Disease Sites

Breast Cancer

In Hong Kong, breast cancer is the most common female malignancy, accounting for 15.8% of all newly diagnosed cases and 9.1% of all cancer deaths. The crude incidence rate has increased from 34.6 per 100,000 in 1985 to 42.3 per 100,000 in 1994. We are a major tertiary referral center for the management of breast cancer patients. Over the past five years, the number of patients referred to our center has been steadily increasing to reach over 300 in 2000.

Treatments offered in our center include neoadjuvant chemotherapy, and adjuvant therapy (chemotherapy, radiotherapy and hormonal therapy) for early stage breast cancer, salvage therapy (chemotherapy and hormonal therapy) and palliative therapy (radiation therapy and symptomatic medical treatment in non-cytotoxic nature) for advanced disease. There is close inter-departmental liaison with Combined Breast Cancer Clinic, and bi-weekly Combined Breast Cancer Meeting involving the Departments of Clinical Oncology, Surgery, Diagnostic Radiology and Organ Imaging, and Anatomical and Cellular Pathology.

We have continued to enter patients into international collaborative studies and to expand our interest in quality of life studies as well as investigating new therapeutic approaches.

Hepatocellular Carcinoma

Hong Kong has a high incidence rate of hepatocellular carcinoma (HCC). The annual age adjusted incidence rate of HCC is about 50 per 100,000. At the Prince of Wales Hospital, we see around 500 new cases each year. The treatment of HCC is challenging. Only about 10% are suitable for surgical resection and such patients remain at a very high risk of recurrence. Currently there is no proven benefit from any post-operative adjuvant treatment nor is there any standard treatment for those with inoperable disease. Conventional systemic chemotherapy and intra-arterial treatment can only benefit a small proportion of patients. In order to discover new forms of treatment we have undertaken several phase II trials for inoperable HCC as well as postoperative treatment for patients with a high risk of development of HCC. All HCC patients referred to our hospital are seen in the Joint Hepatoma Clinic by a combined team of hepatologists, oncologists, interventional radiologists and surgical oncologists. This ensures patients are treated promptly according to agreed protocols and entered into appropriate clinical trials. The Joint Hepatoma Clinic also holds bi-weekly hepatoma meetings with the pathologists and radiologists to discuss difficult cases for management decision.

In terms of publications, we have shown that the post-operative treatment with lipiodol-iodine-131 after surgical resection is successful in a prospective randomized trial and these results were published in The Lancet (353:797-801, 1999). Secondly, the prospect of an effective systemic treatment (PIAF combination) capable of delivering complete pathological remission seems to be becoming a reality (Clinical Cancer Research, 5:1676-1681, 1999). We also completed phase I and II studies in the use of intra-arterial yttrium-90 microspheres in treatment of unresectable hepatocellular carcinoma (British Journal of Cancer, 70:994-999, 1994. International Journal of Radiation Oncology, Biology, Physics, 33:4, 919-924, 1995). With both PIAF and yttrium-90 the concept of neoadjuvant therapy to convert inoperable to operable lesions has now been established (Annals of Surgery 233(2): 236-241, 2001). Supported by the Health Services Research Committee, we have also completed a cost and quality of life study on palliative strategies in HCC patients (Pharmacoeconomics, in-press 2001). Through another support from the Hong Kong Cancer Fund, we also finished accrual of over 1000 high-risk patients for hepatocellular carcinoma into an early detection and screening program and the results recently presented in ASCO 2001 (Proceedings of ASCO 2001, abstract #672).

Lung Cancer

Lung cancer, accounting for 21% of all newly diagnosed cancer and 30% of all cancer deaths, is the most common cancer in Hong Kong. In 1994, 3772 new cases were diagnosed and 2968 patients died from the disease. The age standardized incidence rate of lung cancer in Hong Kong is ranked as the highest among the developed countries in Asia. Cigarette smoking, the major cause of lung cancer, is still on the rise in Hong Kong and Asia and we anticipate the incidence of lung cancer to remain high.

Non-small cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. The only curative treatment is complete surgical resection. Unfortunately this group accounts for less than 15% of cases. For the remainder the outcome is poor. Salvage chemotherapy may improve disease-related symptoms but leads to only a small improvement in overall survival. Patients with stage III disease are considered inoperable, but combined modality therapy may improve both survival and quality of life. Stage I and II NSCLC are potentially curable by surgery and the value of adjuvant chemotherapy remains debatable. For small cell lung cancer, chemotherapy is the treatment of choice. Despite the good response rate, long-term survival is unusual. New drug combinations have been the primary focus of clinical research over the past decade. Our unit is active in clinical research on lung cancer that ranges from translational to phase III study.

Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is a major public health problem in Hong Kong with an annual incidence of 15.4/100,000. About 180 new cases are seen and treated each year in our department. All patients are subjected to a uniform staging protocol, and the aggressive radiotherapy (RT) technique used has resulted in the highest loco-regional control rate in the region. In patients with loco-regionally advanced disease on presentation, the rate of subsequent distant metastasis is high. In these patients the use of a multi-modality approach has been extensively investigated in our center. The publications of these trials have made significant impact on standard treatment approach for these patients. Patients with the most loco-regionally advanced disease on presentation have an improved outcome with concurrent chemotherapy-radiotherapy compared with radiotherapy alone. For patients with loco-regionally recurrent and/or distant metastatic disease, encouraging results of several Phase II chemotherapy trials and translational studies have led to the initiation by the group of a multicenter prospective trial using chemotherapy and specific targeting agent against Epidermal Growth Factor Receptor (EGFR). The Epstein-Barr virus (EBV) is consistently associated with NPC. In collaboration with the Johns Hopkins Oncology Center and the University of Birmingham CRC Institute of Cancer Studies, with funding from the National Cancer Institute (USA) and the Cancer Research Campaign (UK), we have initiated trials of novel immunotherapeutic approaches in the treatment of patients with NPC. The first of these has been completed and preliminary results have been reported.

Neuro-Oncology

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Sarcoma

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