Study of efficacy and tolerability of tropisetron in the prevention of cisplatin induced nausea and vomiting.

The efficacy and tolerability of tropisetron alone or in combination with dexamethasone was studied in an open randomised trial in a total of 30 patients undergoing cisplatin based chemotherapy. Patients received tropisetron 5 mg plus dexamethasone 8 mg i.v. on day 1 followed by tropisetron 5 mg p.o. plus dexamethasone 4 mg orally bid on day 2-6 (group I) versus tropisetron 5 mg p.o. alone on day 2-6 (group II). No demographic difference among the groups was observed. Tumor locations were mainly at cervix (23%) and ovary (17%). Acute emesis was prevented completely, defined as no nausea and no vomiting, in 75 per cent of patients in group 1 compared with 73 per cent in group II. Delayed emesis was completely prevented in significantly more patients in group I (81% versus 49%). Adverse events were mild and similar in both groups. The most frequent side effects were headache, stupor and diarrhea. In conclusion, tropisetron is an effective and well tolerated antiemetic for preventing acute and delayed emesis in cisplatin-based chemotherapy. In addition, combining dexamethasone improved the efficacy in particular in controlling delayed emesis.

Cervical tuberculous lymphadenitis: mimicking recurrence of gestational trophoblastic disease.

A 32-year old Thai woman, gravida 1, para 1, had low risk gestational trophoblastic disease. Evacuation and chemotherapy was given (January 1990). She presented two years later (June 1992) with bilateral cervical lymphadenopathy. Cervical tuberculous lymphadenitis was confirmed by biopsy and Ziehl-Neelsen method. There were no clinical symptoms of tuberculosis. Antituberculous drugs, 2HRZ/4HR (H = isoniazid, R = rifampicin, Z = pyrazinamide) were given and no relapse of either choriocarcinoma or tuberculous lymphadenitis mimicking other pathologic processes and clinical suspicion is warranted.

Five years survival result of twenty-two breast cancers treated by breast conserving therapy at NCI Bangkok.

From November 1984 to July 1992 Breast Conserving Therapy (BCT) has been offered to clinical stage 1 & 2 breast cancers. Twenty two breast cancers were treated and passed the five year period. Only one patient was lost in follow-up. The treatment consisted of tumorectomy, full axillary nodal dissection and total breast irradiation with a booster dose at the biopsy site. Adjuvant chemotherapy is administered in cases of positive axillary nodes. There are seventeen living and four deaths. The 5 year survival was 80.95 per cent. The four deaths were node negative and in the young age group (under 36 years of age). Three out of four who died of distant metastasis showed precedent local recurrence. Local recurrence was noted in four patients (19.04%). Second primary breast cancers were found in four patients and two of them died of distant metastasis and one of these two had local recurrence in the first breast carcinoma. There were two survivors from distant metastasis, one with single pulmonary metastasis and another with spine and pelvic bony metastases. Slight to moderate arm edema was found in 5 patients. (22.73%). From our study we have been convinced that BCT seems to give poorer results in terms of survival in the young age group (especially under 36 years of age). Those who are under 36 years of age and have T2 lesion with negative node or local recurrence as well as second primary breast carcinoma should receive adjuvant chemotherapy.