Results of radiation therapy in stage 1B cervical carcinoma at King Chulalongkorn Memorial Hospital: fifteen-year experience.

A retrospective study was performed on 131 patients with stage 1B cervical carcinoma who were referred and treated with external beam radiation and intracavitary brachytherapy at the Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between February 1985 and February 2000. Primary outcomes were overall survival rate, progression free survival rate, recurrence, and treatment-related complications. The treatment results from different sources of intracavitary radiation therapy were secondary endpoints. The number of patients treated with Ra-226, Cs-137, and Ir-192 intracavitary irradiation were 12, 84, and 35 patients respectively. The median follow-up times were 69, 59, and 21 months for Ra-226, Cs-137, and Ir-192, respectively. Actuarial 5-year overall survival rate was 89 per cent. The 5-year progression free survival rate was 80 per cent. Actuarial 5-year survival and progression free survival rate were comparable among different sources of intracavitary brachytherapy (p = 0.553 and p=0.793, respectively). The overall recurrent rate was 16.8 per cent. Of the recurrence; 40.9 per cent was locoregional, 54.6 per cent was distant failure, and 4.5 per cent was combined locoregional and distant failure. The overall complication rate was 25.95 per cent. The severe complication rates (Grade III-V) from treatment occurred in the urinary bladder (0.76%) and in the small bowel (0.76%.) These results suggest that radiation therapy alone is an effective treatment for stage 1B cervical carcinoma. Additionally, all types of intracavitary brachytherapy provide comparable clinical results.

Paclitaxel in patients with platinum-resistant ovarian cancer: a selected review of literature and clinical experience.

Single-agent paclitaxel infused over 24 hours produces response rates of 10 per cent to 20 per cent and 48 per cent respectively, for doses of 135 mg/m2 and 250 mg/m2. This suggests a dose response relationship. However, only a randomized trial comparing the 135 mg/m2 and 250 mg/m2 doses can confirm this result. Unfortunately, the median survival is comparable despite the difference in response rates. This may be secondary to a low CR noted at all doses. The apparent lack of benefit in terms of increased survival for the high dose group, with its attendant increase in incidence of toxic effects and cost (owing to both the paclitaxel and the G-CSF), suggest that the role of higher doses remains to be proven. It may be most useful in alleviating the severe cancer induced symptoms of some patients with advanced platinum resistant ovarian cancer(19). Despite the extensive international experience with paclitaxel in the ovarian cancer clinic its role still needs to be better defined both for salvage therapy and in combination with platinum as a front-line treatment.