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AimsAnaplastic thyroid carcinoma (ATC) is a fatal disease despite combined treatment consisting of chemotherapy, radiotherapy and surgery. The optimal sequence of treatment modalities is not known. The purpose of our retrospective non-randomized study was to find out whether timing of the treatment modality had any influence on survival, and to find out if primary surgery prolongs survival in comparison to primary chemotherapy and/or radiotherapy. MethodsFrom our database of 162 patients with ATC treated at the Institute of Oncology Ljubljana from 1972–98, 79 patients (26 men, 53 women; age: 40–86 years, mean age 65 years) were included in this retrospective study. The 83 patients with distant metastases on admission, with the survival shorter than one month or patients without any treatment were excluded. The 79 patients were classified into (1) primary surgery group (n=26) and (2) primary chemotherapy and/or radiotherapy group (n=53), including the 12 patients in whom surgery was performed after chemotherapy and/or radiotherapy. The survival of both groups was compared by log-rank test and group characteristics by ANOVA and2 test using SPSS program.ResultsIn comparison to the primary surgery group, the patients from the primary chemotherapy and/or radiotherapy group were older and had faster growing, and larger tumours, which were not confined to the thyroid, and more frequently had regional metastases. There was no difference in the survival of the two groups (P=0.17). Survival for longer than one year was observed in 25% of patients with primary surgery and in 21% of patients with primary chemotherapy and/or radiotherapy. The best results (50% survival at one year) were obtained in patients in whom the tumour was surgically removed after primary chemotherapy and radiotherapy. ConclusionThis study suggests that the timing of the treatment modalities has an impact on survival and that treatment should start with chemotherapy and/or radiotherapy, with surgery to follow if possible.

Aims: Multivariate studies of the diagnosis, treatment and prognosis of patients with follicular carcinoma of the thyroid gland are relatively scarce. The aim of our multivariate analysis was to study the factors associated with survival of patients with follicular carcinoma in Slovenia, in an iodine-deficient region. Methods: This retrospective study was carried out in a group of 154 patients (113 women, 41 men; median age 61 years) with follicular carcinoma of the thyroid treated at the Institute of Oncology in Ljubljana between 1972–1992. Data on patient gender, age, disease history, extent of disease, morphological characteristics, mode of therapy and survival were collected. Statistical correlations between possible prognostic factors and survival were analysed by univariate and Cox's multivariate analysis. Results and conclusions: The 10-year survival of the 154 patients was 60%. Multivariate analysis showed that tumour differentiation, primary tumour size, vascular invasion, distant metastases, regional lymph-node metastases, histological tumour type and age were independent prognostic factors for survival. The best prognosis was found in patients with well-differentiated T1 or T2 tumours, without extensive vascular invasion, without distant or regional metastases and aged under 46 years. Patients with Hürthle-cell type carcinomas had better prognosis than those with the follicular type. The worst prognosis was found in patients with poorly differentiated T4 tumours, with extensive vascular invasion, with distant or regional metastases and aged over 60 years. Copyright 1999 Harcourt Publishers Ltd

Summary Sixty-one patients with locally advanced squamous cell carcinomas of oral cavity and oropharynx were treated with chemotherapy, intravenously applied, in addition to radiation and/or surgery. An attempt was made to synchronize the tumor cell population by application of low doses of Vinblastine and the subsequent chemotherapy was based on the uptake of 99m-Tc — labelled Bleomycin in the tumor as an indication of synchronization. Increased number of mitoses in aspiration biopsy specimens and shift in the DNA distribution pattern on DNA histograms were taken as indicative of synchronization. A 50–100% regression of the tumor was achieved in 19 out of 38 patients with residual or recurrent tumors. The results were better in those patients, who received chemotherapy based on individual Tc-Bleomycin uptake curves. In 23 patients with previously untreated T3 tumors of oral cavity and oropharynx the results were somewhat better, but there was no statistically significant improvement on attempts with synchronization in this small series. There were no serious complications connected with chemotherapy.

Standard evaluation of the effect of chemotherapy (CHT) and/or irradiation (RT) by measuring tumor diameters can be misleading due to tumor necrosis. The aim of this work was to study the value of sequential tg measurements for monitoring the effect of treatment in inoperable differentiated thyroid cancer (DTC).From 1985–1993, 48 cycles of treatment were applied in 36 patients (27 females, 9 males, age 33–81 years) with primarily inoperable, recurrent or metastatic DTC. Serum tg measurements were performed before therapy (CHT or CHT and RT), 24, 48, 72, 96 hours and 3 weeks after treatment. The changes in tg levels, tumor diameters, cytomorphology and DNA distribution pattern after treatment were evaluated.In 39/48 cycles the results of monitoring the effect of treatment by serum tg measurements were in agreement with the results of other methods. In 6 patients elevated serum TG after treatment were observed, which could classically be interpreted as tumor progression. However, the other methods indicated excellent treatment effect. In latter increased tg was the consequence of tumor necrosis and increased efflux of TG. Consequently, the actual sensitivity of monitoring treatment by tg measurements was 93.7% (45/48). Beside the changes in cytomorphology and DNA distribution pattern, the tg levels can be an early indicator for effectiveness of CHT.

Vinblastine (VLB) infusions 2 rng over 12–24hwere applied to 28 patients (21 females, 7 males, aged 32–85 years) with inoperable or metastatic DTC (follicular 13, papillary 8, Hürthle cell 7). Cytopunctures were performed before and sequentially after VLB infusions. Specimens were processed for Flow Cytometry (FCM) DNA studies (DAPI staining, PAS II cytometer) in all patients and for image cytometry analysis (Cyto-Savant™ cell image analyzer) in 12 patients.In 17/27 patients (67%) a partial response was achieved. In responders, FCM DNA measurements, changes in DNA distribution pattern (increase in S, G2+ M compartment, polyploidy, broad G1peaks and debris) were observed. Cytomorphological changes after VLB appeared later than changes in DNA histograms. Image cytometry data have also been analyzed in terms ofDNA distribution diagrams, as well as changes in other nuclear Ctexture) features.Our results show that VLB is effective in DTC, and that sequential DNA measurements can predict clinical effectiveness of VLB.