Prognostic factors of thyroid cancers in Ramathibodi Hospital.

The need to create different prognostic models for different populations is obvious after the findings that significant prognostic factors can change from one population to another. The purpose of this study is to fit a linear logistic model to a data set of Thai patients with thyroid cancers to find important prognostic factors and their effects on short-term mortality. Among the 89 cases selected, 20 died within 4 years after initial diagnosis and 69 survived more than 4 years. Age at diagnosis, sex, histological type and differentiation, microscopic vascular invasion, and extent of tumor spreading were included as independent variables. These variables were selected into the model by step-down selection procedure. Age at diagnosis was found to be the most significant prognostic factor followed by differentiation, vascular invasion and extent of spreading, respectively. However, vascular invasion appeared to exert the strongest impact on the prognosis with the risk of death increasing 62 fold for those showing microscopic evidence of this parameter. The odds ratios for the extent of spreading, age at diagnosis and differentiation were 7.5, 1.1 and 0.02, respectively.

Nasopharyngeal carcinoma: results of treatment by radiotherapy vs chemotherapy plus radiotherapy.

To determine the efficacy of neoadjuvant chemotherapy over radiotherapy alone in locally advanced nasopharyngeal carcinoma, a prospective non-randomized study was performed from 1 January 1982 to 31 December 1985 at Ramathibodi Hospital, Thailand. There were 69 new cases who completed treatment and were followed up at least once. Thirty-three cases were treated by radical radiotherapy (RT) alone and 36 cases by chemotherapy (CT) + RT. CT were by the combination of cis-diamminedichloroplatinum II and 5 fluorouracil. Of 32 cases, 2 courses of CT were given before RT and 1 after. The other 4 received 3 courses prior to RT. For both groups, RT technique and dosage were similar. Follow-up time of both groups ranged from 6-104 months (mean 50.3, median 50) and 8-100 months (mean 52.2, median 54.5), and total failures were 18/33 and 13/36, respectively, with no statistical difference (p greater than 0.05). Estimated actual survival and disease free survival from Kaplan-Meier curves at 3 years were about 75 per cent vs 75 per cent and 65 per cent vs 65 per cent, respectively, with no statistical differences (Log-Rank test). Therefore, we concluded that induction chemotherapy had some benefit but no statistical significance over RT alone. However, the role of maintenance chemotherapy is now being studied.