Treatment options in bulky stage IB cervical carcinoma.

Cervical cancer is the most common female cancer in the developing countries. Treatments of bulky stage IB cervical cancer have been challenged as the local control is relatively poor compared to smaller stage I disease, whether treated by radical surgery or irradiation. The treatment options are definitive concurrent chemoradiation therapy or radical surgery with or without neoadjuvant or adjuvant therapy. The treatment decision is based on the patients' status and preferences, tumor characteristics, and experiences of clinician. This study will review and compare the treatment modalities and rationales of a combination of treatment including surgery, radiation therapy, and chemotherapy for bulky stage IB cervical carcinoma.

The analysis of peri-tumor necrosis following the subcutaneous implantation of autologous tumor cells transfected with an episome transcribing an antisense insulin-like growth factor 1 RNA in a glioblastoma multiforme subject.

A subject inflicted with glioblastoma multiforme who received partial tumor resection and radiotherapy was recruited for an ex vivo gene therapy protocol using irradiated autologous tumor cells that had been engineered to suppress the expression of insulin-like growth factor I as the tumor vaccine. After subcutaneous injection for 8 weeks, the subject developed peri-tumor necrosis with mass effect. The authors wondered whether this event could have resulted from the tumor vaccine. The tissue section bordering the necrotic tumor tissue to the viable normal tissue was examined for nature of any infiltrated cells and their activities. Lymphocytes, macrophages, and a small number of neutrophils diffused into the necrotic tumor tissue were found. The infiltrated lymphocytes consisted of both CD4+ and CD8+ T cells. The functional activity of these lymphocytes was demonstrated by the active production of interferon y and tumor necrosis factor alpha based on the respective immunofluorescent staining localized to these cells. This finding is compatible with the proposed mechanism underlying the tumor vaccination. However, the contribution of radiation treatment to this event cannot be clearly ruled out.

The efficacy of chemically-stabilized chlorite-matrix (TCDO) in the management of late postradiation cystitis.

Carcinoma of the uterine cervix is the most common cancer of women in Thailand. The most frequent complication after pelvic radiation for uterine cancer is radiation cystitis. The management of severe late postradiation cystis is far from satisfactory. The objective of this study was to evaluate the efficacy of chemically-stabilized chlorite-matrix (TCDO) in patients with severe radiation cystitis. This study was conducted at the Department of Obstetrics and Gynecology, Ramathibodi Hospital and the Department of Radiology, Siriraj Hospital between September 1997 and September 1998. Twenty patients with grade 3 radiation cystitis after radiotherapy were enrolled into this study. TCDO was administered at a dose of 0.5 ml/kg body weight per day on 5 consecutive days as intravenous infusion over 4 hours. The response rate after the first cycle was 80 per cent with 30 per cent of the patients showing complete response. The follow-up time (13 patients) ranging from 1-9 months revealed no recurrent bleeding. There were no side effects from TCDO therapy. The result suggests good efficacy of TCDO in the treatment of postradiation cystitis.

Serum tissue polypeptide specific antigen (TPS) in patients with cervical carcinoma: preliminary report.

Tissue polypeptide specific antigen (TPS) was measured by TPS ELISA in the sera of 88 patients with FIGO stage II and III cervical cancer and 93 healthy Thai women as the control group. The mean serum TPS levels were 63.1 U/L in the control group, and 166.4 and 363.2 U/L in stage II and III cervical cancer respectively. The mean of the control group and stage II patients were not significantly different while the mean of stage III patients was significantly different from those two groups (p < 0.0005). With the cut-off value of 90 U/L, the rates of TPS elevation were 22/35 (65.7%) in stage II and 42/53 (79.2%) in stage III patients. As for the pathology, squamous cell carcinoma showed a statistical difference from adenocarcinoma and adenosquamous carcinoma of P = 0.001. For squamous cell carcinoma, there was no difference between the keratinized and non-keratinized type (P = 0.451). TPS is not sensitive in stage II. However, it might be useful for predicting prognosis if the elevation is significantly high, and distant metastases or local recurrence should be investigated.

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.