Puangtong Kraiphibul

Nasopharyngeal carcinoma: result of treatment with cis-diamminedichloroplatinum II, 5 fluorouracil, and radiation therapy.

Combined CT (CDDP + 5FU) and RT were given to 28 patients with NPC during July 1982-May 1985. Two, 1, 4, and 21 were in Stages I-IV (AJC), respectively. None had distant metastasis. Four did not complete the planned treatment, and one each had more or fewer CT courses than planned. The median duration of follow-up of surviving patients was 29 months (19-52,x 31.1). Objective response (CR + PR) at the primary lesion was 27/28 (96.4%), whereas CR was 23/28 (82%). CR + PR and CR of the regional nodes were 21/22 (95.5%) and 18/22 (82%) respectively. Remaining node in the 2 patients, who did not prematurely die were pathologically negative. Response at N site should therefore be 100% CR. Only patients with T3 (1/5) and T4 (3/13) lesions had residual disease at the T site after initial treatment. Salvage therapy was able to induce CR in all asymptomatic PR patients. There were 4 relapses, 2 at T, and 1 each at T + N and T + M sites. All M disease occurred in patients with huge and/or low cervical lymphadenopathy. Five patients died, one of an unrelated disease, and one each of T, M, T + N, and T + M diseases. The remaining 23 patients were still alive, and all except 3 were free of disease. Side effects, mainly from RT, were clinically acceptable. One had transient cervical myelitis. Myelosuppression was mild and of short duration. Activity of CT was seen at both T, and N sites after the upfront CT. Compared to our previous experience using RT alone, the result of this study suggested a positive role of CT in this disease. However, future prospective randomized trials are required to better define its role.

Vascular Endothelial Growth Factor A and Proliferation Marker in Prediction of Lymph Node Metastasis in Oral and Pharyngeal Squamous Cell Carcinoma

OBJECTIVE To explore the effect of Ki-67 and vascular endothelial growth factor A (VEGF-A) expression on the risks of advanced T category (T3,4) and positive lymph node involvement (N+) in oral and pharyngeal squamous cell carcinoma (SCC) compared with laryngeal SCC. DESIGN Immunohistochemical analysis of prospectively recruited patients. SETTING University-affiliated hospital. PATIENTS A total of 147 previously untreated patients with different stages of SCC in the oral cavity, pharynx, and larynx. MAIN OUTCOME MEASURES Relative risks of T3,4 tumor and N+, a risk ratio comparing risks under high vs low marker expression. RESULTS A significant association of Ki-67 and VEGF-A expression with tumor T category was observed for oral and pharyngeal SCC and for laryngeal SCC (P < or = .006). Regarding nodal status, Ki-67 expression was a significant risk factor for N+ in all tumors (P < or = .009), whereas VEGF-A expression was related to N+ in oral and pharyngeal SCC only (P < .03). Analytically, Ki-67 expression alone in oral and pharyngeal SCC was associated with a relative risk of N+ of 3.83 (95% confidence interval, 1.22-11.99; P = .009), and additional expression of VEGF-A raised the value to 6.12 (2.09-17.93; P < .001). Moreover, the combined expression of both markers was 3.25 times more effective in predicting N+ for T1,2 tumor compared with T3,4 tumor. CONCLUSIONS Proliferative status was a common risk factor for N+ in all of the tumors in this series. Exploitation of VEGF-A in lymph node metastasis in addition to proliferation by oral and pharyngeal SCC but not by laryngeal SCC explains the clinical aggressiveness of oral and pharyngeal SCC, especially the early lymphatic invasion. In the management of cervical lymph nodes, combined expression of Ki-67 and VEGF-A may help identify patients at risk for occult metastases. This study suggests anti-VEGF-A therapy, an additional intervention to the classic antiproliferative regimen, for preventing lymphatic progression of oral and pharyngeal SCC.

Fractionated stereotactic radiotherapy in residual or recurrent nasopharyngeal carcinoma

The aim of this study was to evaluate results of fractionated stereotactic radiotherapy (FSRT) in patients with residual or recurrent nasopharyngeal carcinoma (NPC) in terms of local progression-free (LPFS) and overall survival (OS) rate and complications after treatment. There were 32 residual or recurrent NPC patients treated with FSRT using linac-based radiosurgery system. Time from the previous radiotherapy to FSRT was 1–165 months (median, 15). Two patients were treated for the second and one for the third recurrence. Thirteen patients (40.6%) also received chemotherapy with FSRT. Tumor volume ranged from 6.2–215 cc (median, 44.4). Average FSRT dose was 17–59.4 Gy (median, 34.6) in 4–25 fractions (median,6) in 1–5.5 weeks (median, 3). Median follow-up time was 25.5(3–67) months. LPFS rate at 1 and 3 years after FSRT was 67.8% and 37.9%. OS rate at 1 and 3 years was 89.7% and 71.2%. If all patients who had tumor progression with no further follow-up were assumed dead, the OS rate at 1 and 3 years would be 75.0% and 37.9%. Univariate analysis showed better local tumor control in patients with tumor volume ≤100 cc (p=0.04) or in those without chemotherapy (p=0.0005). Only chemotherapy retained significance in multivariate analysis (hazard ratio 5.47, 95%CI 1.86–16.04). Eight patients (25%) had complications after FSRT, all grade 2–3 except 1 grade 4 with complete recovery.

Results of treatment in stage IIB squamous cell carcinoma of the uterine cervix: Comparison between two and one intracavitary insertion

To compare the results of treatment in stage IIB squamous cell carcinoma of the uterine cervix of two treatment regimens, two radium insertions vs one insertion, a prospective randomized study was carried out at Ramathibodi Hospital from 1 January 1983 to 31 December 1986, and the results were evaluated at the end of March 1991. The patients in treatment I (90 cases) received 40-41.4 Gy whole pelvic external irradiation and two intracavitary radium insertions, while patients in treatment II (53 cases) received 50.0-50.4 Gy and one intracavitary insertion. Both groups received the same total dose at point A, about 85-90 Gy. At 4 and 5 years, by the Kaplan-Meier survival curve, the disease-free survivals were 76 and 76% vs 79 and 79%, respectively, in treatment I and treatment II, which showed no significant difference by the log-rank test. Both groups had comparable serious complication rates, 0% vs 1.9%, respectively. However, grade I complications in treatment II, 35.8%, were higher than those in treatment I, 17.8% (P less than 0.01). Therefore, we concluded that treatment II provided the same disease-free survival and a very low rate of serious complications. To replace treatment I, the dose at the rectum and urinary bladder should be maintained with caution.

Differences in in vitro photodynamic sensitivity among head and neck cancers

This study was conducted to address the question of how cancers of different histologies of the head and neck region responded to photodynamic therapy (PDT). Five human cancer cell lines were investigated: two squamous cell carcinoma lines (pharynx and tongue), mucoepidermoid carcinoma (submaxillary gland), rhabdomyosarcoma (embryonic) and adenocarcinoma (colon). The cell lines were treated with haematoporphyrin derivative (HpD) at doses of 0.78-25Μg ml-1, with excitation of the absorbed drug by a ‘black light’ source (340–380 nm). An MTT assay demonstrated different PDT responses among the various cell types. On the basis of LD50, the sensitivity of the different cell lines was ranked as follows: adenocarcinoma> squamous cell carcinoma> rhabdomyosarcoma> mucoepidermoid carcinoma. The magnitude of the LD50 was suggested by a drug uptake study to be governed in part by cellular levels of sensitizer and in part by intrinsic cell sensitivity. This study provided information that may help to identify the histological types of head and neck cancers that would respond favourably to PDT.