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.

Carcinoembryonic antigen in patients with carcinoma of cervix.

Seventy two patients with different stages of cervical cancer have attended the Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, for radiation therapy. Before treatment, 38.9 percent of these patients had serum carcinoembryonic antigen (CEA) level above normal range (normal=0-3.38 ng/ml). Among these patients, 48 cases had serial serum CEA determinations through 11-36 months after prognosis within 1 year after treatment. The patients who had pretreatment CEA levels between 3.38-10 ng/ml had better prognosis if CEA declined to normal level within 1-2 months after treatment, since only 15.4 percent had recurrence within 3 years. The patients who had decreasing CEA levels after treatment but increased upon follow up always had distance metastasis. The patients who had adenocarcinoma had slightly higher levels of CEA than those with squamous cell carcinoma. The CEA levels did not correlate with staging of the disease, but rather depend on the natural properties of individual’s cancer cells. The usefulness of serial CEA determinations was found only in the patients who had increased CEA before treatment. We suggest that the serum CEA determination should be performed in every patient with carcinoma of cervix and serially thereafter in those who have pretherapy increment, i.e. immediately or 1-2 months after radiation therapy and later every 3-6 months.

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.

New method for measuring blood volume.

Patients without nausea received a capsule of 200 mg of Sn Cl2 orally and waited for 1 hour or patients with nausea were injected intravenously with a dose of MDP-Sn (II) and waited for 10 minutes. After the waiting time, 10 ml of blood was withdrawn. Whole blood was incubated with 99mTc 200 ตCi for 30 minutes and 1 wash with normal saline was sufficient. This procedure of labeling RBC with 99mTc is much more convenient than the conventional one. We have used this method since 1979 until 1984 with 52 patients without any adverse reaction occurring. The results are satisfactory not only in accuracy and cost but also in reducing the radiation dosage to patients and operators. This report offers 3 main benefits for this procedure. First of all it can help doctors to make decisions about the priority of examination. Secondly, it can be useful for those who are looking for a good method of measuring blood volume. Finally it can be most helpful in a teaching programme.