Randomized trial radiotherapy with and without concomitant 13-cis-retinoic acid plus interferon-alpha for locally advanced cervical cancer: a preliminary report.

Locally advanced cervical cancer could be treated with Interferon-alpha plus retinoic acid concomitant with standard radiotherapy. It showed some response in local control. The pattern of relapse and the survival of the patients should be observed in the follow-up period for the conclusion.

Arm and body fixator Siriraj B-34: Results of treatment and complications in breast cancer patients.

Twenty-three patients with cancer of the breast were referred to the Department of Radiology, Siriraj Hospital, for breast irradiation. The arm and body fixator Siriraj B-34 was used both during the treatment planning and the radiation treatment. Complications were 4 cases of radiation pneumonitis, 1 of radiation lung fibrosis and 3 of lymphedema of arms. But after supportive and symptomatic treatment these conditions were resolved. After 2-years of follwed-up, one patient had a local recurrence and distant metastasis, and two patients had distant metastases. We conclude that the arm and body fixator Siriraj B-34 is an acceptable & safe aid in the radiation treatment of breast cancer patients.

Risk factor for recurrence of nasopharyngeal cancer.

The nasopharyngeal carcinoma is the common disease in Thailand. Following the initial treatment, because of the locally advanced disease, there are some recurrences The purpose of the study was to determine the risk factors for the recurrence of nasopharyngeal carcinoma. We found that the undifferentiated carcinoma, microscopic residual disease and mild radiation reaction of the normal tissue were the risk factors for local recurrence (35.71%, 80% and 33.33%, respectively). Comparing with the squamous cell carcinoma, poorly diferentiated, no residual disease and marked radiation reaction of the normal tissue, which had lower incidence of local recurrence (7.69%, 25% and 25%, respectively).

Neoadjuvant carboplatin & 5 fluorouracil combination chemotherapy and radiotherapy in the treatment of locally advanced head and neck cancer: primary report.

We studied the effect of neoadjuvant carboplatin/5-FU combination chemotherapy and radiotherapy in the treatment of 53 patients with locally advanced head and neck cancer in Siriraj Hospital. Carboplatin 350-450 mg/m2 I.V. on day 1, and 5-FU 1,000 mg/m2/d on days 1-4, were administered either on an in- or out-patient basis. We obtained a response rate of 85 per cent, with 13 per cent complete response after 2-3 cycles of neoadjuvant chemotherapy. After the completion of subsequent radiotherapy, the response rate increased to 94 per cent, with 40 per cent CR. After the additional 2-3 cycles of postradiation chemotherapy, the final overall response rate was 96 per cent, with 77 per cent CR. Only 4 per cent of patients had grade 3 GI toxicity and 25 per cent of patients had grade 2, 3 myelosuppression. All patients tolerated the treatment very well. Long-term study for the duration time of response and survival are being collected.

Megestrol acetate as the supportive treatment of Thai patients with advanced cancer.

We studied the effect of the standard oral dose (160 mg/d) of megestrol acetate on the weight gain of 115 advanced cancer patients. All were underweight and were receiving only supportive or symptomatic care. The median treatment time was 74 weeks (range: 4 weeks to 2 years). The mean body weight gain of all patients was 4.84 kg (range: -3 to 18 kg) regardless of the disease status. Weight gain was dependent on the length of treatment time. The performance status after therapy also shifted to the better status with significant statistical difference. All patients felt an increase of appetite and also had an improved sense of well-being. No serious side-effects of the treatment were noted in this study.

Osteoradionecrosis of the jaw.

All 252 patients, post-irradiation for oral cancer of the head and neck, who attended dental clinic for the treatment of oral and dental disease during January 1984 and December 1989, were found to have complications, i.e., mucositis 126 cases (50%), dental caries 162 cases (64%), root abscess 74 cases (29%), xerostomia 140 cases (55%), trismus 59 cases (23%), periodontitis and gingivitis 188 cases (74%), and osteoradionecrosis 12 cases (5%). This bone complication was very difficult to treat and often caused facial deformity, or fatality without correlation to the primary tumour. The authors advise proper oral care before radiation therapy in order to minimize the incidence.

Neo-adjuvant chemotherapy by using methotrexate prior to radiation therapy in the treatment of advanced oral cancers.

One hundred and forty-one advanced squamous sell carcinomas of the oral cavity (T3,4; NO-3;MO) were treated with neoadjuvant chemotherapy by using methotrexate 50 mg. administered intravenously, once weekly for 3-5 injections and then followed by radiation therapy 6000 – 6500 cGy in 6-6.5 weeks. Seventy patients with the same tumour extent, receiving radiation therapy alone were randomized numerically for the control group. The result of combined treatment showed 86 percent effective on the basis of objective primary tumour response with MTX alone, and 46 percent showed CR. For the nodal status, only 53 percent showed effective and only 10 percent was CR. After radiation therapy, the response of both primary and lymph node in the study group showed definitely more effective than the control group. Seventy-two percent of patient in the study group showed CR, while only 20 percent of the radiation alone group showed CR. The patients in the study group also showed better survival rate with 14 percent of 5-year survival rate, while none of the control group survived more than 5 years after treatment. All the patients tolerated methotrexate and radiation treatment very well. Only grad 1 and 2 toxicities were found.

Mitoxantrone as single agent in the treatment of advanced breast cancer: clinical experience at Siriraj Hospital.

A total of 35 patients with advanced breast cancer were treated with mitoxantrone, 14 mg/m2 I.V. every 3 weeks. Of these, 27 patients or 78 lesions could be evaluated for response and all 35 patients for toxicity. The overall response rate (CR + PR) was 35 per cent (or CR + PR + SD = 82%), ten lesions achieved a complete response and 17 lesions a partial response. The duration of response varied from a minimum of 2 months to more than 11 months (median = 4 months). Myelosuppression was the dose-limiting toxicity with moderate to severe degree in 19 patients. The most frequent severe degree in 19 patients. The most frequent non-hematologic toxicity was mild grade of nausea and vomiting (67%). No cardiotoxicity was noted in this study after the maximum cumulative dose of mitoxantrone 157.5 mg.

Mitoxantrone as single agent in the treatment of advanced breast cancer: Clinical study at Siriraj Hospital.

During August 1986 – August 1988, a total of 35 patients with advanced breast cancer were treated with Mitoxantrone (Novantrone), 14 mg/M3 intravenously every 3 weeks. Of these, 27 patients with total 78 lesions could be evaluated for response and 30 patients for toxicity. The mean follow-up period was 18 months (2-24 months). The median time to achieve response was 9 weeks after treatment. Eleven patients (41%) achieved an objection tumor response (CR+PR) including four (7%) complete response. In another way of evaluation, a total of 78 evaluable lesions were assessed of which 29 (37%) achieved response (CR+PR), including 10 (13%) complete response. The duration of response varied from minimum 2 months to more than 19 months (median=5 months). The median time to treatment failure was 5.9 months. Myelosuppression was the dose-limiting toxicity and was observed with moderate to severe degree in 19 patients (63%). The most frequent non-haematological toxicities were mild grade of nausea and vomiting occurred in 137 cycles from the total number of 195 evaluable cycles (70%). No cardiotoxicity was noted in this study after the maximum cumulative dose of Mitoxantrone 157.5 mg. This agent is well tolerated and offers comparable efficacy with less tolerable toxicity than other effective agents currently used as single agent in the treatment of advanced breast cancer.