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.

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.

Social services for cancer patients in the mobile tumour clinic.

The medical social services for cancer patients referred by doctors in provincial hospitals through the Mobile Tumour Clinic, Cancer Institute, Siriraj Hospital, were analyzed. The Mobile Tumour Clinic was started on June 15, 1977 and ended on August 14, 1985. Staffs of the Mobile Clinic consisted of a pathologist, surgeon, radiotherapist, medical oncologist, dentist, social worker and secretary. The Mobile Tumour Clinic visited and consulted on treatment of each patient with staff of provincial hospitals on 102 occasions. A total of 649 cancer patients were discussed, and 197 patients (30.35%) were referred to Siriraj Hospital for further treatment. One hundred and forty patients (71.1%) required a total of 446 medical social services. This figure was higher when compared with general cancer patients treated at Siriraj Hospital, who were not referred through the Mobile Tumour Clinic. This was due to patients having many problems before coming to Siriraj Hospital by themselves and after initial treatment at the provincial hospitals.

A study of social services for the patients investigated with computed tomography at Siriraj Hospital.

The medical social services, with special reference to the reduction of fee, for out-patients who were investigated with computed tomography in the Department of Radiology, Siriraj Hospital, between October 3, B.E. 2524 to February 28, B.E. 2528 were analyzed. The total number of patients were 253 or 3.92 percent of the total 6450 computerized patients. The age of the patients, sex, domiciliary origin, profession and side of computed tomographic study are demonstrated in 6 tables. Fifty-one point four of the consulted patients were investigated free of charge, and 48.6 percent were partially charged. Eighteen percent of the patients were charged more than 1000 bahts.