure stability, but in some
circumstance prosthetic reconstruction may be necessary such as extensive bony destruction.
75
PCIOC 2019
MANAGEMENT OF BONE METASTASES IN EXTREMITIES:

BONE ANTIRESORPTIVE AGENTS
Prakrit Suwanpramote, MD
Department of Orthopaedics, Faculty of Medicine Ramathibodi hospital,
Skeletal system is the third common metastatic site of solid organ cancer (breast, prostate, lung,
thyroid and renal cell carcinoma) and one of the most common site of myeloma. Skeletal metastasis
causes unpleasant conditions that were categorized in term of “skeletal-related events” or “SREs”,
such as pathologic fracture, tumor-induced osteomalacia, hypercalcemia, neural structure com-
pression and cancer-induced bone pain. The goal of treatment in metastatic bone disease is
prevention and/or treatment of SREs.
In the past decades, treatment modality of various primary cancer has been well developed, result
in satisfied long term survival of cancer patients and increase incidence of bone metastasis and
SREs. Most of SREs occur via OPG/RANK/RANKL pathway create imbalance of bone formation
(osteoblastic activity) and bone resorption (osteoclastic activity) lead to skeletal destruction that
has been inhibited by some antiresorptive agents, such as bisphosphonates (zoledronate) and
denosumab.
Currently, zoledronate and denosumab are standard agents for prevention and reduction of SREs
in patient with advanced cancer and skeletal lesions1. Nevertheless, these agents in the adjuvant
of early cancer for cancer treatment-induced bone loss and/or impede metastasis still in the trials.
Duration and frequency of antiresorptive agent administration are still controversy.
This session will describe about usage of antiresorptive agents in metastatic bone disease in
extremities and discuss about role of these agents in various situation including controversy about
zoledronate and denosumab.
References
1. Coleman R, Gnant M, Morgan G, Cle´zardin P. Effects of bone-targeted agents on cancer progression and mor-
tality. J Natl Cancer Inst. 2012; 104: 1059–67.
2. Terpos E, Confavreux CB, Clézardin P. Bone antiresorptive agents in the treatment of bone metastases associated
with solid tumours or multiple myeloma. Bonekey Rep. 2015;4:744.
3. Himelstein AL, Foster JC, Khatcheressian JL, et al. Effect of Longer-interval vs standard dosing of zoledronic acid
on skeletal events in patients with bone metastases: A randomized clinical trial. JAMA. 2017;317:48–58.
76
RADIATION THERAPY OF BONE METASTASIS IN EXTREMITIES
Sasikarn Chamchod, MD
Faculty of Medicine and Public Health, Chulabhorn Royal Academy, Bangkok, Thailand
Radiation Oncology Department, Chulabhorn Royal Academy, Bangkok, Thailand
Metastatic disease to the bone is a common cause of pain and other significant symptoms that
are detrimental to quality of life. The ultimate prognosis for patients with bone metastases is poor,
with median survival typically measured in months rather than years. Overall survival depends on
the primary site and the presence or absence of visceral metastases. In the appendicular skeleton,
the proximal femurs are the most common site of metastatic disease, and humeral lesions also
occur frequently. The acral sites (feet and hands) are rarely involved.
Radiation therapy has been reported to be effective in palliating painful bone metastases, with
partial pain relief seen in 80% to 90% of patients and complete pain relief in 50% of patients. These
data are primarily from studies using physician evaluation of pain. When patient evaluation of
pain is used, pain improvement is seen in 60% to 80% of patients and complete pain relief is seen
in 15% to 40% of patients. The effectiveness of the treatment also depends on the goal: palliation
of pain, prevention of pathologic fracture, avoidance of future treatments, or local control of the
disease. In addition to pain relief, other symptoms may be relieved by radiotherapy. Patients who
have improvement in pain after radiotherapy may also have improvement in emotional function-
ing, decreased insomnia and decreased constipation, and overall improvement in quality-of-life
scores. Radiation therapy should be an integral part of palliative treatment for bone metastases
for treatment of pain and prevention of other symptoms.
There have been multiple randomized, prospective trials in the last 30 years comparing shorter-
course, lower–total-dose treatment to the more “standard” longer-course, higher–dose treatment.
Several conclusions are clear from the studies:
1. Single-dose treatments of 8 Gy provide similar pain relief to longer-treatment regimens
(30 Gy in 10 fractions or 20 to 24 Gy in five to eight treatments).
2. The retreatment rates are higher after short-course treatment by a factor of two to three.
3. Response rates are lower when scored by the patient instead of by the treating physician.
4. Response rates are better when the initial pain scores are lower, that is, when the patients are
treated for moderate pain rather than severe pain.
5. There is no consistent dose–response relationship for palliation of bone metastases.
Palliative radiation therapy is of significant benefit to patients after painful bone metastasis, with
most patients experiencing relief in the magnitude of pain following treatment. Response rates
to palliative radiation therapy for localized sites of pain are consistently higher than response rates
from palliative systemic therapy, and palliative external-beam radiation therapy remains the
mainstay of treatment for clinically localized painful bone metastasis.
77
PCIOC 2019
PALLIATIVE CARE FOR PATIENTS WITH CANCER
Nongluck Ananta-ard, RN, PCN, PhD

Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
The early palliative care refers to comprehensive cancer care by multidisciplinary team approach
during cancer treatment in order to improve quality of life for advanced cancer patients. It is
introduced to cancer patients earlier than the usual palliative care measures. Unfortunately,
current evidences have reported that people with hematologic malignancies tend to unmet
palliative care needs compared to patients with solid tumors. However, based on our experience
early integration of palliative care into routine hematologic malignancy care along with their
treatment trajectory may possible for achievement of outcomes.
Hematology unit of the King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand, is a
medical training center for a specialty of hematologic diseases, and also provides both services
and research to improve the effectiveness of treatments. There is a large number of patients
receiving treatment as inpatients and outpatients including the patients who are in palliative care
stage. Unlike solid tumors, the prognosis of hematologic malignancies is quite difficulty to proceed
concerning types of disease, dose of chemotherapy, new optional treatments and supportive care
by administering blood transfusion in particular end of life stage. Although the palliative care
center of the hospital provides specialized palliative care for both inpatients and outpatients, an
integration of early palliative care for the patients are difficult in routine practice. This is the reason
why the palliative care nurse (PCN) navigator is setting up. Here, we would like to share experiences
in the context of nurse-led early palliative care for people with hematologic malignancies.
From 2018, the hematologists who focus not only on treatments, but also disease in order to
improve patient outcomes. A PCN navigator is considered as indispensable part of a team to deliver
medical services in which the early palliative care has been initiated. Our team administer
the early palliative care for patients having following inclusion criteria as follow: (1) incurable
disease, (2) at risk of adverse outcomes from receiving intensive treatment, (3) high symptoms
burden, (4) significant psychological distress, (5) psychosocial needs, and (6) transition to end of
life phase.
The PCN has coordinated with multidisciplinary team to provide symptom management and
psychosocial support. Our team has provided palliative education and created emotional and
spiritual support for patients, their families, and nurses. Also, the team has consulted with specialist
from a palliative care team to help foster patents, their families and caregivers according to their
individual needs. Additionally, the PCN has a proactive approach to facilitate an advance care plan,
and prepare them for the end-of-life.
In the past year, we provided early access to 68 patients. Thirty-eight patients needed early palliative
care at outpatient hematological clinic while 30 patients required the service at inpatient ward.
78
The most frequent entities were acute myeloid leukemia (39%), aggressive lymphoma (28%) and
multiple myeloma (19%) respectively.
Regarding the record, 55 out of 68 patients passed away and it revealed that 80% of patients died
in hospital (26 patients died in the KCMH, 15 patients died in their primary hospitals), 18.2% died
peaceful at home, and 1.8% died in unknown places in succession.
The Distress score was a wide range between 2-10 on the distress thermometer (performing a rating
score 0-10 at the first visit and along with their treatment trajectory). Fatigue and pain were the
most common symptom distress meanwhile sadness was considered as the common emotional
problems. Evidently, deep breathing exercise is viewed as the best way to reduce the extreme
fatigue. Regarding psychological distress, 25% patients suffered from a level of moderate and
severe of mental issues. Then, the care team notified the relevant physicians and spiritual
leaders such as monks to help them. In what way, it is beneficial in terms of emotional and spiritual
supports.
Out of the total of 55, decreased patients, 26 were consulted with palliative care specialist team
of the hospital for preparing patients and their families for the end-of-life issues. Ten patients
needed spiritual care from monks, and 3 patients required art therapists for supportive care.
Based upon our experiences, a nurse-led early palliative care for people with hematological
malignancies with a multidisciplinary team should be presented as soon as possible. The model
of a palliative care nurse navigator for this specialized population is taking into consideration and
it will be established in practical ways based on context and clinical practice. The needs for
conducting effectiveness research to test a nurse-led early palliative care for this specific
population is significant for benefits for these patients in relation to better quality of life.
79
PCIOC 2019
CHULABHORN HOSPITAL’S PALLIATIVE CARE MODEL
Thitaree Boonchaue
Chulabhorn Oncology Medical Centre, Chulabhorn Hospital, which is a part of the Chulabhorn
Royal Academy under supervision of the Prime Minister’s Office, is a 100-bed hospital specialising
in cancer treatment and care. Due to the imperative of palliative care in cancer treatment, the
palliative care team at Chulabhorn Hospital was established in 2014. This multidisciplinary team
is composed of medical doctors from various specialities, nurses and practical nurses, psychologists,
physiotherapists, nutritionists, pharmacists and social workers.
The palliative care pathway of the Chulabhorn Hospital is developed and implemented to provide
a clear and practical process of holistic care. The palliative care team looks after the patients with
collaboration of their primary doctors when: 1) The patient’s distress score is four or more 2) the
patient is diagnosed with end stage cancer 3) the patient and care taker need home visit 4) there
is any issue that the primary doctors would like the team to support. The team is continuously
taking care of the patients and families until the end of life and after the patient died with
bereavement care for the families and care givers. Moreover, the integrative care such as Chinese
traditional medicine, group activities and religious spiritual support is also provided.
80
THAI NURSES’ PALLIATIVE CARE COMPETENCIES AT A GLANCE
Tiraporn Junda, RN, PhD

Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital,
Currently, palliative care is now classified as one of the significant cares in health care system
worldwide. With an aging population and modern technology, people with chronic illnesses are
rising dramatically as well as patients at the end of life stages. There are estimates about 20 million
worldwide who need palliative cares. Thailand also similarly faces this dilemma. Thai Ministry of
Public Health reported that in 2015 there was about 163,860 elderly with bedridden had been
taking care at home, and about 41,557 were at their end of life.
In the past 20 years, palliative care services were limited to cancer patients and Thai health care
teams were struggling with palliative care services due to many factors such as limited resources,
negative attitude of the health care team, or no supporting system. At that time there was no
palliative care standard or system to guide the Thai health care system. And definitely few
preparations for palliative care personnel mostly focus on nurses and some family doctor teams.
However, there was not enough staff who run palliative care services with the rising palliative
population who in need of palliative care. Since 2015, the Thai government had launched the
policy require that all hospitals at all levels have had to have palliative care service and real
operation. From the previous study of following up the services in the central area in 2017 founded
that to provide good quality of palliative care, the nurse is one of the key personals. There were
eminent that most quality nurses had been trained about palliative care at least 10 days to 4 months.
However, there were a lot of nurses who provided services by heart or volunteering without any
former training, but they seem to be quality nurses, too because there past care experiences,
but some nurses felt unsure whether their care was good enough due to their few background
knowledge of palliative care. In addition, based on the analysis of Thai nursing curriculum also
confirmed the dilemma of few preparations of the palliative topics about 1-2 hour at most.
The previous study confirmed that with lack of knowledge or preparation about palliative care,
most novice nurses about palliative care felt uncomfortable and unsure how to provide quality of
palliative cares.
With the missing part of palliative care teaching course, Thai Nursing Council palliative care
consortium suggested about cores requirement of palliative care in nursing. Based on Bloom and
colleagues’ competency model, palliative care competency consist of knowledge about palliative
care, good attitude about the care, and confident in skills how to giving care (K = Knowledge,
A = Attitude, P = Practice). And in 2015, Thai Nursing Council announced their mandate cores
palliative care competencies at three levels; A, basic postgraduate; B, advanced post graduated;
and C, specialist post graduated. Which mandated that all nurses after graduated must receive
basic palliative care training at least 3 days. The required competencies were at beginner level
81
PCIOC 2019
with six core competencies included 1) providing care for patients and family, 2) Pain management,
relieving suffering symptoms and promote comfort, 3) Caring at near death, 4) Grief, loss, and
bereavement care, 5) Communication and 6) Ethic and legal care. The advanced post graduated
is a 10 days training aimed at nurses who will be in a palliative care team who work in the ward
or call palliative care ward nurse (PCWN). Their required seven core competencies which add
collaboration with the team to the beginner level competencies. And specialist post graduated
level with 2 - 4 months training or short course program consists of 9 competencies which adding
1) religion, spiritual, and cultural care, and 2) teaching and education.
Since then many nurses had been trained and ongoing. In Thailand, there are about 11,035 hospitals
under the Ministry of Health regulation not include university hospitals and private hospitals.
Thai Nursing Council expected that about one nurse per hospital should get training each year
and expected about 12,000 -15,000 nurses will get training per year. The total number of Thai
nurses in 2017 was about 108,293. However, up until now, there had been no report on the
outcome of palliative care training as a whole, due to lack of standard measurement. Each training
centre has their own evaluation form and mostly evaluate the course, not on trainees’ competencies.
In addition, there are few follow-up evaluations after training when trainees go back to work
and give palliative care services. Thus, we cannot conclude that after training, whether nurses
will improve palliative care knowledge, attitude, and their skills of care which reflect 6-9 core
competencies or not.
Some measurement had been developed to assess nurses palliative care core competencies based
on different theory or analysis. For example, Slatten and colleague developed new measurement,
the nurses’ core competence in palliative care (NCPC) for Norwegian Nurses based on 5 domains of
Becker. Montagnini and colleagues used the ethics committee of the society of critical care medicine
recommendation for the end of life care in ICU to create the assessment of self-perceived end-of-life
care competencies of ICU providers. For Desbiens and Fillion developed the palliative care nursing
self-competence scale (PCNSC) based on Bandura’s social cognitive theory or self-efficacy was in
the context of measurement. The issue the gap of previous self-efficacy measurement was lacking
of important dimensions of palliative care; spirituality, team collaboration, and professional
development. They rigorously developed new measurement with three phrases and ended of 10
dimensions with 50 questions. For some papers separately measure knowledge, attitude, and
skills with different measurement. Thus how to evaluate nurses’ palliative care core competencies
can be differently chosen.
For this report after exploring each measurement, the PCNSC by Desbiens and Fillion was quite
fit with Thai nine core competencies and it was also used in Vietnam. After getting permission from
the original authors we got the PCNSC Thai version from another researcher who translated and
conducted research with Thai nurses in central of Thailand. Then PCNSC was evaluated by our
research team comparing with Thai Nursing Council core competencies and found that some items
needed and we generated our new items with nine competencies. We also kept all original 50 items.
82
Thus 15 new items were added to fit with Thai context. This measurement is now being tested
with nurses in 5 parts of Thailand.
References
1. Bureau of Policy and Strategy, Ministry of Public Health. Public Health Statistics A.D. 2015. Bangkok: Samcharoen
Panich (Bangkok);2016.
2. Montagnini M, Smith H, & Balistrieri T. Assessment of Self-Perceived End-of-Life Care Competencies of Intensive
Care Unit Providers. J Palliat Med. 2012;15:29-36.
3. Desbiens J, Fillion L. Development of the palliative care nursing self-competence scale. J Hospice Palliat Nurs.
2011;13:230-41.
83
Abstracts
84
Oral Presentations
OP-G-1: EXPANDING THE UNIVERSE OF ACTIONABLE NEOANTIGENS THROUGH
DEEP LEARNING AND HUMAN LEUKOCYTE ANTIGEN PEPTIDOMICS
Sriswasdi S, Karunratanakul K, Sricharoensuk C, Chuangsuwanich E
OP-G-2: IDENTIFICATION OF ANAPLASTIC LYMPHOMA KINASE-EXPRESSING LUNG

ADENOCARCINOMA BY NEWLY-DEVELOPED ULTRASHORT RT-PCR ASSAY
Amornrit W, Ruangchira-urai R, Poungvarin N
OP-G-3: CHIMERIC ANTIGEN RECEPTOR T CELLS AGAINST BREAST CANCER CELLS

BY TARGETING FOLATE RECEPTOR ALPHA PROTEIN
Luangwattananun P, Junking M, Wutti-in Y, Sujjitjoon J, Yenchitsomanus P
OP-T-1: POTENTIAL ROLE OF CARBOHYDRATE RESPONSE ELEMENT BINDING

PROTEIN IN NON-SMALL CELL LUNG CANCER
Ruangpracha A, Grove H, Suriyaphol P, Tuekprakhon A, Poungvarin N
OP-T-2: EVALUATION OF GLUCOSE TOLERANCE IN HIGH DOSE RADIOACTIVE

IODINE-131 TREATED THYROID CARCINOMA PATIENTS
Porntharukchareon T, Houngngam N, Kingpetch K, Srichomkwan P
OP-T-3: RETROSPECTIVE ANALYSIS OF FACTORS INFLUENCING THE DECISION

BETWEEN INPATIENT OR OUTPATIENT RADIOACTIVE IODINE ABLATION/TREATMENT
OF PAPILLARY THYROID MICROCARCINOMA
Kanokwongnuwat W, Sritara C, Kositwattanarerk A, Thamnirat K, Utamakul C,
Larbcharoensub N, Chamroonrat W
OP-T-4: THE MIR-483-5P AS A MARKER PREDICTING CHEMORESISTANCE IN

EPITHELIAL OVARIAN CANCER KEYWORDS: MIR-483-5P, CHEMORESISTANCE,
OVARIAN CANCER
Rattanapan Y
G, General; T, Trainee
85
PCIOC 2019
OP-G-1
EXPANDING THE UNIVERSE OF ACTIONABLE NEOANTIGENS THROUGH DEEP

LEARNING AND HUMAN LEUKOCYTE ANTIGEN PEPTIDOMICS
Sriswasdi S, Karunratanakul K, Sricharoensuk C, Chuangsuwanich E

Background: The success of cancer immunotherapy relies on the discovery of neoantigens that
can be used to activate the patient’s immune response to specifically target his/her tumor cells.
Currently, the most direct method for identifying antigens presented on the tumor cell surface
involves mass spectrometry (MS)-based characterization of human leukocyte antigen (HLA)-bound
peptides. However, standard analysis of MS data is not effective at discovering unexpected amino
acid sequences, including those that would be produced by translation of canonical non-coding
RNA and proteasome-mediated peptide splicing. In light of recent findings that a significant number
of targetable tumor-specific antigens belong to this pool of poorly-characterized antigens, a major
improvement in MS data analysis is needed to address this limitation.
Study Design & Methods: We developed SMSNet, a deep artificial neural network model that is
able to identify amino acid sequences from MS data without any restriction, based on >25 million
MS datapoints. The performance of SMSNet was evaluated against state-of-the-art methods on
diverse HLA peptidomes deriving from monoallelic cell lines or patient samples. Origins of newly
identified antigens were determined by searching against databases of known human proteins,
noncoding RNAs, and in silico generated spliced peptides. Binding affinities between new antigens
and their respective HLA molecules were evaluated in silico predictions.
Results: SMSNet uncovers >10,000 previously uncharacterized HLA antigens, including >6,000
antigens with new amino acid sequences that have not been studied before according to the
Immune Epitope Database (IEDB) and >1,500 antigens that can be traced to proteasome-mediated
peptide splicing and translation of non-canonical open reading frames. Newly identified antigens
also exhibit high predicted binding affinities with HLA molecules and rank competitively against
previously reported antigens. Overall, SMSNet expands the coverage of identified HLA antigens
by almost 30% from standard approaches.
Conclusions: SMSNet identifies a large number of new HLA antigens and should be incorporated
into future HLA peptidomics-based neoantigen discovery pipeline.
86
OP-G-2
IDENTIFICATION OF ANAPLASTIC LYMPHOMA KINASE-EXPRESSING LUNG

ADENOCARCINOMA BY NEWLY-DEVELOPED ULTRASHORT RT-PCR ASSAY
Amornrit W, Ruangchira-urai R, Poungvarin N

Research Division, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background: Anaplastic lymphoma kinase (ALK) fusion is highly correlated with ALK inhibitor
therapy response rate in patients with non-small cell lung cancer (NSCLC). Reverse-transcription
PCR (RT-PCR) is a highly sensitive technique but it suffers from a lack of diagnostic value in
formalin-fixed paraffin embedded (FFPE) tissue specimens and detection of all known and unknown
ALK fusion variant patterns.
Study Design & Methods: Isolated RNA samples were subjected to complementary DNA synthesis,
followed by expression analysis using real-time PCR based on published assays developed by our
research group. Detection of 18S ribosomal RNA gene were utilized for evaluation of FFPE tissue
quality. Complementary DNA samples from cell lines were included as positive and negative
controls. Sections of tissues from 47 Thai lung adenocarcinoma patients were subjected to
determination of ALK expression, an indirect indicator of ALK fusion, by immunohistochemistry
(IHC) and our RT-PCR.
Results: We successfully developed a new quantitative RT-PCR method for amplifying ultrashort
(approximately 45 bases) target sequences in 3’ region of ALK and 18S ribosomal RNA gene.
We were able to confirm the presence of the ALK fusion in the NCI-H2228 human NSCLC cell line
and the absence of the ALK fusion in the non-cancerous HEK293 cells. Our newly-developed assay
revealed ALK expression in 3 of 47 FFPE lung adenocarcinoma tissues and achieved a high
concordance rate with IHC results. It is noteworthy that extremely degraded RNA from improper
tissue collection, handling, processing, or storage may affect the performance of the assay.
Conclusions: We demonstrate the first ultrashort RT-PCR assay in detecting ALK expression which
potentially overcome the limitations of currently available RT-PCR assays. Careful attention of
preanalytical factors is critically important in molecular analysis.
87
PCIOC 2019
OP-G-3
CHIMERIC ANTIGEN RECEPTOR T CELLS AGAINST BREAST CANCER CELLS BY

TARGETING FOLATE RECEPTOR ALPHA PROTEIN
Luangwattananun P, Junking M, Wutti-in Y, Sujjitjoon J, Yenchitsomanus P

Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Research Division,
Background: Breast cancer (BCA) is the most common malignancy in women worldwide. Although
treatments have greatly advanced, the patients with BCA still suffer from side effects, metastasis
and relapse, suggesting the need of new therapies. Adoptive chimeric antigen receptor (CAR) T
cell therapy has demonstrated remarkable efficiency against several malignancies. Folate receptor-
alpha (FRα) is a promising target protein for CAR T cells due to its high expression on various types
of BCA cells but rare on normal cells. Therefore, in this study, we aimed to construct CAR T cells
targeting FRα and evaluate their cytotoxicity against BCA cells.
Study Design & Methods: FRα expression in Thai BCA tissues and breast cell lines (MCF10A, MCF-7
and MDA-MB-231) were studied by immunohistochemistry and flow cytometry, respectively.
FRα-specific single-chain variable fragment (scFv) gene was cloned into lentiviral vector bearing
CAR generation 4 (CAR4) cassette genes (CD28, 4-1BB, CD27 and CD3ζ). Lentiviruses containing
this construct were used to transduce into human primary lymphocytes. Surface FRα-CAR4 protein
expression was monitored by flow cytometry. Cytotoxicity against FRα+ MDA-MB-231 cell line was
then evaluated by using luciferase assay.
Results: Different levels of FRα expression in Thai BCA tissues were observed. Surface FRα was
present in BCA cell lines (10% in MCF-7 and 30% in MDA-MB-231) but not in breast normal-like
cell line (1% in MCF10A). The FRα-CAR4 construct was effectively transferred to primary T cells by
lentiviral system with transduction efficiency up to 48%. The FRα-CAR4 T cells, containing both
CD4+ and CD8+ cells, conferred superior cytotoxicity against MDA-MB-231 cells over CD19-CAR
and untransduced T cells.
Conclusions: We have successfully generated human FRα-CAR4 T cells by lentiviral system. The
FRα-CAR4 T cells held specific anti-FR+ BCA cells. This study thus provided fundamental knowledge
for generation of FRα-CAR4 T cells, which can potentially be developed as a treatment for FRα+
BCA patients.
88
OP-T-1
POTENTIAL ROLE OF CARBOHYDRATE RESPONSE ELEMENT BINDING PROTEIN

IN NON-SMALL CELL LUNG CANCER
Ruangpracha A, Grove H, Suriyaphol P, Tuekprakhon A, Poungvarin N

Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Background: Carbohydrate response element binding protein (ChREBP) is a transcription factor that
plays crucial roles in major tissues involved in metabolism. Evidence indicates that ChREBP may
have roles in cancer. The presence and function of ChREBP have never been identified in non-small
cell lung cancer (NSCLC).
Study Design & Methods: We investigated ChREBP expression in NCI-H1975 NSCLC cell line using
reverse transcription quantitative PCR. To study ChREBP loss-of-function, we constructed
Doxycycline-inducible lentiviral vector containing dominant negative ChREBP or nuclear form of
enhanced yellow fluorescent protein. RNA samples from induced cell lines were subjected to RNA
sequencing.
Results: Both alpha and beta isoforms of ChREBP are present in NCI-H1975 cells. Inhibition of
ChREBP function using dominant negative form of ChREBP leads to downregulation of 1,210 genes
and upregulation of 188 genes as compared to control. Gene set enrichment analysis reveals the
potential function of ChREBP to control expression of genes involved in several pathways, including
interferon response, NFKB response to TNF, and complement signaling pathway. Interestingly,
expression of 51 genes in epithelial-to-mesenchymal transition (EMT) pathway was altered.
The EMT markers, vimentin/E-cadherin expression ratio and ZEB1 expression, were decreased.
Conclusions: Our study is first to demonstrate expression of both ChREBP isoforms in NSCLC cell
line. We also identify several pathways regulated by this transcription factor. Further study is
needed to explore the role of ChREBP in EMT in NSCLC.
89
PCIOC 2019
OP-T-2
EVALUATION OF GLUCOSE TOLERANCE IN HIGH DOSE RADIOACTIVE

IODINE-131 TREATED THYROID CARCINOMA PATIENTS
Porntharukchareon T, Houngngam N, Kingpetch K, Srichomkwan P

Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background: Radioactive iodine is an effective therapy for differentiated thyroid carcinoma (DTC).
Radioactive iodine enters thyroid follicular cells via sodium iodide symporter (NIS) to destroy the
residual normal thyroid tissue. NIS was also found on pancreatic tissue by immunohistochemistry
and gene expression study. We make a hypothesis that high doses radioactive iodine may have
harmful effect to beta cell function and result in impaired insulin secretion.
Study Design & Methods: Sixteen DTC patients (median age at evaluation was 46 years; range 26
- 69 years) treated with a single doses radioactive iodine (range 100-150 mCi ) were evaluated for
glucose tolerance by 75 grams oral glucose tolerance test at before, 3 months and 6 months after
radioactive iodine treatment. We measured plasma glucose, insulin level and C-peptide level every
at 0, 30, 60, 90 and 120 minutes. At baseline we also measured lipid profile, HbA1C, free thyroxine
(FT4), thyroid stimulation hormone (TSH), thyroglobulin (Tg) and anti-thyroglobulin (anti-Tg).
Indices of beta cells function were calculated. Indices of insulin secretion were determined using
1) Insulinogenic index 2) homeostasis model assessment (HOMA) of beta cells function (HOMA-B).
Indices of insulin sensitivity were determined using 1) HOMA of insulin resistance (HOMA-IR) 2)
insulin sensitivity index or Matsuda Index 3) oral disposition index. Indices based on the areas
under the concentration curves were computed as AUCinsulin (0-120)/AUCglucose (0-120).
Results: Fasting plasma glucose level were increased significantly (84, 84 and 87 mg/dl at baseline,
3 months and 6 months; P=0.021). No significant difference were observed in metabolic parameters,
indices of beta cells function and indices of insulin sensitivity. Interestingly, the indices of beta
cells function, HOMA-B but not insulinogenic index, were declined following radioactive iodine
treatment but not statistically significant (65.5, 62.9 and 61.1, at baseline, 3 months and 6 months
after radioactive iodine treatment, respectively, P=0.368).
Conclusions: The results of this study could not prove the probable effect of high dose radioactive
iodine on glucose tolerance at 6 months after receive high doses radioactive iodine. Whether
higher dose of radioactive iodine or longer follow up time might have harmful effects to glucose
tolerance are still needed to explore.
90
OP-T-3
RETROSPECTIVE ANALYSIS OF FACTORS INFLUENCING THE DECISION

BETWEEN INPATIENT OR OUTPATIENT RADIOACTIVE IODINE
ABLATION/TREATMENT OF PAPILLARY THYROID MICROCARCINOMA
Kanokwongnuwat W, Sritara C, Kositwattanarerk A, Thamnirat K, Utamakul C,

Larbcharoensub N, Chamroonrat W
Nuclear Medicine Division, Department of Radiology, Faculty of Medicine Ramathibodi Hospital,
Background: The aim of this study was to evaluate factors that relate to the physician decision for
inpatient or outpatient initial radioactive iodine (RAI) ablation/treatment of papillary thyroid
microcarcinoma.
Study Design & Methods: We retrospectively included consecutive 199 patients with papillary
thyroid microcarcinoma (171 women and 28 men with mean age of 52 years old) who underwent
at least subtotal thyroidectomy at Ramathibodi Hospital during 2012-2017 without co-existing
cancer. All patients had initial RAI ablation/treatment with (at least 3.7 GBq; 100 mCi) or without
(1.1 GBq; 30 mCi) hospital admission.
Results: On the basis of RAI ablation/treatment, there were 92 (46.2%) inpatients and 107 (53.8%)
outpatients. The median stimulated serum Tg levels prior RAI ablation/treatment were 1.71,
2.5, 1.23 ng/ml in the group of total patients, inpatient RAI, and outpatient RAI, respectively.
The respective median tumor sizes (cm) were 0.6, 0.7 and 0.4. We found higher risk features as
vascular invasion, extrathyroidal extension, microscopic not-free-margin and local/cervical nodal
metastases in 13 (14.1%), 29 (31.5%), 10 (10.9%), 29 (31.5%) of 92 patients in inpatient RAI group,
respectively, and in 3 (2.8%), 3 (2.8%), 5 (4.7%), 1 (0.9%) of 107 patients, in outpatient RAI group,
respectively.
Conclusions: In our practice, scheduling inpatient RAI doses for patients with thyroid
microcarcinoma depended on the presence of higher risk features, especially initial/first RAI
ablation/treatment. Although, stimulated Tg levels and various microcarcinoma (up to 1 cm) sizes
are hardly part of physician decision when preordering RAI, the higher risk features seem to relate
to higher stimulated serum Tg levels and larger tumor sizes in inpatient RAI group.
91
PCIOC 2019
OP-T-4
THE MIR-483-5P AS A MARKER PREDICTING CHEMORESISTANCE

IN EPITHELIAL OVARIAN CANCER KEYWORDS: MIR-483-5P,
CHEMORESISTANCE, OVARIAN CANCER
Rattanapan Y
Background: Almost a quarter of a million women are diagnosed with ovarian cancer each year
and more than half will die within five years of their diagnosis partly due to the difficult to cure
together with develops resistance to the most common form of treatment, platinum-based
chemotherapy. The aim of this study was to examine the relationship between miRNA expression
and response to chemotherapy.
Study Design & Methods: To conduct a genome-wide analysis of miRNA expression, epithelial
ovarian cancer tissues from 7 resistance and 9 sensitive chemotherapy were analyzed using
microarray chips. Candidate miRNAs were selected for validation by a quantitative reverse
transcription-polymerase chain reaction.
Results: Among 2,578 human mature microRNAs, high expression levels of miR-483-5p correlated
with poor response to chemotherapy in patients with epithelial ovarian cancer. Our bioinformatics
analyses show that miR-483-5p could promote ovarian cancer progression by modulating the gene
expression of the cell cycle, cell proliferation, DNA damage, or apoptosis pathways.
Conclusions: Our findings suggest that miR-483-5p may be a predicting the response of
chemotherapy or promising therapeutic candidate for the treatment of ovarian cancer. Further
studies are required to characterize the mechanism involved in the chemoresistant process.
92
Poster Presentations
PP-01: (E-Poster Presentation) VALUE OF SUPERB MICROVASCULAR IMAGING (SMI) IN
CHARACTERIZING OF NODULAR TYPE FOCAL FAT SPARING LESION, BENIGN NODULE, AND
MALIGNANCY IN THE BACKGROUND OF FATTY LIVER
Bhumiwat S, Siripongsakun S, Vichitpunt S
PP-02: PREVALENCE AND ASSOCIATION FACTORS OF DEPRESSION AND ANXIETY IN HEAD

AND NECK CANCER PATIENTS
Charoenlux P, Rawangban W, Roomruangwong C, Tangjaturonrasme N
PP-03: ANTIPROLIFERATIVE ASSESSMENT INDUCED BY LEAF EXTRACTS OF ANDROGRAPHIS

PANICULATA, ZIZIPHUS SPINA-CHRISTI AND VERNONIA EXTENSA ON CANCER CELL LINES
Faisal M, Liu X, Tedasen A, Rattanaburee T, Graidist P
PP-04: DOES PROSTHETIC RECONSTRUCTION HAVE BETTER SURVIVAL THAN BIOLOGIC IN

LIMB SPARING TUMOR SURGERY?
Hongsaprabhas C
PP-05: SQUAMOUS CELL CARCINOMA OVER CORNEA AFTER DIAGNOSIS OF NON-HODGKIN

LYMPHOMA
Jermjutitham M, Kasetsuwan N
PP-06: (E-Poster Presentation) MYCOPHENOLIC ACID AS A POTENTIAL DRUG FOR THE

TREATMENT OF OSTEOSARCOMA
Klangjorhor J, Chaiyawat P, Teeyakasem P, Sirikeaw N, Phanphaisarn A, Settakorn J,
Lirdprapamongkol K, Yama S, Svasti J, Pruksakorn D
PP-07: (E-Poster Presentation) STRATIFYING RISK OF DEVELOPING HCC IN HBV INFECTION

PATIENTS BY CLINICAL STAGES OF THE DISEASE MAY HELP OPTIMIZE SURVEILLANCE
INTERVALS: A LONG-TERM COHORT STUDY
Leknamongkol B, Siripongsakun S, Tangsermvong P
PP-08: PROLINE-RICH HOMEODOMAIN PROTEIN MIGHT SERVE AS A PROGNOSTIC MARKER

OF CHOLANGIOCARCINOMA AND INDICATES SENSITIVITY TO ADENOSINE
Lertsuwan J, Phoaubon S, Tasnawijitwong N, Lertsuwan K
93
PCIOC 2019
PP-09: POSTOPERATIVE OUTCOMES OF SUBAXIAL CERVICAL SPINE METASTASES:

A COMPARISON OF THE ANTERIOR, POSTERIOR AND COMBINED APPROACH
Luksanapruksa P
PP-10: THE EFFECTIVENESS AND SAFETY OF ULTRA-LONG NAVIGATED MINIMALLY INVASIVE

PALLIATIVE SPINE SURGERY IN EXTENSIVE SPINAL METASTASIS
Luksanapruksa P, Wilartratsami S, Jiamamornrat S
PP-11: NON-FUSION PALLIATIVE SPINE SURGERY WITHOUT ANTERIOR RECONSTRUCTION

IS SAFE AND IMPROVING QUALITY-OF-LIFE IN SPINAL METASTASES PATIENTS
Luksanapruksa P, Wilartratsami S, Suvithayasiri S
PP-12: EXPRESSION LEVELS OF MIR-34-FAMILY MICRORNAS ARE ASSOCIATED WITH TP53

MUTATION STATUS IN HEAD AND NECK SQUAMOUS CELL CARCINOMA
Metheetrairut C, Chotigavanich C, Amornpichetkul K, Keskool P, Ongard S, Metheetrairut C
PP-13: (E-Poster Presentation) TISSUE SPECIFIC MICRORNA MEAN EXPRESSION IN

LIPOSARCOMA AND LIPOMA
Namsiri R, Charoenlap C, Hongsaprabhas C, Vongpaisarnsin K, Thanakit V, Shuangshoti S
PP-14: UNIQUE CHARACTERISTICS AND PROGNOSIS OF MET EXON14 SPICE-SITE MUTATION

AND CO-MUTATION IN NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS
Oranratnachai S, Iemwimangsa N, Sanvarinda P, Detarkom P, Trachu N, Incharoen P,
Prosongsook N, Chantratita W, Reungwetwattana T
PP-15: CHIMERIC ANTIGEN RECEPTOR T CELLS TARGETING ΑVΒ6 INTEGRIN FOR

CHOLANGIOCARCINOMA
Phanthaphol N, Chieochansin T, Sujjitjoon J, Wongkham S, Junking M, Yenchitsomanus P
PP-16: (E-Poster Presentation) RECURRENT COLORECTAL CANCER: CLINICAL PRESENTATION

AND MODE OF DETECTION
Ruchakorn T
PP-17: (E-Poster Presentation) ANTI-TUMOR EFFECT OF ANTI-CD133 CHIMERIC ANTIGEN

RECEPTOR T CELLS AGAINST CHOLANGIOCARCINOMA CELLS
Sangsuwannukul T, Supimon K, Sujjitjoon J, Chieochansin T, Junking M, Yenchitsomanus P
94
PP-18: SOLID/TRABECULAR VARIANT PAPILLARY THYROID CARCINOMA IN A 10-YEAR-OLD

GIRL WITH AUTOIMMUNE THYROID DISEASE
Siranart N
PP-19: PROSPECTIVE ANALYSIS OF CLINICAL CHARACTERISTICS AND RISK FACTOR FOR

CHOLANGIOCARCINOMA
Soonklang K, Sungkasubun P, Siripongsakun S, Jaroenpatarapesaj S
PP-20: (E-Poster Presentation) USE OF P16/KI67 FOR TRIAGE OF CERVICAL INTRAEPITHELIAL

NEOPLASIA II-III IN PATIENTS INFECTED WITH HIGH RISK TYPE OF HUMAN PAPILLOMA VIRUS
(HPV)
Srisuttayasathien M, Luasiripanthu T, Petchjorm S, Kraisorakun W, Chatchotikawong U,
Vanichtantikul A, Wetcho T, Ittiamornlert P, Krongthong W, Saeloo S, Kantathavorn N
PP-21: FACTORS OF EXCLUSIVE BREASTFEEDING FOR BREAST CANCER PREVENTION AT

PESAWAHAN VILLAGE, PORONG, SIDOARJO - INDONESIA, MAY 2018
Sugiharto S, Handayani N, Dyas S, Palguna I, Reniati R
PP-22: GENERATION OF CHIMERIC ANTIGEN RECEPTOR T CELLS TARGETING MUCIN 1

AGAINST CHOLANGIOCARCINOMA
Supimon K, Sangsuwannukul T, Sujjitjoon J, Chieochansin T, Junking M
PP-23: (E-Poster Presentation) SONOGRAPHIC APPEARANCE OF DETECTED LIVER NODULES

IN LONG-TERM HEPATITIS B SURVEILLANCE PROGRAM
Tangsermvong P, Siripongsakun S, Leknamongkol B
PP-24: TAI CHI AND CARDIAC HEALTH, EJECTION FRACTION AMONG CANCER PATIENTS:
A PILOT STUDY (TICHEFCAP)
Tanking C
PP-25: ASSOCIATION BETWEEN QUANTITY OF ADIPOSE-DERIVED STEM CELLS AND

DEMOGRAPHIC FACTORS IN BREAST CANCER PATIENTS
Thitilertdecha P, Lohsiriwat V, Trongkamonthum W, Poungpairoj P, Tantithavorn W,
Onlamoon N
95
PCIOC 2019
PP-26: PRELIMINARY OUTCOME OF MINIMALLY INVASIVE SPINAL SURGERY IN SPINAL

METASTASIS PATIENTS: CHULABHORN HOSPITAL EXPERIENCE
Trathitephun W, Suwanaratana R, Kongtharvonskul J, Udomwongsub W
PP-27: (E-Poster Presentation) CLINICAL FEATURES OF PARANEOPLASTIC NEUROLOGICAL

SYNDROME RELATED TO ANTI-RI (ANNA2): THAI CASE SERIES AND REVIEW OF THE
LITERATURES
Treesuthacheep P, Katasrila P, Sonpee C, Hemachudha T, Saraya A
PP-28: STRENGTHENING CERVICAL CANCER PREVENTION THROUGH BEHAVIORAL

ECONOMICS INTERVENTIONS IN CLINICAL PRACTICE
Woratanarat T
PP-29: (E-Poster Presentation) IDENTIFICATION AND CHARACTERIZATION OF NOVEL HUMAN

SINGLE CHAIN VARIABLE FRAGMENT AGAINST CD19 FOR ENGINEERED T CELL THERAPY
Wutti-in Y, Sujjitjoon J, Panya A, Sawasdee N, Yongpitakwattana P, Yamabhai M, Junking M,
Yenchitsomanus P
96
PP-01 (E-Poster Presentation)
VALUE OF SUPERB MICROVASCULAR IMAGING (SMI) IN CHARACTERIZING

OF NODULAR TYPE FOCAL FAT SPARING LESION, BENIGN NODULE,
AND MALIGNANCY IN THE BACKGROUND OF FATTY LIVER
Bhumiwat S, Siripongsakun S, Vichitpunt S

Sonographer School, Faculty of Health Science Technology,
HRH Princess Chulabhorn College of Medical, Bangkok, Thailand
Background: In fatty liver, true focal liver lesions often show different features on sonographic
finding than those in normal parenchyma, which usually appear as hypoechoic lesions rather than
the hyperechoic lesion. This may be confusing to differentiate true liver lesion with focal fat sparing.
Superb microvascular imaging (SMI) has been used to identify slow flow vascularity and vascular
pattern in order to differentiate benign and malignant lesion in focal liver lesion by subtracting
tissue motion signal but is not currently use for separating focal fat sparring and true liver lesion
in fatty liver background. So, this study aims to evaluate the diagnostic performance of SMI for
differentiation between focal fat sparing and the true liver lesions of both benign and malignant
nature in the fatty liver background.
Study Design & Methods: In this prospective study, we included patients who diagnosed as having
hypoechoic liver lesions, size between 0.8-4.0 cm., in the background of fatty liver. All hepatic
lesions will have proved by CT and/or MRI for confirming the diagnosis of the hepatic lesions. Size,
margin, and features of the superb microvascular imaging (SMI) pattern were evaluated between
two groups. Group of true hepatic nodules of both benign and malignant nature was compared
with the focal fat sparing lesion group, using Fischer’s exact test.
Results: There are 44 patients with fifty-seven hypoechoic lesions in fatty liver background
underwent CT and/or MRI for diagnosis. Twenty-two focal fat sparing lesions and 35 true nodules
including 22 hemangiomas, 7 metastases, 3 FNHs, 2 benign regenerative nodules, 2 parasitic
related inflammation are included. The average size of focal fat sparing and true lesion groups are
1.4 cm and 1.6 cm, respectively. True nodules appear as well-defined margin in 34/35(97%) while
focal fat sparing lesions have only 8/22 (36%, p<0.001). In the focal fat sparing group, SMI feature
was non-specific in 10/22 (45.5%), no signal 9/22(40.9%), nodular rim 2/22(9.1%), and staining
pattern 1/22(4.5%). In true nodule group, SMI feature was non-specific in 11/35(31.5%), nodular
rim 7/35(20%), nodular rim with dot-like 7/35(20%), no signal in 6/35(17.1%), spoke wheel pattern
2/35(5.7%) and straining pattern 2/35(5.7%). In the true nodule groups, all nodular rim with dot-like
are hemangioma and all spoked-wheel pattern nodules are FNHs.
Conclusions: Nodular-liked focal fat sparing lesions are more likely to have ill-defined margin while
true nodules tend to have a well-defined margin. Both focal fats sparing and true nodules have
overlapped SMI flow pattern; however, a few specific patterns including nodular rim with dot-like
and spoke wheel pattern may be helpful in suggesting these two benign entities.
97
PCIOC 2019
PP-02
PREVALENCE AND ASSOCIATION FACTORS OF DEPRESSION AND ANXIETY

IN HEAD AND NECK CANCER PATIENTS
Charoenlux P, Rawangban W, Roomruangwong C, Tangjaturonrasme N

Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
Background: Our aim was to evaluate the prevalence of depression and anxiety in HNC patients
and investigate relationship between demographic/ physical-psychosocial/ disease factors and
depression or anxiety among these patients.
Study Design & Methods: We conducted a cross-sectional study with self-completed questionnaire.
Patients with HNC in our institution were recruited. We evaluated depression or anxiety according
to the Thai HADS. Univariate and multivariate analysis were performed to assess whether
the presence of any factors was associated with depression or anxiety.
Results: 293 patients (210 male,71.7% ; 83 female,28.3%) were enrolled. The mean age was 58.25
(SD±14.28) years (range 19-92 years). The prevalence of anxiety was 17.75% and depression was
16.04%. Univariate and multivariate analysis demonstrated that diagnostic time > 12 months
(adjusted OR (95%CI) = 4.79 (1.48, 15.54), p 0.009), and perception of disfigurement (adjusted OR
(95%CI) = 4.68 (1.42, 15.38), p 0.011) were associated with anxiety. While, education level had
direct positive correlation with anxiety prevention (adjusted OR (95%CI) = 0.13 (0.03, 0.57), p 0.006
and adjusted OR (95%CI) = 0.07 (0.01, 0.48), p 0.007 for education level < Bachelor degree and
≥ Bachelor degree, respectively). For depression, univariate and multivariate analysis showed that
patient age > 65 years (adjusted OR (95%CI) = 4.09 (1.6, 10.46), p 0.003), group staging 4 (adjusted
OR (95%CI) = 3.12 (1.2, 8.08), p = 0.019), and fatigue (adjusted OR (95%CI) = 5.7 (1.92, 16.93),
p 0.002) were related to depression. While, married status was a protective factor of depression
(adjusted OR (95%CI) = 0.38 (0.16, 0.94), p 0.037).
Conclusions: The prevalence of anxiety and depression in HNC patients was 17.75% and 16.04%,
respectively. Diagnostic time > 12 months, and perception of disfigurement were associated with
anxiety. While, education level had direct positive correlation with anxiety prevention. Age > 65
years, group staging 4, and fatigue were related to depression, in contrast to married status revealed
as a protective factor.
98
PP-03
ANTIPROLIFERATIVE ASSESSMENT INDUCED BY LEAF EXTRACTS

OF ANDROGRAPHIS PANICULATA, ZIZIPHUS SPINA-CHRISTI AND
VERNONIA EXTENSA ON CANCER CELL LINES
Faisal M, Liu X, Tedasen A, Rattanaburee T, Graidist P

Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Background: Cancer is the most numerous health issues worldwide. Andrographis paniculata (AP),
Ziziphus spina-christi (ZSC) and Vernonia extensa (VE) are well-known as medicinal herbs. Potentiate
bioactivities of these plants are possible as the natural chemotherapeutic drugs.
Study Design & Methods: Leaves of three plants were extracted with water, methanol, ethanol
and dichloromethane at ratio 1:10 (w/v). The antiproliferative effects of three plants were deter-
mined by MTT assay on MCF-7 (human breast adenocarcinoma), HT-29 and SW-620 (human
colorectal adenocarcinoma) and Vero (normal kidney cells) cells. The apoptotic was assessed
using Annexin-V assay.
Results: Results revealed that methanolic extract of AP had the highest antiproliferative effect
towards MCF-7 cells with IC50 value of 10.92 ± 0.46 µg/ml. Ethanolic and dichloromethane extract
of AP exhibited strong antiproliferation against SW-620 and HT-29 cells with IC50 values of 12.04
± 1.15 and 12.91 ± 5.12 µg/ml, respectively. Other plants, ZSC extracted with dichloromethane
exhibited high antiproliferation to MCF-7 cells with IC50¬ value of 12.99 ± 0.21 µg/ml. Hot water
extract of AP exhibited antiproliferative effect to MCF-7 cells and induces high antiproliferation
against Vero cells. Water extract of ZSC and VE induces antiproliferative effect to MCF-7 and
SW-620 cells. The methanolic extract of AP showed the highest antiproliferative effect against
MCF-7 cells. Therefore, apoptosis was determined by treated with IC50 of methanolic extract of
AP. Methanolic extract of AP induces apoptosis as 33.94% within 24 hours. After decreasing of
dose at 0.25, 0.5 of IC50 concentration and increasing incubation time at 48 hours, the apoptosis
percentage were increased as dose-dependent manner
Conclusions: In conclusion, AP has the highest antiproliferative effect when extracted with methanol
on MCF-7 cells. Moreover, methanol extract of AP inflicts apoptosis with a dose-dependent manner.
Further studies about in vivo or molecular mechanisms induced by these plants chemical
constituents are needed to be conducted.
99
PCIOC 2019
PP-04
DOES PROSTHETIC RECONSTRUCTION HAVE BETTER SURVIVAL THAN

BIOLOGIC IN LIMB SPARING TUMOR SURGERY?
Hongsaprabhas C
Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University
and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background: Prosthetic and biologic reconstructions are standard methods of management for
large bone defects in limb sparing tumor surgery with comparable results. The purpose of this
study was to evaluate the survival of both type of reconstruction.
Study Design & Methods: We performed a retrospective comparative study of the patients who
underwent limb sparing tumor surgery in King Chulalongkorn Memorial Hospital between 2009
and 2018. All clinical records, imagings, surgical techniques and complications were evaluated.
Fifty-three patients were enrolled with mean age of 39 years old (range, 10-76) and mean follow-up
time of 26 months (range, 1-89). Twenty four patients were male (45%). Most common indications
for surgery were osteosarcoma (34%), giant cell tumor (30%) and metastasis (17%) retrospectively.
While distal femur (28%), proximal femur (17%) and proximal humerus (15%) were the 3 most
common locations of surgery.
Results: There were 25 (47%) prosthetic reconstruction and 28 (53%) biologic reconstruction
including non-vascularized autograft (19%), frozen autograft (11%), pasteurized autograft (7%)
and allograft (6%). Overall patient mean survival time was 54 months (95%CI: 43-66). Reconstruction
mean survival time was 70 months (95%CI: 58-81) without significant differences between both
groups (p=0.152). Prosthetic reconstruction had 1-year and 5-year reconstruction survival of 94%
and 75%, while biologic had 88% and 65% (p=0.174) sequentially. Failure of reconstruction occurred
in 3 locations including distal femur (4 patients), proximal tibia (3 patients), mid femur (1 patient).
Causes of failure in biologic group were 3 infections, 2 recurrences, 1 graft fracture, while infections
were the main cause of failure in 2 prosthetic cases.
Conclusions: Prosthetic reconstruction did not have significant longer reconstruction survival over
biologic reconstruction. However, failures of biologic reconstruction tend to occur sooner than
prosthesis. Infection was the main cause of failure in both groups. Attempt to prevent is the key
to increase longevity of limb sparing surgery.
100
PP-05
SQUAMOUS CELL CARCINOMA OVER CORNEA AFTER DIAGNOSIS OF

NON-HODGKIN LYMPHOMA
Jermjutitham M, Kasetsuwan N
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University
and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background: The risk of second malignancy has increase in patients who diagnosed non-Hodgkin
lymphoma (NHL). We present a case of squamous cell carcinoma on ocular surface after diagnosis
of NHL and complete remission for 12 years
Study Design & Methods: Case description - An 81-year-old male presented with chronic irritation
right eye for two months. The eye examination showed dark brown elevated mass 12 x 5 x 0.6
mm extended from corneal limbus, encroached temporal half of the right cornea. The lesion was
not movable. He had been diagnosed diffuse large B-cell lymphoma and complete remission after
having chemotherapy and radiation therapy in 2007. The ultrasound biomicroscopy showed no
intraocular extension. The lymph nodes were all not palpable and other physical examinations
revealed normal.
Results: The wide excision with cryotherapy and amniotic membrane graft was performed using
no-touch technique. The histopathology diagnosed invasive squamous cell carcinoma with positive
margins on nasal side. Mitomicin C 0.02% eye drop, qid, 1 wk on and 1 wk off, was applied
postoperatively. The patient was followed up for more than two months with no recurrence seen.
Conclusions: Squamous cell carcinoma on ocular surface can develop as the second malignancy
after diagnosed of non-Hodgkin lymphoma.
101
PCIOC 2019
MYCOPHENOLIC ACID AS A POTENTIAL DRUG FOR THE TREATMENT

OF OSTEOSARCOMA
Klangjorhor J, Chaiyawat P, Teeyakasem P, Sirikeaw N, Phanphaisarn A,

Settakorn J, Lirdprapamongkol K, Yama S, Svasti J, Pruksakorn D
Musculoskeletal Science and Translational Research Center, Department of Orthopedics,
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background: Because of its heterogeneity, osteosarcoma still is an incompletely curable disease

and the new therapeutic options for improving outcomes have not yet been discovered. From our
previous proteomics data review, we found that osteosarcoma overexpressed some proteins,
which have been identified as targets of FDA-approved immunosuppressive and anti-arrhythmic
drugs, including Mycophenolate Mofetil (MMF), Ribavirin, Leflunomide, Azathioprine, and Digoxin.
In preliminary screening, Mycophenolic acid (MPA: an active metabolite of the MMF) at the
therapeutic range of organ transplant patients showed a higher efficient inhibition of human
osteosarcoma cell growth when compared to the other drugs. We hypothesized that MPA/MMF
are promising candidate for drug repurposing in osteosarcoma.
Study Design & Methods: MNNG-HOS, U2OS, SaOS2, MG63 and 143B human osteosarcoma cell
lines were subjected to MPA treatment in order to investigate mechanism of its anticancer activities.
In vivo anti-tumor growth and anti-metastatic effects of MMF were determined by using 143B cell
line-derived xenograft nude mice model.
Results: MPA at 10 µM, a therapeutic dose, significantly inhibited colony formation, induced cell
cycle arrest, and caused apoptosis. Moreover, MPA significantly reduced in vitro invasion through
inhibition of migration capability of osteosarcoma cells. In vivo antitumor growth of MMF was
determined in nude mice harboring xenografts of 143B cells. Daily oral administration of MMF at
200 mg/kg/day for 2 weeks significantly suppressed tumor growth of treated mice, achieving 57.4
± 11.1% tumor growth inhibition. In a tail vein-lung metastasis model, MMF administration at
50-200 mg/kg/day for 3 weeks significantly reduced the number of lung metastatic nodules.
Doses of MMF at 50, 100 and 200 mg/kg/day are approximately equivalent to 250, 500 and
1000 mg/day, which are non-toxic doses in humans.
Conclusions: From these findings, MPA/MMF shows an effective control of tumor growth and
metastasis in osteosarcoma. Therefore, MPA/MMF would be of great interest as a drug repurposing
candidate for osteosarcoma chemotherapy.
102
STRATIFYING RISK OF DEVELOPING HCC IN HBV INFECTION PATIENTS BY

CLINICAL STAGES OF THE DISEASE MAY HELP OPTIMIZE SURVEILLANCE
INTERVALS: A LONG-TERM COHORT STUDY
Leknamongkol B, Siripongsakun S, Tangsermvong P

Chulabhorn Hospital, Bangkok, Thailand
Background: Hepatitis B virus remains the most common liver infection, causing a major risk factor
for development of hepatocellular carcinoma (HCC). Surveillance of HBV patients using ultrasound
(US) and alpha-fetoprotein (AFP) are recommended as a standard practice in major guidelines e.g.
AASLD.
However, hepatitis B infection with distinct clinical stages which may contributed to different
likelihood of developing HCC. We conduct a long-term cohort of HCC surveillance to evaluate the
risk of developing in different clinical stages of the disease.
Study Design & Methods: Total 2,293 patients with HBV infection who met criteria for HCC
surveillance by AASLD criteria have been recruited in this cohort from July 2010 to May 2018.
All patients have upper abdominal ultrasound surveillance for HCC every 6 months. Focal lesions
sized more than 1 cm detected during the surveillance period underwent further investigation by
CT or MRI with the diagnosis of HCC based on AASLD criteria. The annual risk of detection of HCC
and dysplastic nodules was calculated in each clinical stage consisting of inactive carrier, chronic
HBV infection, and HBV cirrhosis.
Results: Of 2,293 patients, aged between 40-60 years old, enrolled in this cohort, 17 HCC and 12
dysplastic nodules are detected and confirmed, with an average size of 1.5 ± 0.9 cm (SD) in size.
The annual risk of developing HCC and dysplastic nodules in the inactive carrier are 0% and 1%,
in chronic hepatitis B are 1% and 1.2%, and in cirrhosis are 8 % and 3%, respectively.
Conclusions: Patients in the clinical stage of HBV inactive carrier have significant lower HCC risk
compared to those with chronic hepatitis B and cirrhosis. Stratifying patients’ risk by clinical
hepatitis B stage may be potentially used to optimize surveillance interval in order to maximize
surveillance benefit at a lower cost.
103
PCIOC 2019
PP-08
PROLINE-RICH HOMEODOMAIN PROTEIN MIGHT SERVE AS A PROGNOSTIC

MARKER OF CHOLANGIOCARCINOMA AND INDICATES SENSITIVITY
TO ADENOSINE
Lertsuwan J, Phoaubon S, Tasnawijitwong N, Lertsuwan K

Laboratory of Chemical Carcinogenesis, Chulabhorn Research Institute, Bangkok, Thailand
Background: Cholangiocarcinoma (CCA) is a lethal cancer of bile ducts. Molecular category of this
disease has not been established yet due to its high heterogeneity. CCA was shown to be sensitive
to adenosine and has Proline-Rich Homeodomain protein (PRH) as a driver. Herein, we demonstrated
that high invasive and fast growing CCA cell lines express high PRH level and more sensitive to
adenosine.
Study Design & Methods: Six CCA cell lines including 5 Thai and 1 Caucasian plus 2 immortalized
cholangiocyte cell lines represented CCA cells. Cell growth was measured by MTT assay and cell
invasion was assessed by transwell assay. Adenosine receptors expression was screened by using
RT-PCR. PRH protein knockdown was achieved by using siRNA.
Results: Immortalized cholangiocyte cell lines and some CCA cell lines were resistant to adenosine.
Purinergic receptors expression profile showed no pattern among these 8 cell lines. In addition,
pro-inflammatory molecules and CK2 showed no pattern too. Interestingly, PRH protein expression
was high in adenosine-sensitive cell lines and low in adenosine-resistant cell lines. PRH knockdown
CCA cell lines grow approximately 2-8 times slower and invaded approximately 4 times less. Next,
we showed that PRH knockdown cell lines were more resistant to adenosine treatment. IC50 of
adenosine in PRH knockdown CCA cells increased from 350 µM to 1000 µM in RMCCA-1 and
CCLP-1 cells, and more than 1000 µM in HuCCA-1 cells. The molecular mechanism of adenosine
on CCA cell inhibition was through an inhibition of PRH via a receptor-independent mechanism.
Conclusions: PRH expressed highly in some CCA cells and low in immortalized cholangiocyte cell
lines. High PRH CCA cell lines grew faster, invaded more, and were more sensitive to adenosine.
Adenosine inhibited CCA cell growth via a receptor-independent mechanism by increasing a level
of phosphorylated PRH, which is an inactive form.
104
PP-09
POSTOPERATIVE OUTCOMES OF SUBAXIAL CERVICAL SPINE METASTASES:

A COMPARISON OF THE ANTERIOR, POSTERIOR AND COMBINED APPROACH
Luksanapruksa P
Background: Incidence of subaxial spinal metastases is increasing due to longer life expectancy
resulting from successful modern treatments of cancer. The three most utilized approaches for
surgical treatment include the anterior, posterior, and combined approach. However, despite
increasing surgical volume, data on the postoperative complication profiles of different operative
approaches for this patient population is scarce.
Study Design & Methods: Institutional databases of two hospitals were reviewed retrospectively.
Patients with subaxial cervical spine metastases who underwent cervical surgery between 2005
and 2015 were identified. Clinical presentations, baseline characteristics, operative approach,
perioperative complications, and postoperative outcomes including pain, neurological recovery
and survival were compared between the three surgical approaches.
Results: This study included 70 patients (44 anterior, 14 posterior, 12 combined). There were no
statistically significant differences in preoperative characteristics, which included the Charlson
comorbidity index, Tomita score, and revised Tokuhashi score, between the three groups.In addition,
there were no statistical differences in rates of medical, surgical complications, neurological
recovery, verbal numeric score improvement, survival time, and ambulatory status improvement
between the three approaches. However, the combined approach did show a significantly higher
rate of overall perioperative complications (p=0.01), intraoperative blood loss(p<0.001), and
operative time (p<0.001).
Conclusions: Results from the current study do not reveal any clear superiority between the three
main surgical approaches for treatment of subaxial spinal metastases. Patients in the combined
approach group had the highest rates of perioperative complications. However, although not
statistically significant, patients in the combined group also tended to have better clinical outcomes
after follow up and the longest survival time.
105
PCIOC 2019
PP-10
THE EFFECTIVENESS AND SAFETY OF ULTRA-LONG NAVIGATED MINIMALLY

INVASIVE PALLIATIVE SPINE SURGERY IN EXTENSIVE SPINAL METASTASIS
Luksanapruksa P, Wilartratsami S, Jiamamornrat S

Background: Previously, the extensive spinal metastasis (Tomita stage 7) (ESM) with pathological
fracture preferred palliative treatment but pain and no-ambulatory status impaired quality of
life (QOL). The ultra-long navigated minimally invasive palliative spine surgery (UNMISS) has
revolutionized the treatment of spinal metastasis. The purpose is to report outcome of UNMISS
in ESM patients.
Study Design & Methods: Between 2017 and 2018, 13 ESM with pathological fracture were treated
by UNMISS at Siriraj Hospital. The patients were assessed by Tomita score, pain score, operation
time, blood loss, neurological status, time to ambulation and survival.
Results: Eight patients required decompression in addition to stabilization. Average operating time
was 268±90 minutes. Mean blood loss for stabilization was 515±160 ml. Preoperative visual analog
scale pain score was 7.4±1.6 that was decreased to 0.2±0.6 postoperatively. No patient had worsen
neurological status. One patient showed improvement of one Frankel grade. The average time to
ambulation of 4.4±1.4 days, except one patient was delayed due to postoperative sepsis. There
was no early post-operative implant related complication but one patient had wound dehiscence
and one case had early post-operative mortality.
Conclusions: The UMISS is effective and safe option for ESM, relieving back pain, improving
ambulatory status and no serious surgical-related complication.
106
PP-11
NON-FUSION PALLIATIVE SPINE SURGERY WITHOUT ANTERIOR

RECONSTRUCTION IS SAFE AND IMPROVING QUALITY-OF-LIFE IN SPINAL
METASTASES PATIENTS
Luksanapruksa P, Wilartratsami S, Suvithayasiri S

Background: Considering shorter life expectancy and poorer prognosis, anterior reconstruction
and/or fusion in spinal metastases patients may be unnecessary. Therefore, we investigate the
outcomes of palliative surgery of non-fusion without anterior reconstruction in our institution.
Study Design & Methods: A single-center retrospective review of patients, with thoracic, or lumbar
spinal metastases from July 2015 to December 2017, were included. All were undergoing posterior
decompression, and instrumentation alone without reconstruction. Data collection and analysis
from preoperative to follow-up at 1 year, including complication; revision surgery rate; and
quality-of-life-related outcome scores, was conducted.
Results: A total of 30 patients, mean age, 59.83 ± 11.73 years, were included. Mean operative
time was 208.17 ± 58.41 minutes. At least one Frankel grade improvement was reported in 53.33%
(N = 16). The pain visual analog scale, EQ5D5L, and ODI were all significantly improved at a minimum
of 3 months. No instrument-related complication and revision was reported. Mean survival period
was 11.4 ± 8.97 months.
Conclusions: From this study, palliative non-fusion surgery without anterior reconstruction is a
safe and effective procedure in treating spinal metastases patients (low revision rate, no report
of implant failure, improved quality-of-life-related outcomes).
107
PCIOC 2019
PP-12
EXPRESSION LEVELS OF MIR-34-FAMILY MICRORNAS ARE ASSOCIATED

WITH TP53 MUTATION STATUS IN HEAD AND NECK
SQUAMOUS CELL CARCINOMA
Metheetrairut C, Chotigavanich C, Amornpichetkul K, Keskool P,

Ongard S, Metheetrairut C
Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background: Head and neck squamous cell carcinoma (HNSCC) is a cancer of the squamous
epithelia in the head and neck region. The majority of HNSCC cases in developing countries are
associated with cigarette smoking and TP53 gene mutations. p53 is a transcription factor that
activates many downstream genes, including hsa-miR-34a locus and hsa-miR-34b/c locus, to
achieve cell cycle arrest, senescence, and/or apoptosis.
Study Design & Methods: In this study, we examined surgically resected tumor samples and normal
adjacent tissues from HNSCC in oral cavity, larynx, and hypopharynx regions for levels of expression
of miR-34-family miRNAs and p53 mutation status.
Results: We have shown that levels of expression of miR-34a, miR-34b, miR-34b*, and miR-34c
are significantly up-regulated in tumors with wild-type TP53 genes (n = 23); while levels of expression
of miR-34-family miRNAs are not increased in tumors with mutant TP53 (n = 19). Although levels
of expression of miR-34-family miRNAs do not correlate with many demographic and
clinicopathological data (gender, age, or tumor staging), interestingly, expression levels of miR-34b,
miR-34b*, and miR-34c are correlated with smoking status and tumor sites. miR-34b/b*/c are
up-regulated in tumors from those who ever smoked or those who have recently smoked (quit
smoking less than 15 years ago); but such up-regulation was not seen in those who never smoked
or those who did not smoke recently (quit smoking for at least 15 years). In addition, HNSCC of
the oral cavity also up-regulated miR-34b/b*/c while no such overexpression was observed in
HNSCC of the larynx and hypopharynx.
Conclusions: Levels of expression of miR-34-family miRNAs were correlated with p53 mutation
in HNSCC.
108
TISSUE SPECIFIC MICRORNA MEAN EXPRESSION IN LIPOSARCOMA

AND LIPOMA
Namsiri R, Charoenlap C, Hongsaprabhas C, Vongpaisarnsin K, Thanakit V,

Shuangshoti S
Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
Background: Lipomatous tumors is common soft-tissue tumors. Diagnosis and differentiation between
lipoma and liposarcoma subtype are mandatory for management and prognostic prediction.
Multiple methods can distinguish between lipoma and liposarcoma including immunohisto-
chemistry and messenger ribonucleic acid (mRNA), however they both have some disadvantages.
Recent studies revealed that microRNA (miRNA) had an important role in the tumorigenesis,
therefore it could be used as an aid for diagnosis, respond to treatment and development to tar-
geted therapy.
Study Design & Methods: We performed a retrospective analytical study looking into the different
expressions of mir-143, mir-144, mir-422a, mir-451 and mir-485-5p between lipoma and liposarcoma
by using quantitative real-time polymerase chain reaction (PCR). All microRNAs were extracted
from formalin-fixed paraffin-embedded (FFPE) sample of 65 liposarcomas including all subtypes
compare with 13 lipomas. The expressions level of 5 microRNAs were analysed by TaqMan real-time
PCR assays. Statistical analysis were determined by Mann-Whitney U-test and ROC curve.
Results: There was a 0.92–fold change decrease in expression of mir-143 (p=0.004), 0.91–fold
change in mir-144 (p=0.004), 0.90–fold change in mir-422a (p=0.001), and 0.93–fold change in
mir-451 (p=0.003) comparing between liposarcoma and lipoma. We also found that miRNAs
decrease in expression of mir-143, mir-144, mir-422a, mir-451 were significantly lower in
well-differentiated, dedifferentiated, myxoid-round cell, and unclassified liposarcomas compare
to the lipoma. The change of expression in mir-485 was not significant in other subtype, except
in unclassified liposarcoma with a 0.94-fold change (P=0.022) when compare with the lipoma.
Conclusions: The expression level of microRNA could serve as an available liposarcoma biomarker.
We found that the under-expression level of mir-143 mir-144 mir-451 and mir-485-5p had diagnostic
value for lipomatous tumors. In addition, microRNA is a powerful tool to discriminate liposarcoma
subtypes. Hence, it can be used as an aid for diagnosis, respond to treatment and development
to targeted therapy.
109
PCIOC 2019
PP-14
UNIQUE CHARACTERISTICS AND PROGNOSIS OF MET EXON14 SPICE-SITE

MUTATION AND CO-MUTATION IN NON-SMALL CELL LUNG CANCER (NSCLC)
PATIENTS
Oranratnachai S, Iemwimangsa N, Sanvarinda P, Detarkom P, Trachu N,

Incharoen P, Prosongsook N, Chantratita W, Reungwetwattana T
Division of Medical Oncology, Faculty of Medicine Ramathibodi Hospital,
Background: Previous studies reported that oncogenic MET exon 14 splice-site mutation (METex14)
contributes to 2-4% of NSCLC patients and is associated with poor prognosis. However, identifi-
cation of distinct mutation profiles of NSCLC between Western and Asian countries poses the
necessity to obtain population-specific database. We aimed to explore the prevalence, clinical
characteristic, and prognosis of METex14 in Thai NSCLC patients.
Study Design & Methods: Tissue archive of stage I-IV NSCLC from Ramathibodi and Phramong-
kutklao Hospitals during 2012-2015 was retrieved for DNA extraction. Samples were analyzed by
Next Generation Sequencing with Lung Cancer Panel 45 Genes on Ion Torrent system. Variants
from NGS with coverage of higher than 1000X and ≥3% alternate variant frequency were consid-
ered as positive. Clinical data correlation was analyzed.
Results: Of the 159 NSCLC patients, 14 (8.8%) had METex14. Mean age of METex14 patients was
64.5 ± 8.6 years old. Majority of the patients were female (71.4%) and never-smokers (71.4%).
Nine patients were diagnosed with stage IV disease. Co-mutations were identified in 10/14 (71.4%)
patients, in which, EGFR was the most common (8/10=80%), followed by KRAS (5/10=50%),
BRAFV600E (3/10=30%) and AKT1 (1/10=10%). Patients with single METex14 had median overall
survival (mOS) of 24.1 months. EGFR co-mutation was associated with better prognosis, with the
mOS of 39.1 months versus 13.2 months of those without (HR 0.12, p=0.015). Interestingly
BRAFV600E co-mutation was associated with a trend toward poorer prognosis, with the mOS of
10.4 months versus 35.8 months (HR 2.39, p=0.213).
Conclusions: We identified the high prevalence and discovered the unique characteristics of
METex14 in Thai lung cancer patients. Although METex14 was thought to be mutually exclusive
with other driver mutations, our study discover the presence of several co-mutations, of which,
each was associated with a distinct prognosis. Targeting METex14 is one of the potential effective
treatments for NSCLC in the future.
110
PP-15
CHIMERIC ANTIGEN RECEPTOR T CELLS TARGETING ΑVΒ6 INTEGRIN

FOR CHOLANGIOCARCINOMA
Phanthaphol N, Chieochansin T, Sujjitjoon J, Wongkham S, Junking M,

Yenchitsomanus P
Background: Cholangiocarcinoma (CCA) is a fetal bile duct cancer that has poor prognosis and
treatment outcome. The development of chimeric antigen receptor (CAR) T-cell is one of potential
treatments for CCA. The αvβ6 integrin may serve as target for the development of CAR T-cells
against CCA. This study aimed to investigate αvβ6 expression in patients’ tissues and developed
αvβ6-specific CAR T-cells against CCA cells.
Study Design & Methods: The expression of αvβ6 was investigated in CCA tissues and cell lines
using immunohistochemistry (IHC) and flow cytometry, respectively. The CAR targeting αvβ6 was
engineered by using a published A20 peptide (A20) as a tumor-targeting domain fused to CD3ζ
with either CD28 costimulatory domain (A2028z) or 4-1BB (A20BBz). T cells expressing αvβ6-targeted
CAR were prepared using lentiviral vector transduction.
Results: αvβ6 expression was found in 86% (31/36) of CCA tissues but not at adjacent normal bile
duct tissues. The αvβ6 also was expressed at the cell surface of CCA cell lines, KKU055, KKU100,
and KKU213, but was not in immortal cholangiocytes, MMNK-1. CARs targeting αvβ6 were
constructed in lentiviral-based vector and checked for expression in HEK293T cells.
Conclusions: This preliminary study showed that αvβ6 integrin serves as a potential target for
CAR T-cell development for CCA. The αvβ6-specific CAR was constructed and could be expressed
in human cells. The efficiency of αvβ6-specific CAR T-cells on CCA cell killing will be investigated.
111
PCIOC 2019
RECURRENT COLORECTAL CANCER: CLINICAL PRESENTATION

AND MODE OF DETECTION
Ruchakorn T
Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
Background: Active surveillance after colorectal cancer (Stage I-III ) treatment with curative intent
aims to detect recurrences. The objective of this study is to assess how recurrent disease presents
and is diagnosed within scheduled follow-up according to the Faculty of Medicine Ramathibodi
Hospital, and to determine how much different in survival benefit between symptomatic and
asymptomatic patients.
Study Design & Methods: In a retrospective study of consecutive patients with colorectal cancer
who were treated in Faculty of Medicine Ramathibodi Hospital, we identified patients with colorectal
cancer who underwent surgery with curative intent between January 2013 and December 2016.
Patients who developed recurrent disease were included for further analyses.
Results: From a total of 1,096 patients who were been treated for colorectal carcinoma (Stage I-III)
with curative intent, 184 developed recurrent disease (16.7%). In 155 of those patients (84.2%),
recurrent diseases were detected during a scheduled follow-up visit, being asymptomatic. Tumor
marker testing, imaging, and colonoscopy identified all of these recurrences. In the remaining 29
patients with recurrent disease (15.7%), recurrence was found during non-scheduled interval
visits; patients were symptomatic. The most prevalent symptoms were gut obstruction and
abdominal mass. Patients with asymptomatic recurrences had significantly higher overall survival
compared with patients with symptomatic recurrences (45.2 months vs. 28.4 months, HR 2.4 (95%
CI 1.52 -3.87) p= 0.0006). Patients with asymptomatic recurrences had a significantly longer time
to treatment compared with patients with symptomatic recurrences (1.6 months vs. 0.5 month,
HR 1.85 (95% CI 1.23 -2.17), p = 0.003).
Conclusions: Active surveillance after adjuvant therapy in colorectal cancer (Stage I-III) could
prolong survival of the patients with recurrent disease due to the detection of resectable metastatic
disease. Early detection of recurrent disease during asymptomatic period could prolong survival
than late detection when symptom occurred.
112
ANTI-TUMOR EFFECT OF ANTI-CD133 CHIMERIC ANTIGEN RECEPTOR T CELLS

AGAINST CHOLANGIOCARCINOMA CELLS
Sangsuwannukul T, Supimon K, Sujjitjoon J, Chieochansin T, Junking M,

Yenchitsomanus P
Background: Cholangiocarcinoma is the second most common liver cancer with no effective
curative treatment. Chimeric antigen receptor (CAR) T cell is genetically modified T cells enables
direct-targeting tumor-associated antigen without requirement of major histocompatibility
complex. Remarkable clinical outcomes of CAR T cells have been shown in hematological
malignancies; however, the anti-tumor effect against cholangiocarcinoma is still unclear. Overex-
pression of CD133 tumor-associated antigen was found in cholangiocarcinoma patients related to
low survival rate and high metastasis. In addition, CD133 has been considered as a cancer stem
cell marker, which plays role in tumor progression and resistance to therapy. Thus, it is interesting
to investigate whether cholangiocarcinoma cells can be eradicated by CAR T cells targeting to
CD133 (CD133-CART).
Study Design & Methods: Initially, expression of CD133 on KKU-213 cell line was examined by
using flow cytometry. Lentiviral vector containing CD133-CAR was constructed and its expression
in human cell line (HEK293T) was tested by using immunoblotting of CD3z. Then, CD133-CART
cells were generated using lentiviral transduction. Finally, anti-tumor effect of CD133-CART were
examined under fluorescent microscope.
Results: Here, we report that CD133-CART exhibits anti-tumor effect against cholangiocarcinoma
patient-derived KKU-213 cell line. The membranous CD133 expression represents possible target
for CAR T cells treatment. Co-culture of CD133-CART and fluorescent protein-expressing KKU-213
cell lines resulted in tumor cell lysis at different effector to target ratio.
Conclusions: Thus, this study indicates feasibility and potent anti-tumor effect of CD133-CART
against cholangiocarcinoma KKU-213 cells, which will be further developed for treatment of
cholangiocarcinoma and other CD133-expressing tumors.
113
PCIOC 2019
PP-18
SOLID/TRABECULAR VARIANT PAPILLARY THYROID CARCINOMA IN

A 10-YEAR-OLD GIRL WITH AUTOIMMUNE THYROID DISEASE
Siranart N
Background: Autoimmune thyroid disease (AITD) is a common organ specific autoimmune disorder
affecting frequently the middle aged women. In addition, it is believed that AITD increases a risk
for a well-differentiated thyroid carcinoma. However, the association between AITD and thyroid
cancer remains controversial. The authors report a case of papillary thyroid carcinoma, solid/
trabecular variant, in a child who has been diagnosed with AITD.
Study Design & Methods: A 10-year-old girl was found to have an increase in size of left thyroid
mass. She had experienced hyperthyroidism along with enlarged thyroid gland for three years.
Her blood tests showed increased level of thyroxin and decreased thyroid stimulating hormones
as well as positive results for thyroid peroxidase and thyroglobulin antibodies. Then, she had been
diagnosed as AITD, treated with oral medication. Fine needle aspiration of the left thyroid mass
showed papillary thyroid carcinoma. Thereafter, the patient underwent total thyroidectomy.
Results: The left thyroid mass revealed solid/trabecular variant papillary carcinoma. The tumor
was non-encapsulated with invasive borders and composed of round solid nests resembling filled
up follicles in association with fibrous and hyalinized stromas and scattered psammoma bodies.
Such neoplastic cells are markedly pleomorphic possessing vesicular nuclei and visible nucleoli
with occasional intranuclear grooves.
Conclusions: Our case report supports the linkage between AITD and thyroid cancer. The clinical
manifestation of AITD in very young of age as seen in our patient is unusual. This case reminds
physicians to follow up such patient for early detection and management of possible cancer arising
in the thyroid gland with AITD.
114
PP-19
PROSPECTIVE ANALYSIS OF CLINICAL CHARACTERISTICS AND RISK FACTOR

FOR CHOLANGIOCARCINOMA
Soonklang K, Sungkasubun P, Siripongsakun S, Jaroenpatarapesaj S

Data Management Unit, HRH Princess Chulabhorn College of Medical Science,
Background: Cholangiocarcinoma (CCA) is a tumor of the biliary tract, presumably of cholangiocytic

origin, with a rising global incidence. The objective of this retrospective cohort study was to develop
risk factors of CCA.
Study Design & Methods: Our predictor model was derived from completed data obtained on
4,074 participants (follow-up: 2011-2016) in Ban Luang district, Nan Province of Northern Thailand.
Forward stepwise Cox proportional hazard model was applied to obtain coefficients for each
predictor. Model input included age, sex, body mass index, cigarette smoking, alcohol consumption,
Opisthorchis viverrini (OV) infection, antiparasitic drug consumption, occupation, agricultural
chemical exposure, family history of CCA in first-degree relatives, calcified bile duct dilatation and
fibrosis from abdominal ultrasound, cancer antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA)
and alkaline phosphatase (ALP). All statistical tests were two-sided.
Results: During a median follow-up of 50 months, 32 cases of CCA and 19 cases of pre-malignant
lesions were newly diagnosed. In the bootstrap simulation (1000 random samplings), family history
of CCA in first-degree relatives (HR=1.96), ALP > 100 (HR=2.62) and bile duct dilatation (HR= mild,
4.61, moderate:16.10) were statistically significant independent predictors of CCA risk. The Harrell’s
C concordance statistic was 0.80.
Conclusions: In conclusion, 6 month ultrasound follow-up is recommended in those with family
history of CCA in first-degree relatives, ALP>100 IU/L and bile duct dilatation.
115
PCIOC 2019
USE OF P16/KI67 FOR TRIAGE OF CERVICAL INTRAEPITHELIAL

NEOPLASIA II-III IN PATIENTS INFECTED WITH HIGH RISK TYPE
OF HUMAN PAPILLOMA VIRUS (HPV)
Srisuttayasathien M, Luasiripanthu T, Petchjorm S, Kraisorakun W,

Chatchotikawong U, Vanichtantikul A, Wetcho T, Ittiamornlert P,
Krongthong W, Saeloo S, Kantathavorn N
Background: Adding P16/Ki-67 Dual-immunostaining to HPV screening test has been shown to
increase detection rate of high-grade cervical intraepithelial neoplasia (CIN2+). This study was
aimed to evaluate the diagnostic performance of P16/Ki67 dual-staining, combined with co-testing
(PAP/HPV), for the detection of histologic confirmed CIN2+.
Study Design & Methods: Women aged 20-70 years coming for cervical screening who had positive
high-risk type of HPV were invited to participated in the study(N=192). P16/Ki67 testing was
performed on residual liquid-based cytologic material within 2 weeks after specimen collection.
Colposcopy and colposcopic directed biopsy were done in all patients. Pathologic results were
correlated to positive or negative P16/Ki-67 test.
Results: Sensitivity of P16/Ki-67 dual-staining for the detection of CIN 2+ in women infected with
either HPV 16/18 or other high-risk genotypes was 74.2% (23/31 cases). Specificity and positive
predictive value were 64.0% (103/161 cases) and 28.4% (23/81 cases), respectively. Negative
predictive value was high at 92.8% (103/111 cases). Combining dual-staining with PAP smear,
negative predictive value for the detection of CIN 2+ in negative cytology was 94.7%, ASC-US was
88.9% and LSIL was 95.8%.
Conclusions: P16/Ki-67 dual-stained cytology combined with co-testing represents a high negative
predictive value and potentially be used to avoid unnecessary colposcopy in patients with negative
and low-grade cytology.
116
PP-21
FACTORS OF EXCLUSIVE BREASTFEEDING FOR BREAST CANCER PREVENTION

AT PESAWAHAN VILLAGE, PORONG, SIDOARJO - INDONESIA, MAY 2018
Sugiharto S, Handayani N, Dyas S, Palguna I, Reniati R

Faculty of Medicine of Wijaya Kusuma Surabaya University, Republic of Indonesia
Background: Exclusive breastfeeding (fully in 0-6 months) has a great contribution to the growth
and endurance of a child. Children exclusively breastfed will grow and develop optimally and not
easily sick. Besides, the mother who gives breastfeeding will take some advantages, especially
from preventing breast cancer. This study aimed to analyze factors of exclusive breastfeeding for
breast cancer prevention at Pesawahan Village, Porong, Sidoarjo - Indonesia, May 2018.
Study Design & Methods: This study was an observational cross-sectional approach. The sample
was 38 mothers who had babies aged >6-24 months. The variables observed were respondent’s
age, knowledge level, formal education level, job, number of children, family income, family
support, and exclusive breastfeeding. Data analyzed with Chi Square of SPSSC 25.0.
Results: Respondent’s characteristic were: 74% young-age (20-34 years old) mother, 74% good
knowledge level, 74% high education level, 76% had >2 children, 71% housewife, 61% low level
family income, 71% had family support, and 63,2% exclusive breastfeeding mother. The factors
that have relationship with exclusive breastfeeding were: knowledge level (p=0,021), formal
education level (p=0,021), and family support (p=0,018) with α <0.05.
Conclusions: We must focused on the related factors: knowledge level, formal education level,
and family support. We should give more information and its accesses to people for good knowledge
and building a strong family support for exclusive breastfeeding. We hope that breastfeeding
activity will protect the mother, especially the young mother from breast cancer, because the good
circulation inside mammary tissues.
117
PCIOC 2019
PP-22
GENERATION OF CHIMERIC ANTIGEN RECEPTOR T CELLS TARGETING

MUCIN 1 AGAINST CHOLANGIOCARCINOMA
Supimon K, Sangsuwannukul T, Sujjitjoon J, Chieochansin T, Junking M

Background: Cholangiocarcinoma (CCA) is a fetal malignancy of bile duct epithelial cells with poor
prognosis and treatment outcome. It is a rare disease worldwide but frequent in the northeast of
Thailand. Standard treatments are not effective in the advanced stage of CCA, leading to high
recurrence rate, low prolong-survival, and chemo-resistance in the patients. Therefore, a novel
therapy for CCA is needed. Chimeric antigen receptor (CAR) T cells have emerged as a new modality
for cancer therapy with high efficacy. These cells recognize specific cancer antigen and induce
cancer cell lysis. One of cancer-associated antigens, Mucin 1 (MUC1), is highly expressed in CCA
tissue related to cancer progression. The cancer-associated MUC1 is hypoglycosylated when it is
compared to heavy glycosylation in normal cells. MUC1-targeted CAR T cells have recently been
studied in several cancer models; however, none of them have been used in CCA. Thus, this study
aims to investigate anti-tumor efficacy of MUC1-targeted CAR T cells against CCA.
Study Design & Methods: Initially, MUC1 expression was confirmed in CCA cells by Western blotting
technique and flow cytometry. Then, anti-MUC1-CAR T cells were generated by using lentiviral
vector system. These anti-MUC1-CAR T cells were evaluated for CAR expression and anti-tumor
efficacy against CCA cells in vitro.
Results: We found expression of MUC1 in CCA cells, suggesting that MUC1 can be used as an
antigen for targeting CCA. The anti-MUC1-CAR T cells were generated by lentivirus transduction.
These anti-MUC1-CAR T cells showed high efficiency of CCA cell lysis in highly expressed MUC1 as
detected by luciferase assay.
Conclusions: This study showed that anti-MUC1-CAR T cells against MUC1 are potential to be
further developed for CCA therapy.
118
SONOGRAPHIC APPEARANCE OF DETECTED LIVER NODULES

IN LONG-TERM HEPATITIS B SURVEILLANCE PROGRAM
Tangsermvong P, Siripongsakun S, Leknamongkol B

Background: Hepatitis B virus infection is common in Asia which is considered to be a major risk
factor for developing hepatocellular carcinoma (HCC). Ultrasound surveillance in these populations
is recommended in many guidelines in order to detect early-stage HCC leading to good treatment
outcome. Better understanding of ultrasonographic (US) appearance of nodules detected on US
surveillance may increase awareness of pitfalls during US surveillance; therefore, this study aims
to study the sonographic appearance of detected hepatic nodules during long term hepatitis B
surveillance program.
Study Design & Methods: A total of 2,293 patients with HBV infection who met the criteria for
HCC surveillance were recruited in this cohort study from July 2010 to May 2018. All patients have
upper abdominal ultrasound surveillance for HCC every 6 months. Focal lesions sized more than
1 cm detected during the surveillance period underwent further investigation by CT or MRI.
Ultrasound appearance of the lesions with definite diagnosis by MRI/CT and long-term follow-up
as well as sub-analysis of non-fatty and fatty liver were analyzed using chi-square test.
Results: Of 2,293 patients, aged between 40-60 years, enrolled in this cohort, there were 273
nodules in 260 patients, with an average of 1.5 ± 0.9 cm (SD) in size. Of all nodules, 17 HCCs, 12
dysplastic nodules, 163 hemangiomas, 32 fatty psuedo-lesions, and 49 other nodules were
confirmed by MRI, CT scan and long-term follow-up. HCC, dysplastic nodules, hemangiomas, and
fatty pseudo lesions share common US appearance of either hypoechoic (35.3%, 50%, 26%, and
69.4%, respectively) or hyperechoic nodules (47.1%, 50%, 64.4%, and 28.6%, respectively). Within
the fatty liver, hemangiomas have significantly been found to be more hypoechoic than typical
hyperechoic nodule (54.5% versus 16%, p,0.001). Reverse target appearance can be found mostly
in hemangiomas (10 out of 11) and hemangiomas are rare to have rim hypoechoic capsule (2/163,
1.2%)
Conclusions: Distinguished among HCC, dysplastic nodules, hemangioma and fatty pseudo lesions
in HBV infected patients is challenging due to the overlapping of sonographic appearances.
However, a few US findings may be useful for specific awareness including rim hypoechoic capsule
for HCC and reverse target appearance for hemangiomas. Fatty liver may alter the appearance of
hemangiomas to be more hypoechoic and not typical for diagnosis of hemangioma.
119
PCIOC 2019
PP-24
TAI CHI AND CARDIAC HEALTH, EJECTION FRACTION AMONG

CANCER PATIENTS: A PILOT STUDY (TICHEFCAP)
Tanking C
Background: Particular chemotherapy such as Adriamycin and Trastuzumab were reported to

cause worsening cardiac function. Previous studies had shown that Tai chi might have favorable
cardiovascular effect as well as improve quality of life, still not enough evidence to make Tai chi a
standard care.
Study Design & Methods: In this single-blinded, randomized controlled trial, 30 patients who were
sent for echocardiogram before receiving either Adriamycin or Trastuzumab were recruited and
allocated into either Tai chi or no training group. Participants in Tai chi group will be taught 18
standard forms of Tai Chi individually along with receiving CD and you tube link for self-practice.
Primary outcomes were LV systolic function and global longitudinal strain (GLS) measured by one
blinded cardiologist. Secondary outcomes were quality of life measured with FACT-G score and
distress thermometer scale.
Results: Data from 18 patients were analyzed (9 patients each group). In primary outcome,
LV systolic function was increased by 1.44±1.74 % in Tai chi group whereas decreased by 1.11±4.91%
in control group (p-value 0.161). When adjusted for confounding factor Tai chi group have 4.37%
improving in LV systolic function when compared with control group (p=0.087). GLS improved by
0.56±1.51 in Tai chi group and worsen by 0.67±3.46 in control group (p-value = 0.301). Tai chi also
shown benefit in raising quality of life demonstrated by higher increase in post treatment FACT G
score (5.25±16.21 in Tai chi group and 2.56±5.85 in control group, p-value = 0.647). Distress
thermometer scale was lower in Tai chi group as well (Difference of 0.56±2.79 in tai chi group,
-0.11±1.54 in control group, p-value = 0.538)
Conclusions: Tai chi program showed favorable trend in improving cardiac function (LV systolic
function and GLS), as well as may raise quality of life among cancer patients receiving cardiotoxic
chemotherapy agent.
120
PP-25
ASSOCIATION BETWEEN QUANTITY OF ADIPOSE-DERIVED STEM CELLS

AND DEMOGRAPHIC FACTORS IN BREAST CANCER PATIENTS
Thitilertdecha P, Lohsiriwat V, Trongkamonthum W, Poungpairoj P, Tantithavorn W,

Onlamoon N
Background: Fat grafting has become a standard procedure for breast reconstruction in
post-mastectomy breast cancer patients; however, resorption rates of the transferred fat are high
and various among individuals. Little is known whether quantity of adipose-derived stem cells
(ADSC) in transferred lipoaspirates is associated to demographic data of the patients and contributes
to clinical outcomes and fat survival.
Study Design & Methods: Lipoaspirates were withdrawn from thirty-nine breast cancer patients
at different anatomical sites. Stromal vascular fraction (SVF) was freshly isolated from the
lipoaspirates and quantified for ADSC by using bead-based absolute counting, immunofluorescent
straining and flow cytometric analysis. The relationship between ADSC quantity and demographic
factors including age, body mass index (BMI) and menopausal status was also statistically evaluated.
Results: ADSC was characterized by the expression of CD31-CD34+CD45- and quantified as
a predominant population in SVF. Of anatomical sites including abdomen, thigh, breast and axilla,
the number of ADSC obtained from abdomen was the highest with ~48,000 cells/g lipoaspirate.
However, no significant difference was observed among these sites. For the association of ADSC
with each demographic factor, no correlation was found between ADSC quantity with either age
(i.e., 22-64 years old), BMI (i.e., 17.8-33.5 kg/m2), or menopausal status (i.e., premenopausal and
postmenopausal).
Conclusions: This study suggests that ADSC obtained from different breast cancer patients are
similar in term of quantity, regardless of anatomical sites collecting the fat and demographic data
of individual patient. However, the inter-subject variation in ADSC quality still require for further
investigation.
121
PCIOC 2019
PP-26
PRELIMINARY OUTCOME OF MINIMALLY INVASIVE SPINAL SURGERY

IN SPINAL METASTASIS PATIENTS: CHULABHORN HOSPITAL EXPERIENCE
Trathitephun W, Suwanaratana R, Kongtharvonskul J, Udomwongsub W

Department of Orthopedics, Faculty of Medicine, Chulabhorn Hospital, Bangkok, Thailand
Background: The purpose of this study is to report the outcome of minimally invasive spinal surgery
by percutaneous pedicular screw in spinal metastasis.
Study Design & Methods: This retrospective study was conducted in Chulabhorn Hospital from
August 2016 to December 2018. The patients were evaluated before and after surgery by Tomita
Score, Modified Tokuhashi Score, and Visual Analog Scale Pain Score.
Results: The patients had average Tomita Score 7.05±2.16 and Modified Tokuhashi Score 8.17±2.6.
The average surgical level was 4.82±1.94. The average surgical time was 196.70±97.01 minutes.
The average volume of blood loss was 728±824 milliliters. The survival rate was 5.87±6.03 months.
The pain score decreased significantly after surgery from 9.25±0.93 to 1.56±1.75, including
radiating leg pain, which decreased from 5.31±3.22 to 0.75±1.29.
Conclusions: Minimally Invasive Spinal Surgery was a new and effective option which significantly
reduced pain in the patients with spinal metastasis.
122
CLINICAL FEATURES OF PARANEOPLASTIC NEUROLOGICAL SYNDROME

RELATED TO ANTI-RI (ANNA2): THAI CASE SERIES AND REVIEW
OF THE LITERATURES
Treesuthacheep P, Katasrila P, Sonpee C, Hemachudha T, Saraya A

Background: Paraneoplastic neurological syndrome (PNS) related to anti-Ri (ANNA2) had been
reported since 1991. However, until recently, there were only 28 studies that had been published
in English with few cases from Asian ethnicities. The clinical characteristics of anti-Ri (ANNA2)
related PNS in Asian countries still have yet to be elucidated.
Study Design & Methods: 9 records of anti-Ri (ANNA2) related PNS patients admitted to King
Chulalongkorn Memorial Hospital (KCMH) between January 2011 and December 2018 were
reviewed. MEDLINE database was used to find relevant studies with keyword “anti-Ri” or “anti
neuronal nuclear antibody type 2” and “encephalitis” or “paraneoplastic”.
Results: Of 9 patients, there were only 6 that had available records. The female: male ratio was
2:1. Clinical manifestations ranged from limbic encephalitis (50%), peripheral neuropathy (33%),
opsoclonus-myoclonus syndrome (17%) and dorsal root ganglionopathy (17%). Brain imaging
abnormalities were reported in 75% of patients. No malignancy found in our study during short-term
follow up.
Conclusions: We report clinical features of anti-Ri (ANNA2) related PNS in 6 Thai patients.
The classic presentation of opsoclonus-myoclonus-ataxia was not common in our study, as well
as the association of malignancy. Further study with more number of patients should be conduct
in the future.
123
PCIOC 2019
PP-28
STRENGTHENING CERVICAL CANCER PREVENTION THROUGH BEHAVIORAL

ECONOMICS INTERVENTIONS IN CLINICAL PRACTICE
Woratanarat T
Background: Cervical cancer is the third most common cancer among women worldwide, and
it is ranked in the top five. Overall impact are high to both patients and national health expenditures.
Primary and secondary prevention strategies are essential and must be well implemented at
individual, societal, and health system levels. Behavioral economics is proposed to be integrated
in clinical practice worldwide to optimize cervical screening practice as well as vaccination to
prevent high-risk human papilloma viral infections. However, evidence-based interventions are
still not well-documented for use in clinical setting and are needed for national policy formulation.
Study Design & Methods: We conducted a state-of-the-art review of behavioral economics
interventions in clinical practice from PubMed and Scopus databases from 1966-2019. Searching
terms included cervical cancer, cervical carcinoma, behavioral economics, nudge, reward, and
incentive, in order to identify relevant literature. The retrieved lists underwent screening by title
and abstract, duplication checking, and full-text articles were obtained for analysis. Policy
recommendations were synthesized through comparative analysis with national resolution from
11th National Health Assembly (NHA) in 2018.
Results: 106 articles were initially entered the screening processes and 23 articles were finally
included in the analysis. Twelve articles (52.17%) were based on population in the US and Canada,
7 (30.43%) in Europe, 2 (8.7%) in Australia, 2 (8.7%) in Asia. Fifty percent of the interventions
focused on providers, and the remaining targeted the population. Main behavioral economics
interventions were designed as incentives (financial and non-financial), information provision/
education (conventional, personalized, and gamified), and others (e.g. financial, human resources,
services, and organizational management). 18 out of 23 articles pointed out positive effects where-
as 4 showed no significant changes and 1 revealed negative effect. Performance measures and
outcomes included knowledge, perceived self-efficacy, cervical cancer screening rate, immunization
rate, etc. Three policy recommendations were formulated in accordance with 11th NHA resolution
to put into clinical practice and health systems management.
Conclusions: Behavioral economics interventions have been proven to be effective in behavioral
changes, not only for targeted population but also for healthcare professionals. To strengthen
cervical cancer prevention such as pap smear and HPV vaccination, newer strategies should be
considered to put into practice in clinical setting and societal level.
124
IDENTIFICATION AND CHARACTERIZATION OF NOVEL HUMAN SINGLE CHAIN

VARIABLE FRAGMENT AGAINST CD19 FOR ENGINEERED T CELL THERAPY
Wutti-in Y, Sujjitjoon J, Panya A, Sawasdee N, Yongpitakwattana P, Yamabhai M,

Junking M, Yenchitsomanus P
Background: CD19 is the most promising target to generate chimeric antigen receptor (CAR) T cell
therapy for B-cell malignancies. CAR is composed of antigen-binding domain usually derived from
single chain variable fragment (scFv) and intracellular signaling domain of T cell receptor. Since
the previous approved CD19 CAR T contains murine derived scFv, this might cause human
anti-mouse antibody (HAMA) due to immunogenicity of murine part and reduce CAR T cells efficacy.
In order to avoid this problem, we aimed to screen novel human scFv against CD19 and to
characterize its function.
Study Design & Methods: HeLa cells were engineered to overexpress CD19 or eYFP. HeLa-eYFP
was incubated with human phage display library before incubating with HeLa-CD19. After
subtraction and selection, expressed scFv proteins were examined for binding on native CD19
antigen expressed on Raji and/or HeLa-CD19 and K562 cells that did not express CD19 using flow
cytometry.
Results: Five scFv clones were found to express and secret proteins in bacterial culture. Only one
clone of scFv, designated as 1E7, could bind to CD19 antigen expressed on Raji, K562-CD19,
and HeLa-CD19, while it could not bind to K562 and HeLa cells that did not harbor CD19 antigen.
Conclusions: We could identify a novel human scFv against CD19 that exhibited specific binding
to native CD19 antigen on cancer cells. Human CD19-specific CAR T cells will be generated and
examined for their cytotoxicity, cytokine production, and immunophenotypes.
125
Committees
126
Faculty of Medicine Siriraj Hospital,

Mahidol University
Academic Committee
Supakorn Rojananin Advisor
Manee Rattanachaiyanont Advisor
Vichien Srimuninnimit Advisor
Chaiyong Nualyong Advisor
Vitoon Chinswangwatanakul Chairman
Pa-thai Yenchitsomanus Committee
Sanya Sukpanichnant Committee
Thawatchai Akaraviputh Committee
Kleebsabai Sanpakit Committee
Janjira Petsuksiri Committee
Charuwan Akewanlop Committee
Suwanit Therasakvichya Committee
Rapin Phimolsarnti Committee
Siwanon Jirawatnotai Committee
Oraporn Damrongwattanakun Committee
Thananya Boonyasirinant Committee
Wasinee Sangsukaim Assistant Secretary
Yupa Praphaiphong Assistant Secretary
Piyanuch Paochang Assistant Secretary
Kanokwan Thongtubtim Assistant Secretary
Research Sub-committee
Prasert Auewarakul Chairman of the Sub-committee
Thawornchai Limjindaporn Sub-committee
Thawatchai Akaraviputh Sub-committee
Vitoon Chinswangwatanakul Sub-committee
Somruedee Chatsiricharoenkul Sub-committee
Varalak Srinonprasert Sub-committee
Naravat Poungvarin Sub-committee
Sarinya Ngamtipvatana Sub-committee
Premsak Pongjit Sub-committee
Chalotorn Olanprasert Sub-committee
Wannalak Thansuwanwong Sub-committee and Secretary
127
PCIOC 2019
Nutcharee Thapungaw Sub-committee and Assistant Secretary

Siwawan Charuroteskulchai Sub-committee and Assistant Secretary
Conference Document and Abstract Sub-committee

Prasong Tanmahasamut Chairman of the Sub-committee
Pornprom Muangman Sub-committee
Wanee Wisuthsarewong Sub-committee
Praveena Chiowchanwisawakit Sub-committee
Pochamana Phisalprapa Sub-committee
Rujipas Sirijatuphat Sub-committee
Yupa Praphaiphong Sub-committee and Secretary
Piyanuch Paochang Sub-committee and Assistant Secretary
Fundraising Committee
Visit Vamvanij Chairman
Naris Kitnarong Vice Chairman
Prasert Auewarakul Committee
Jarupim Soongswang Committee
Pipat Chiewvit Committee
Chanean Ruangsetakit Committee
Surin Thanapipatsiri Committee
Surasak Angsuwathana Committee
Chairat Permpikul Committee
Vitoon Chinswangwatanakul Committee
Wimon Anansakunwatt Committee
Gulapar Srisawasdi Committee and Secretary
Premsak Pongjit Assistant Secretary
Apinya Jannualmeka Assistant Secretary
Phiriya Siriwan Assistant Secretary
Honorary Exhibition Committee

Sanjai Sangvichien Advisor
Puttinun Patpituck Chairman
Wikan Phongphanittanon Committee
Sanya Sukpanichnant Committee
Tumtip Sangruchi Committee
Yodying Dangprapai Committee
128
Naravat Poungvarin Committee

Jiraart Samingchai Committee
Wangcha Chumtap Committee
Bandit Phuangmalai Committee
Thanita Poonsiri Committee
Thapatpol Aimphim Committee and Secretary
Apinya Jannualmeka Committee and Assistant Secretary
Wasan Sangsawadikul Committee and Assistant Secretary
Premsak Pongjit Committee and Assistant Secretary
Management Committee
Gulapar Srisawasdi Chairman
Tara Vongviriyangkoon Vice Chairman
Patarabutr Masaratana Committee
Nopphol Pausawasdi Committee
Daranee Pipatkulchai Committee
Premsak Pongjit Committee and Secretary
Thapatpol Aimphim Assistant Secretary
Phiriya Siriwan Assistant Secretary
Public Event Committee

Keerati Chareancholvanich Chairman
Methee Chayakulkeeree Vice Chairman
Thapatpol Aimphim Committee
Phiriya Siriwan Committee
Jedsada Suwanwaree Committee and Secretary
Natthinee Seeprasert Assistant Secretary
Public Relation Committee

Naris Kitnarong Chairman
Vitoon Chinswangwatanakul Committee
Puttinun Patpituck Committee
Wanatpreeya Phongsamart Committee
Nuntakorn Thongtang Committee
Benjapa Khiewvan Committee
Saipin Muangman Committee
129
PCIOC 2019
Torpon Vathana Committee

Methee Chayakulkeeree Committee
Jedsada Suwanwaree Committee
Premsak Pongjit Committee
Darunee Vinantamarakul Committee and Secretary
Nispassorn Hornavarat Assistant Secretary
Janjira Ruangsone Assistant Secretary
Warayuth Tada Assistant Secretary
Suchada Sangtawan Assistant Secretary
Punyavut Sanpa Assistant Secretary
Kanitta Usachai Assistant Secretary
Thapatpol Aimphim Assistant Secretary
Treasurer Committee
Kritvikrom Durongpisitkul Committee
Gulapar Srisawasdi Committee
Santhiti Kietburanakul Committee
Tuanjai Sangtlap Committee
Porntip Deemanop Committee
Phiangphit Boonnok Committee
Tanyaluck Wannaviroj Committee
Waleerat Klinkesorn Committee
Pornchanok Luxsanawibool Committee
Praphasikarn Wiwattanawanit Committee
Amornrat Sangkaew Committee
Pawitra Youngsabuy Committee
130

Academic Committee
Buranee Kanchanatawan Advisor
Nijasri Charnnarong Co-Chairman
Nattiya Hirankarn Committee
Wichai Termrungruanglert Committee
Apichai Angspatt Committee
Virote Sriuranpong Committee
Kanjana Shotelersuk Committee
Surbpong Tanasanvimon Committee
Udomsak Bunworasate Committee
Thun Itthipanichpong Committee
Aem-orn Saengsiri Committee
Kamon Kawkitinarong Committee and Secretary
Gompol Suwanpimolkul Committee and Assistant Secretary
Piti Techawichit Committee and Assistant Secretary
Vorasuk Shotelersuk Advisor
Supatporn Tepmongkol Co-Chairman of the Sub-committee
Pawinee Rerknimitr Sub-committee

Chusana Suankratay Co-Chairman of the Sub-committee
Noppacharn Uaprasert Sub-committee
Piyada Sitthideatphaiboon Sub-committee
Gompol Suwanpimolkul Sub-committee and Secretary
Chanchai Sittipunt Co-Chairman
Nipon Khemapech Vice Chairman
Penprapa Tangwancharoen Committee
Wipat Sangtong Committee
Apinya Vijitmakthong Committee
Wannee Ittiwattanakul Committee and Secretary
Nuchanart Sumetchotimaytha Committee and Assistant Secretary
131
PCIOC 2019

Kanyarat Kraivichian Co-Chairman
Somrat Charuluxananan Committee
Rachasak Wiroj Committee
Vorapol Jaroonvanichkul Committee and Secretary
Pongsak Wannakrairot Advisor
Nijasri Charnnarong Co-Chairman
Mana Taweevisit Committee
Kamon Kawkitinarong Committee
Amornpun Sereemaspun Committee
Depicha Jindatip Committee
Chalida Udayachalerm Committee
Pattanun Rujipaksan Committee
Gompol Suwanpimolkul Committee and Secretary
Piti Techawichit Committee and Assistant Secretary
Sutthiwan Preecha Committee and Assistant Secretary
Public Relation and Public Event Committee

Suttipong Wacharasindh Advisor
Chanchai Sittipunt Advisor
Pongsak Yuktanandana Advisor
Nijasri Charnnarong Chairman
Surin Assawawitoontip Vice Chairman of Public Relations
Kanyarat Kraivichian Vice Chairman of Public Relations
Virote Sriuranpong Vice Chairman of Public Events
Bharkbhum Khambhiphant Committee
Nattiya Hirankarn Committee
Mana Taweevisit Committee
Kamon Kawkitinarong Committee
Gompol Suwanpimolkul Committee
Trairak Pisitkun Committee
Witthawat Naeowong Committee
Rachasak Wiroj Committee
132
Ankanee Chanakul Committee and Secretary of Public Relations

Piti Techawichit Committee and Secretary of Public Events
Sutthiwan Preecha Committee and Assistant Secretary
Teerpone Yincharoen Committee and Assistant Secretary
Satesuphanat Rasmidatta Committee and Assistant Secretary
Treasurer Committee
Kanya Suphapeetiporn Co-Chairman
Orasri Arayakul Committee
Sutthiwan Preecha Committee and Secretary
Pornporn Lathaing Committee and Assistant Secretary
Nuchjaree Poosurn Committee and Assistant Secretary
133
PCIOC 2019
Faculty of Medicine Ramathibodi Hospital,

Mahidol University
Academic Committee
Sarikapan Wilailak Chairman
Kittinut Kijvikai Vice Chairman
Wasun Chantratita Committee
Suporn Treepongkaruna Committee
Panyu Panburana Committee
Prapaporn Pornsuriyasak Committee
Sorayouth Chumnanvej Committee
Rawee Ruangkanchanasetr Committee
Tipawan Daramas Committee
Chanika Angsanuntsukh Committee
Thanyanan Reungwetwattana Committee
Suradej Hongeng Committee
Ekaphop Sirachainan Committee
Phichai Chansriwong Committee
Prakasit Chirappapha Committee
Arbaroon Lertkhachonsuk Committee
Kittiphon Nagaviroj Committee
Pokket Sirisreetreerux Committee and Secretary
Chinnakhet Ketsuwan Committee and Assistant Secretary
Phobkon Rattanaburee Committee and Assistant Secretary
Research Sub-Committee
Boonsong Ongphiphadhanakul Chairman of the Sub-committee
Natini Jinawath Vice Chairman of the Sub-committee
Kittinut Kijvikai Sub-committee
Premrudee Poomthavorn Sub-committee
Suradej Hongeng Sub-committee
Wiparat Manuyakorn Sub-committee
Koravee Pasutharnchat Sub-committee
Putthapoom Lumjiaktase Sub-committee
Mookdaluk Boonthrong Sub-committee and Secretary
134

Suporn Treepongkaruna Chairman of the Sub-committee
Pokket Sirisreetreerux Co-Chairman of the Sub-committee
Prapaporn Pornsuriyasak Sub-committee
Ekaphop Sirachainan Sub-committee
Noratep Kulachote Sub-committee
Kaevalin Lekhanont Sub-committee
Arbaroon Lertkhachonsuk Sub-committee
Tipawan Daramas Sub-committee and Secretary
Surasak Leelaudomlipi Chairman
Kanjalak Khantapasuantara Vice Chairman
Ekaphop Sirachainan Committee
Pakwan Bunupuradah Committee
Nintita Sripaiboonkij Thokanit Secretary

Chusak Okascharoen Chairman
Charuwan Leelaporn Vice Chairman
Wongsapat Wiriyakarun Committee
Orawan Sittipol Secretary
Artit Ungkanont Chairman
Anna Wongkularb Vice Chairman
Rochana Boonleardkul Secretary

Somkiat Leelasithorn Chairman
Sirinton Chansirikanjana Vice Chairman
Charuwan Leelaporn Secretary

Poolsuk Janepanish Visudtibhan Chairman
Anna Wongkularb Vice Chairman
Luktan Jemkhuntod Secretary
135
PCIOC 2019
Treasurer Committee
Ronnachai Kongsakon Chairman
Somporn Chottivitayatarakorn Vice Chairman
Sarinee Kongtongvattana Committee
Kanyarud Phongrattananan Committee
Valaiporn Kaewjaras Committee and Secretary
136
Faculty of Medicine and Public Health,

Chulabhorn Royal Academy
Academic Committee
Banchon Siripongpreeda Chairman
Sasikarn Chamchod Committee
Prakongboon Sungkasubun Committee
Thanapon Chobpenthai Committee
Sadudee Rojanapirom Committee
Benjamas Preechakoon Committee
Dararat Chuwongin Committee
Danupon Nantajit Chairman
Ornpreya Suptawiwat Committee

Arpaporn Arnamwong Committee
Pattamaporn Krajokkaew Committee
Papasthida Pinyasamma Committee
Siriam Toomthai Committee
Nuttavut Kantathavorn Chairman
Worawit Chaiwiriyawong Committee

Rattanawalee Boonbongkarn Chairman
Darin Luenam Committee
Asama Bumrungkij Committee
Kornwalaitarh Lamliangpol Committee
Chirayu Auewarakul Chairman
Nuttavut Kantathavorn Committee
Danupon Nantajit Committee
137
PCIOC 2019
Kanyada Itsarakunritta Committee

Pattamaporn Krajokkaew Committee
Papasthida Pinyasamma Committee
Sunattee Kessung Committee
Arpaporn Arnamwong Committee and Secretary

Jiraporn Laothamatas Chairman
Wisut Lamlertthon Committee

Rattanawalee Boonbongkarn Chairman
Darin Luenam Committee
Asama Bumrungkij Committee
Treasurer Committee
Chirayu Auewarakul Chairman
Sujitra Intaraphairot Committee
Sumalee Sawadeeputra Committee
Budsaba Plangsron Committee
Thanika Kerdsilp Committee
Napatt Sanpha Committee
Ratchawee Watcharakheere Committee
Danupon Nantajit Committee and Secretary
Chanwit Kaewkam Assistant Secretary
Nongluck Pumpaiboon Assistant Secretary
138
Index
A K
Amornrit Warisa 85, 87 Kanokwongnuwat Wasit 85, 91
Ananta-ard Nongluck 53, 78 Khaiman Chusana 29, 45
Anurathapan Usanarat 52, 60 Kijvikai Kittinut 28, 37
Klangjorhor Jeerawan 93, 102
B
Bhumiwat Siwat 93, 97 L
Boonchaue Thitaree 53, 80 Leknamongkol Boonyika 93, 95, 103, 119
Boonyawan Keeratikarn 28, 39 Lertsuwan Jomnarong 93, 104
Bunworasate Udomsak 52, 59 Luangwattananun Piriya 85, 88
Luksanapruksa Panya 94, 105, 106, 107
C
Chamchod Sasikarn 29, 51, 53, 77 M
Chamroonrat Wichana 28, 31, 85, 91 Metheetrairut Chanatip 94, 108
Chandhanayingyong 53, 74 Muangkaew Paramin 29, 44
Chandhanarat
Chanthong Pratamaporn 29, 48 N
Chantratita Wasun 28, 30, 94, 110 Nagaviroj Kittiphon 29, 47
Charoenlap Chris 53, 75, 94, 109 Namsiri Rattasiri 94, 109
Charoenlux Prapitphan 93, 98
Chayavichitsilp Pamela 53, 70 O
Opanurak Julin 28, 37
D Oranratnachai Songporn 94, 110
Dejthevaporn Thitiya 28, 43
Desomchoke Rasthawathana 53, 70 P
Patoomwan Autchareeya 52, 64
E Pattaranutaporn Poompis 52, 62
Eimpunth Sasima 53, 70 Phanthaphol Nattaporn 94, 111
Piriyajittrakornkij Penprapa 52, 65
F Pisitkun Trairak 28, 33
Faisal Muhammad 93, 99 Pongprutthipan Marisa 53, 70
Pongsapich Warut 52, 63
H Porntharukchareon Thachanun 85, 90
Hongsaprabhas Chindanai 93, 94, 100, 109 Pripatnanont Choosak 28, 37
J R
Jermjutitham Monthira 93, 101 Rattanapan Yanisa 85, 92
Junda Tiraporn 53, 81 Reungwetwattana Thanyanan 28, 34, 94, 110
139
PCIOC 2019
Rojanaporn Duangnate 53, 72 U

Ruangpracha Athisake 85, 89 Uppagan Rapepan 53, 68
Ruchakorn Tanarat 94, 112
V
S Vinaynauwattikun Chanida 52, 61
Saksornchai Kitwadee 28, 42 Viriyapak Boonlert 53, 68
Sangsuwannukul Thanich 94, 95, 113, 118
Sanpakit Kleebsabai 52, 56 W
Shotelersuk Kanjana 28, 35 Woratanarat Thira 96, 124
Shuangshoti Shanop 29, 50, 94, 109 Wutti-in Yupanun 85, 88, 96, 125
Siranart Noppachai 95, 114
Siripongpreeda Bunchorn 28, 38
Sitathanee Chomporn 52, 58
Soonklang Kamonwan 95, 115
Srisuttayasathien Manasawee 95, 116
Sriswasdi Sira 85, 86
Sriwisai Rasarudee 53, 69
Sugiharto Sugiharto 95, 117
Supavavej Archara 28, 40
Supimon Kamonlapat 94, 95, 113, 118
Suwanpramote Prakrit 53, 76
T
Tamthong Kingtip 52, 65
Tangsermvong Poonyisa 93, 95, 103, 119
Tanking Chonthicha 95, 120
Taweemonkongsap Thawatchai 28, 37
Techavichit Piti 52, 57
Thaipisuttikul Iyavut 29, 49
Thamnipa Ploenpit 53, 68
Thananowan Nanthana 53, 68
Therasakvichya Suwanit 52, 54
Thitilertdecha Premrutai 95, 121
Trathitephun Warayos 96, 122
Treesuthacheep Peerasit 96, 123
Tulvatana Wasee 53, 73
140
Editors
Suporn Treepongkaruna
Pokket Sirisreetreerux
Kaevalin Lekhanont
Rujipas Sirijatuphat
Chusana Suankratay
Gompol Suwanpimolkul
Piyada Sitthideatphaiboon
Danupon Nantajit
And the Conference Document and Abstract Sub-committees
Artwork Design
Print and More Co., Ltd.
Printing
Ideol Digital Print
Organizer of the Conference

R.P. Media Group Co., Ltd.
Sponsorship Acknowledgement
MAJOR SPONSOR
SUPER DIAMOND
DIAMOND
PLATINUM
GOLD
SILVER

Final Pcioc 2019 E-Book

Загружено:

Сведения о документе

Исходное описание:

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Final Pcioc 2019 E-Book

Загружено:

Авторское право:

Доступные форматы

New Frontiers in Cancer Combat

August 8-9, 2019

PROGRAM & ABSTRACT BOOK 1

Her Royal Highness Princess Chulabhorn Krom Phra Srisavangavadhana

Professor Prasit Watanapa

Professor Suttipong Wacharasindhu

It is my pleasure to welcome all of you to the Princess Chulabhorn International Oncology

Professor Piyamitr Sritara, M.D., FRCPT, FACP, FRCP

With Her Royal Highness’s determination to help underprivileged, especially patients

Professor Chirayu Auewarakul

Professor Nithi Mahanonda

Faculty of Medicine Siriraj Hospital, Mahidol University

Faculty of Medicine, Chulalongkorn University

Faculty of Medicine Ramathibodi Hospital, Mahidol University

Faculty of Medicine and Public Health, Chulabhorn Royal Academy

Nobel Laureate Speciality Session

10.00-10.30 Break Break

(Alternative Research Highlights

and Robotic Urological Cancer Surgery

Pre-Congress Session 3: Semi-Live Surgical Techniques of Challenging Laparoscopic

Pre-Congress Session 2: Advanced Cancer Investigation

Pre-Congress Session 4: Demonstration of Cancer Bioinformatics

MassARRAY, and StripAssay Technology platforms in Research and Clinical Applications

Pre-Congress Session 1: International Conference on Cancer Immunotherapy

16.30-17.00 Closing Remarks

Pre-Congress Session: Faculty of Medicine Siriraj Hospital, Mahidol University

International Conference on Cancer Immunotherapy

Available seats: 60 pax

Pre-Congress Session: Faculty of Medicine, Chulalongkorn University

Advanced Cancer Investigation and Management

Date: August 7, 2019

Available seats: 30 pax

Pre-Congress 3: Faculty of Medicine Ramathibodi Hospital, Mahidol University

Venue: Meeting room 623, Lecture Hall Building, Ramathibodi Hospital

Available seats: 40 pax

2-Day Pre Congress Programs (August 6-7, 2019)

Available seats: 40 pax

Topic: Demonstration of Cancer Bioinformatics

Day 2: August 7, 2019

Venue: Meeting room, 4th floor, Chulabhorn Hospital

Available seats: 40 pax

Time Activity/Presentation Speakers

9:45-10.15 To be announced Assoc. Prof. Yongyut Sirivatanauksorn

11:05-11.35 To be announced Dr. Naravat Poungvarin

14:00-14.30 To be announced Assoc. Prof. Chanitra Thuwajit

15:45-16:05 Coffee Break

Time Activity/Presentation Speakers

10:00-10:20 Coffee Break

11:00-12.00 Stereotactic Body Radiotherapy (SBRT) Assoc. Prof. Kanjana Shotelersuk

Time Activity/Presentation Speakers

9:00-9.10 Welcoming Message Asst. Prof. Wit Viseshsindh

9:10-9.30 Technique of Laparoscopic Radical Dr. Kamol Panumatrassamee

9:30-10.00 Techniques of Laparoscopic and Robotic Assoc. Prof. Kittinut Kijvikai

10:00-10.20 Techniques of Laparoscopic and Assoc. Prof. Kittinut Kijvikai

10:20-10:40 Coffee Break

11:00-11.50 Techniques of Laparoscopic and Robotic Assoc. Prof. Wisoot Kongcharoensombat

Pre-Congress Session: Cancer Genomics 101

Day 1: August 6, 2019, 08:30-16:30

Time Activity/Presentation Speakers

Day 2: August 7, 2019, 09:00-15:00

Time Activity/Presentation Speakers

10:30-11:00 Coffee Break