A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial / 부인종양

OBJECTIVE: To compare response rate and survivals of locally advanced stage cervical cancer patients who had standard concurrent chemoradiation therapy (CCRT) alone to those who had adjuvant chemotherapy (ACT) after CCRT. METHODS: Patients aged 18–70 years who had International Federation of Gynecology and Obstetrics stage IIB–IVA without para-aortic lymph node enlargement, Eastern Cooperative Oncology Group scores 0–2, and non-aggressive histopathology were randomized to have CCRT with weekly cisplatin followed by observation (arm A) or by ACT with paclitaxel plus carboplatin every 4 weeks for 3 cycles (arm B). RESULTS: Data analysis of 259 patients showed no significant difference in complete responses at 4 months after treatment between arm A (n=129) and arm B (n=130): 94.1% vs. 87.0% (p=0.154) respectively. With the median follow-up of 27.4 months, 15.5% of patients in arm A and 10.8% in arm B experienced recurrences (p=0.123). There were no significant differences of overall or loco-regional failure. However, systemic recurrences were significantly lower in arm B than arm A: 5.4% vs. 10.1% (p=0.029). The 3-year progression-free survival (PFS) and 3-year overall survival (OS) of the patients in both arms were not significantly different. The hazard ratio of PFS and OS of arm B compared to arm A were 1.26 (95% CI=0.82–1.96; p=0.293) and 1.42 (95% CI=0.81–2.49; p=0.221) respectively. CONCLUSIONS: ACT with paclitaxel plus carboplatin after CCRT did not improve response rate and survival compared to CCRT alone. Only significant decrease of systemic recurrences with ACT was observed, but not overall or loco-regional failure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036164 Thai Clinical Trials Registry Identifier: TCTR 20140106001

Environmental risk factors for nasopharyngeal carcinoma: a case-control study in Chonburi, Thailand

Nasopharyngeal carcinoma (NPC) has a unique and complex etiology that is incompletely understood. The incidence of NPC varies widely by geographic location and ethnic background. To understand the role of environmental exposures in the risk of NPC, a case-control study was conducted among 115 newly diagnosed cases of NPC and 85 controls matched by sex, age, and geographic residence. Data were collected by interview for demographic variables, cigarette smoking, alcohol consumption, eating habits, history of disease, family history of cancer, and lifetime history of every job held for one year or longer. The results suggested a strong influence of EBV infection on NPC risk (OR=35, 95%CI= 11.44-110.42). Cigarette smoking was also associated with 2.24-fold increased risk of NPC (OR= 2.24, 95% CI=1.09-4.58). Increased risk was indicated with a history of chronic ear or nose disease (OR= 5.1, 95% CI =1.31-20.00). Furthermore, lower education levels were positively associated with NPC (OR= 2.23, 95% CI= 1.09-4.57). There was no association between NPC and salted-fish intake (OR= 1.38, 95% CI= 0.84-2.25) or alcohol consumption (OR= 0.88, 95% CI= 0.58-1.33). In summary, our results suggested that many risk factors\—including EBV infection, smoking, and chronic ear or nose disease, may play an important role in the pathogenesis of NPC. (Thai Cancer J 2010;30:135-144)