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Background: Preoperative combined chemoradiation treatment (CRT) is now accepted as the treatment of choice due to its benefits of decreasing the primary tumor volume and enhancing the sphincter preservation surgery. Determining whether a patient is responding to therapy is crucial for rectal cancer patients who may benefit from prompt treatment modifications., Objective: To evaluate the use of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the treatment response., Material and Method: Nineteen patients with histologically proven rectal adenocarcinoma who were candidates for neo-adjuvant CRT were prospectively included. All patients were examined by conventional and DCE-MRi at three time points (pre-, during-, and post-CRT). Surgical resection was performed after complete CRT. The pathological response and Dworak regression grade were assessed. All parameters were blindly analyzed., Results: The median pathologic response rate for all patients was 40%. Dworak regression grades of 0, 1, 2, 3, and 4 were found in 0.0%, 21.1%, 42.1%, 26.3%, and 10.5% of patients, respectively. The tumor thickness and length were 30% and 32.9% lower at during-CRT and 40.6% and 44.7% lower post-CRT and had moderate and fair negative correlations with the pathologic response rate and Dworak regression rate, respectively. Among the DCE-MRI parameters, only a change in the time to peak between pre- and during-CRT was correlated with the Dworak regression grade (p = 0.01). The percentage change in the time to peak in patients with poor regression (grades 0-1) was significantly greater than in patients with intermediate/complete regression (grades 2-4) [139.25% vs. 6.13%]., Conclusion: Changes in the tumor thickness and length evaluated by conventional MRI and the time to peak evaluated by DCE-MRI during CRT may be useful for predicting the treatment response of rectal cancer patients.

A retrospective study of the preoperative chemoradiotherapy in locally advanced rectal cancer performed at Ramathibodi Hospital. The median age of twelve patients was 52 years. The tumor locations (upper-, mid-, lower rectum) were 25%, 50% and 25%, respectively. Eleven patients had clinical stage 111 disease. All received concurrent 5-FU-based chemoradiotherapy followed by surgery (if resectable) and chemotherapy. The most common toxicity of preoperative treatment was gr. 1-2 diarrhea (58.3%). The response rate was 41.7%. Five patients (41.7%) underwent sphincter-sparing surgery. Four patients underwent AP resection. Twenty-five percent achieved pathological complete response. Pathological downstaging occurred in 33.3%. The remaining three patients had unresectable disease. With the median follow up of 13 months, five patients had progressive disease and one has expired. The local failure rate was 16.7%. The one-year recurrence-free survival was 75%. The authors conclude that preoperative chemoradiotherapy is an effective treatment with favorable outcome in locally advanced rectal cancer.

In the past decade, increasing attention is being given to more systematic and quantitative ways to evaluate explicitly the impact of disease and medical interventions on quality of life (QOL). Pertaining to the field of oncology, two relatively new instruments--the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the FACT-G, have received growing attention and appear to be excellent QOL instruments in clinical settings. FACT-G has already been validated and has been used in Thailand. Thus in the present study, the English version of the EORTC quality of life questionnaire (QLQ-C30) was translated into Thai and the initial descriptive statistic and scale reliability were reported. Mean score in this study of 75 cancer patients was comparable with the original report. Cronbach's alpha coefficient for multi-item scales range from 0.64 to 0.89. The validity of this translated version will be reported at a later date. The initial findings of the present study indicate that the Thai version of the EORTC QLQ-C30 is reliable. A validating process of this version is in progress with active patients accrual ongoing at present.

The purpose of this prospective study was to assess the efficacy, clinical benefit and safety of irinotecan (CPT-11) in patients with 5-fluorouracil-resistant metastatic colorectal cancer (CRC). Sixteen patients with World Health Organization (WHO) performance status < or = 2 were treated with CPT-11 350 mg/m2 every 3 weeks. The observed partial response (PR) rate was 6.3 per cent with a high rate of stable disease (SD) (43.7%) which was of long duration (21.1 weeks for the best response; 1PR, 7SD). The median survival time for the 16 patients entered into this study was 69.6 weeks. There was no toxic death. The most frequent adverse events were neutropenia (31% grade 3/4) and delayed diarrhea (9.7%). CPT-11 has definite activity in the treatment of progressive metastatic CRC truly resistant to 5-FU which translated into clinical survival benefit. Median survival from first administration of CPT-11 was 78.6 weeks for patients with best response (PR + SD) compared with 28.1 weeks for patients with progressive disease (PD) (P = 0.01). With the appearance of new active drugs in this highly chemotherapy-resistant disease, the definition of response should be reassessed in CRC.

The purpose of this phase II study was to determine the effects of paclitaxel plus carboplatin administered by short duration on response rate, toxicity, and quality of life (QOL) in patients with non-small cell lung cancer (NSCLC). Twenty-seven patients were enrolled in this study. The objective response rate was 48.2 per cent, grade 3 or 4 granulocytopenia and thrombocytopenia were observed in 22 per cent and 1.6 per cent, respectively. QOL was assessed in nineteen patients who completed six cycles of chemotherapy. Quality of Life Index (QLI) after six cycles of treatment showed no significant change from the baseline QOL. Compliance with the QOL protocol in this study diminished with the course of chemotherapy which is comparable to the literature figure. Thus, withholding current effective chemotherapy in patients with NSCLC with good performance status is no longer justified.

We designed a phase II study to determine the feasibility and toxicity of concomitant radiotherapy and Paclitaxel/Carboplatin followed by adjuvant chemotherapy of the same regimen in patients with newly diagnosed inoperable stage III A/B non-small cell lung cancer. Patients were irradiated with a total dose of 66 Gy. Weekly courses of Paclitaxel 45 mg/m2 and Carboplatin AUC 2 were administered intravenously during the irradiation period. After completion of concurrent chemoradiotherapy, adjuvant chemotherapy with Paclitaxel 175 mg/m2 and Carboplatin AUC 6 intravenously every 3 weeks for 4 cycles were given. Since March 1998, 15 patients have been enrolled. All patients were assessable for efficacy and toxicity after concurrent chemoradiotherapy. Eleven patients were assessable for efficacy and toxicity after adjuvant chemotherapy. After concomitant chemoradiotherapy, complete response (CR) was documented in 2 of 15 (13%). Partial response (PR) was documented in 9 of 15 (60%). After completion of adjuvant chemotherapy in 11 patients, the overall response rate was 91 per cent. (18% CR, 73% PR). There were 8 per cent gr. 3-4 neutropenia which occurred during adjuvant chemotherapy. Concomitant Paclitaxel/Carboplatin and radiotherapy are promising modalities in the treatment of inoperable stage III A/B non-small cell lung cancer.

This study was aimed to determine the activity and toxicity of combination paclitaxel and carboplatin in stage III B and IV NSCLC. Eligibililty required performance status. Paclitaxel was administered at a dose of 200 mg/m2, 3-hour infusion, followed by carboplatin at a tartgeted area under the concentration-time curve (AUC) of 6. Treatment was repeated at 3-week intervals for 6 courses. G-CSF 5 micrograms/kg was subcutaneously injected during subsequent courses if there was grade 3-4 leukopenia or granulocytopenia in the previous course. From August 1996 through June 1997, 15 patients were enrolled. The median age was 47 years (range 20-68 years), 60 per cent were female. 73.3 per cent had adenocarcinoma, and 66.7 per cent had stage III B disease. Eighty three courses were administered; 13 patients (86.7%) completed all six cycles. The objective response rate was 53.3 per cent, with 1 (6.7%) complete response and 7 (46.7%) partial responses. Pleural effusion, lung lesion and lymph node were the three most common sites that responded to chemotherapy. The major toxicity was myelosuppression. Grade 3 or 4 granulocytopenia, anemia and thrombocytopenia were observed in 18 per cent, 7.2 per cent and 1.2 per cent, respectively, of 83 courses administered. Four episodes of febrile neutropenia (4.8%) occurred in 3 patients. There was one episode of anaphylaxis during Paclitaxel infusion. Other common toxicities were mild myalgia, paresthesias, alopecia and fatigue. Most of the toxicities showed cumulative effect. Paclitaxel plus carboplatin is a moderately active regimen in advanced NSCLC. Toxicities of this regimen are well tolerated.