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PURPOSE: This single centre, open labelled, randomised non-inferiority trial compared concurrent chemoradiotherapy with carboplatin versus standard concurrent chemoradiotherapy with cisplatin in patients with locoregionally advanced nasopharyngeal cancer (NPC). PATIENTS AND METHODS: From August 1999 to December 2004, 206 patients with locally advanced NPC were randomised with 101 to cisplatin arm and 105 to carboplatin arm. Planned radiotherapy was the same in both groups. All the patients were evaluated for toxicity and survival according to the as-treated principle. RESULTS: With a median follow-up of 26.3 months (range 3-74.6 months), 59% of patients in the cisplatin arm completed the planned concurrent chemoradiation treatment, compared to 73% in the carboplatin arm. Forty-two percent of cisplatin patients completed the 3 cycles of adjuvant therapy compared to 70% in the carboplatin group. There were more renal toxicity, leucopenia, and anaemia in the cisplatin group, and more thrombocytopenia in the carboplatin arm. The 3 year disease free survival rates were 63.4% for the cisplatin group and 60.9% for the carboplatin group (p=0.9613) (HR 0.70, 95% confidence interval (CI): 0.50-0.98). The 3 year overall survival rates were 77.7% and 79.2% for cisplatin and carboplatin groups, respectively (p=0.9884) (HR 0.83, 95% CI: 0.63-1.010). CONCLUSION: We concluded that the tolerability of carboplatin based regimen is better than that of the cisplatin regimen. Moreover, the treatment efficacy of carboplatin arm is not different from the standard regimen in the treatment of locoregional advanced stage NPC. [ABSTRACT FROM AUTHOR]

The Chiang Mai tumour registry was established in 1978 as a hospital-based cancer registry, and population-based cancer registration started in 1986, with retrospective data collection on cancer incidence and mortality since 1983. Registration of cases is done by active methods. Data on survival for 36 cancer sites or types registered during 1993-1997 are reported here. Follow-up has been carried out predominantly by active methods, with median follow-up ranging between 1-39 months for different cancers. The proportion of histologically verified diagnosis for various cancers ranged between 28-100%; death certificate only (DCO) cases comprised 0-56%; 33-92% of total registered cases were included for survival analysis. Complete followup at five years ranged from 59-100% for different cancers. The 5-year age-standardized relative survival rates was the highest for Hodgkin lymphoma (70%) followed by thyroid (65%), cervix (57%), breast (56%) and corpus uteri (49%). The 5-year relative survival by age group showed either an inverse relationship or was fluctuating. An overwhelmingly high proportion of cases were diagnosed with a regional spread of disease, ranging between 44-82% for different cancers and survival decreased with increasing extent of disease for all cancers studied.

Objective: To evaluate the prevalence, severity and differences of high frequency hearing loss in nasopharyngeal carcinoma patients after curative treatment by radiotherapy alone and chemoradiation., Material and Method: Pure tone audiometry was done in nasopharyngeal carcinoma patients who came back to follow-up after curative treatment during the year 2003 and 2004. The patients were divided into three groups, the first group received radiation treatment only, the second group received radiation and cisplatin chemotherapy, and the third group received radiation and carboplatin chemotherapy, Results: Of 192 patients with a mean age 49.9 years, mean radiation dose 6,951.5 cGy, mean follow-up period 3 years and 9 months, 93.8% showed bilateral high frequency hearing loss. There were statistically significant differences in the high frequency hearing threshold between the second group versus the first and the third group., Conclusion: Clinicians should inform patients of the risk of hearing loss, particularly the treatment with cisplatin. Hearing test should be a routine test after treatment completion.

Background: Population-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions., Methods: Survival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined., Findings: For cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76-82% for breast cancer, 63-79% for cervical cancer, 71-78% for bladder cancer, and 44-60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services., Interpretation: The wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources., Funding: Association for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA)., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: To evaluate and assemble late complications of radiotherapy in cases of nasopharyngeal cancer., Methods: From October 2003 to January 2005, a prospective cohort study was done in a tertiary center, Chiang Mai University Hospital. Two hundred patients were evaluated for late complication according to the RTOG/EORTC late radiation morbidity scoring criteria., Results: Of 200 patients, 131 were male (65.5%) and 69 female (34.5%). The mean age was 49.7+/-13.5 years (11-78). The mean pre- and post-treatment body mass indexes (BMI) were 22.5+/-4 (15-35.6), and 19.8+/-3.2 (12.9-34.5; P<0.05). Mean post-radiation period was 3.6+/-3.4 years (0.3-18.6 years). The radiation dosage ranged from 60 to 76Gy (mean 69Gy). Most of the patients (92%) had undifferentiated (50.5%) and poorly differentiated (41.5%) squamous cell carcinoma. Eighty-eight percent of the patients were in Stage III and IV. Chemotherapy was given to 145 patients (72.5%). The mean post-radiation period in the added chemotherapy group was lower than the group treated with radiation alone (2.9+/-2.7 years vs. 5.4+/-4.4 years, P<.05). The most common complication was dryness of mouth (97.5%); followed by hearing impairment (inner ear 82.5%). Added chemotherapy increased the complication severity significantly for the skin (P<0.05). The mean number of complications was 6.3+/-2.2 (range from 1 to 12)., Conclusion: In this study, every patient had a more or less adverse reaction to radiation. Doctors need to be aware of these complications in order to prevent serious ones and to improve the patients' quality of life in the long term.

Objective: To find predicting symptom(s) in patients with a positive skin test, and identify patient characteristics according to ARIA classification., Material and Method: Four hundred and thirty four rhinologic patients were retrospectively studied. Nasal obstruction, rhinorrhea, itching, sneezing, and smell dysfunction were assessed. Patients were also classified according to the ARIA guideline., Results: Of 434 patients, 277 (63.8%) were skin prick test positive. There was no statistical difference in sex, but the mean age of the positive skin test group was lower than that in the negative group (p < 0.05). Intermittent or persistent symptoms and total symptom score were not significantly different. Severe nasal itching was more common in the positive group (p = 0.04). The impact of symptoms was similar between the two groups, except for self-reported comorbidity, which was higher in the negative group (p = 0.039)., Conclusion: There were no predicting symptoms and no difference in the symptom characteristics for the patients with positive skin test.

Unlabelled: This is a phase II clinical study conducted to evaluate the toxicity and efficacy of a 4-day regimen of docetaxel, cisplatin, fluorouracil, and leucovorin (TPFL) in patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN)., Patients and Methods: Twenty-one previously untreated patients with stage III or IV SCCHN were treated with TPFL. Patients who received a complete response (CR) or partial response (PR) to three cycles of TPFL received definitive radiation therapy. The primary end points were toxicity and response to TPFL., Results: Fifty cycles were administered to 21 patients. The major acute toxicities to TPFL were mucositis, fatigue, and anorexia. Additional major toxicities were neutropenia, anemia, and weight loss. The overall clinical response rate to TPFL was 47.6% , with 19% CRs and 28.6% PRs. In addition, the median time to progression and overall survival time were 49.2 months and 42.7 months, respectively., Conclusion: TPFL has an acceptable toxicity profile for patients with locally advanced squamous cell carcinoma of the head and neck and may hold curative potential for some patients with surgically unresectable or medical inoperable situations., Objective: To evaluate the efficacy and safety to TPFL regimen for locally advanced squamous cell carcinoma of the head and neck.

Objective: The authors determined the efficacy and safety of oral pilocarpine tablet in symptomatic relief of post-radiation xerostomia in head and neck cancer patients., Material and Method: Thirty-three radiation-induced xerostomia patients were enrolled in a single-blind method to receive placebo 1-tablet three times daily in the first month and then oral pilocarpine (5 mg) 1-tablet three times daily for the next three months. Patients were evaluated for subjective symptomatic relief of xerostomia using questionnaires. Objective findings of xerostomia were also evaluated at the same time by two radiation oncologists., Results: All 33 patients had received radiotherapy doses at least 4000 cGy to the parotid glands. Improvement of xerostomia symptoms was observed, with a mean total subjective xerostomia score improvement at the first 4 weeks of oral pilocarpine treatment (p = 0.001), and later throughout the present study. Objective xerostomia score also showed statistically significant improvement at the same time point. Adverse effects of pilocarpine included sweating, nausea, palpitation, and tearing, with sweating as the most common side effect. Adverse effects of placebo included mild headache, nausea, and vomiting., Conclusion: Oral pilocarpine was effective and well tolerated in the treatment of radiation-induced xerostomia symptoms.

Through 2004, five cancer registries in Thailand have collected data for more than ten years. Three-year cancer incidence in Thailand covering the years 1989-1997 has been regularly reported in three volumes of 'Cancer in Thailand. Since the data for the last decade of the 20th century have been collected, the trends in incidence of some cancer sites were analyzed. Data sources were registry data from Chiang Mai, Lampang, Khon Kaen, Bangkok, and Songkhla, which are representative of the four major geographic regions of Thailand. The data drawn in 2002 covered the years 1989 to 1997 for Bangkok, the other four registries drew data from 1989 to 2000. The population denominators were estimated from the two censuses in 1990 and 2000. Only cancers of the liver, lung, colon-rectum, female breast, uterine cervix, and all cancer sites were analyzed since cancers of these sites may have major public health impacts. Age-specific incidence rates of different 5-year age groups were projected through the period 2007-2009 using a linear regression model if the rates were increasing, and a log-linear model to prevent prediction of a negative rate if the rates were decreasing. During the past decade, colorectal and breast cancers showed a statistical significant increasing trend, while the trend was generally stable for cancer of other sites. The number of new cancer cases of all sites is expected to be approximately 125,000 by the year 2008, compared with 81,000 in 1999. However, the accuracy of projections depends very much on the quality of the cancer registries' data. The Bangkok registry significantly improved case ascertainment in recent years, while the Chiang Mai registry had a consistent drop in incidence of cancer at many sites. In-depth investigation of some cancer sites and age period cohort modeling are required for better understanding of cancer trends in Thailand.

Objectives: Epistaxis is a common otolaryngologic emergency, and can be severe or even fatal. The causes can be from local or systemic illnesses. The aim of this study was to review and analyze the general and specific data causes, management and results of epistaxis in patients admitted in Chiang Mai University Hospital., Material and Method: A retrospective study by reviewing charts of new epistaxis inpatients, admitted to Chiang Mai University Hospital between January 2001 and July 2004, was done., Results: From 55 cases reviewed, 41 were males (74.5%) and 14 females (25.5%). The mean age was 46.98 +/- 17 years (12-87 years). The peak of prevalence was between January and April. The average length of hospital stay was 6.2 +/- 3.8 days, (1-17 days). The most common cause of epistaxis was hypertension (32.72%) followed by tumor, local trauma and coagulopathy, subsequently. About 18 per cent of the patients had more than one cause of the illness. According to the bleeding site, 33 patients (60%) had anterior bleeding, 14 (25.45%) had posterior bleeding, and the rest had non-identifiable bleeding sites. There were 5 abnormalities from 52 patients (9.6%) tested for clotting profile. A bout one third of the patients received more than one type of procedure, while 2 patients (3.6%) treated by a local hospital before being transfered, were observed with successful outcome., Conclusion: The most common and preventable causes of epistaxis in this review are hypertension and facial and paranasal sinus injuries. The other common curable cause is tumor Otolaryngologists and general physicians should find out the causes and know characteristics of the patients and diseases, especially in their own area of practice in order to be able to perform optimal management.

The incidences of childhood cancers in Thailand between 1995 and 1997 were determined from cancer registrations collected at five locations around the kingdom and compared with similar analyses performed at cancer registries in Asia, Europe and the USA. The incidence in Thailand was found to be lower than in some Asian and Western countries. Between 1988-1994 and 1995-1997, the incidence of childhood cancer rose 32.5%. As elsewhere in the world, leukemias, brain tumors and lymphomas comprised two-thirds of all childhood cancers. The age-peak for incidence was between 2 and 5 years, particularly for acute lymphoblastic leukemia. Carcinomas were rare. Several features of the cancer pattern correspond to other Asian populations, in particular the low incidence of Hodgkin s disease, Wilms tumor and Ewing s sarcoma. Neuroblastoma was more common than in neighboring Southeast Asian countries.

A four-generation Thai family affected with Van der Woude syndrome is reported. The disorder appeared to be originally inherited from a person who was half Thai and half Pakistani. The lip lesions found in this family were varied and did not appear to be related to other phenotypes. There were some clinical manifestations possibly specific for the condition in this family. They included sensorineural hearing loss, prominent frontal bone, large frontal/sphenoidal/maxillary sinuses with increased mastoid air cells, long tooth roots, dental pulp stones, ankyloglossia, brachydactyly of hands, brachyphalangy, and hyperphalangy of toes, and single flexion crease of the fifth fingers. Fluorescence in situ hybridization analysis revealed no visible deletion at a 1q32-41 region., (Copyright 2002 Wiley-Liss, Inc.)

Background: The aim of this trial was to compare the outcome achieved with neoadjuvant chemotherapy followed by radiotherapy to that achieved with radiotherapy alone for patients with locoregionally advanced undifferentiated or poorly differentiated nasopharyngeal carcinoma (NPC) meeting one of the following criteria: Ho's T3 disease, Ho's N2-N3 disease, or lymph node size > or =3 cm., Methods: Between September 1989 and August 1993, 334 patients were enrolled in the study, with equal numbers of patients randomized to the neoadjuvant chemotherapy arm (CT arm) and the radiotherapy arm (RT arm). Neoadjuvant chemotherapy consisting of 2-3 cycles of cisplatin (60 mg/m2 on Day 1) and epirubicin (110 mg/m2 on Day 1) followed by radiotherapy was given to the CT arm. For radiotherapy, a dose of 66-74 gray (Gy) (median, 71 Gy) was delivered to the primary tumor and 60-76 Gy (median, 66 Gy) to the neck. Two hundred eighty-six eligible patients completed the treatment and were evaluable for treatment response (134 in the CT arm, 152 in the RT arm). All patients were included in the survival analysis based on the intention to treat. The median follow-up was 30 months for the whole cohort and 41 months for the surviving patients., Results: Analysis of the 334 patients based on the intention to treat showed no significant difference in relapse free survival (RFS) or overall survival (OS) between the 2 treatment arms (3-year RFS rate: 48% in the CT arm vs. 42% in the RT arm, P = 0.45; 3-year OS rate: 78% vs. 71%, P = 0.57). In an efficacy analysis based on only the 286 evaluable patients, a trend of improved RFS favoring the CT arm was observed (3-year RFS rate: 58% vs. 46%, P = 0.053), with again no significant difference in OS (3-year OS rate: 80% vs. 72%, P = 0.21). In the subgroup of 49 patients with bulky neck lymph nodes >6 cm, improved RFS (3-year RFS rate: 63% vs. 28%, P = 0.026) and OS (3-year OS rate: 73% vs. 37%, P = 0.057) were observed, favoring the CT arm., Conclusions: This multicenter randomized study did not demonstrate any benefit with the addition of cisplatin-epirubicin neoadjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma; therefore routine administration of neoadjuvant chemotherapy to this target group cannot be recommended. Although the overall incidence of recurrence was reduced with the addition of chemotherapy in the efficacy analysis, the overall survival was not affected. A more effective chemotherapy regimen, the selection of an appropriate target group, and the use of an alternative strategy for combining chemoradiotherapy should be explored in future trials.

Pseudomonas aeruginosa, Diphtheroid bacilli, Staphylococcus aureus were the major causes of diffuse bacteria otitis externa and chronic suppurative otitis media. This study showed that 0.3 per cent ofloxacin used for 2 weeks gave good clinical and bacteriological control of chronic suppurative otitis media and diffuse bacterial otitis externa without significant side effects.

Carcinoma of the nasopharynx is one of the common head and neck cancers in Southeast Asia. We had studied 205 cases of nasopharyngeal cancer who attended the ENT clinic of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand from 1980-1984. The majority of the patients were found in stage IV. One hundred and five patients received a curative dose of radiation therapy. The observed actuarial 5 year survival was 34 per cent. There was a significant decrease in survival of patients with T4 disease. Differences in age, sex, histopathology and N-stage did not affect the survival. So far, the only specific treatment we can offer patients is radiation therapy, so an earlier diagnosis must be established in order to get better results of treatment.