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Superselective intra-arterial carboplatin infusion with concurrent radiotherapy for locoregionally advanced squamous cell carcinoma of the oral cavity and the oropharynx
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024-DClinicalmanagement of malignant neoplasm
4. Preoperative Intra-arterial Chemotherapy versus Preoperative Irradiation in the Treatment of Lingual/ Sublingual Carcinomas. A Prospective, Randomized, Multicentre Study
therapy is very important considering blood toxicity. Development of mucositis was severe in all the patients. As this therapy had a remarkable clinical and histological antitumor effect, we think it is a good treatment method for organ preservation of patients with advanced oral and oropharyngeal carcinomas.
Szabo, G.* Kreidler, J.** Hollmann, K.***, Nemeth, Z.* Department of Oral and Maxillofacial Surgery, *Budapest, Hungary, **Ulm, Germany, ***Vienna, Austria This study included 136 patients with T2-T4 SCC'g in the tongue or sublingual area, who had previously not been treated. They were divided at random, prior to radical surgery, in two groups. One group received intraarterial cytostatic treatment (cisplatin/Ebewe-Epirubicin) while the other group received preoperative irradiation. The patients were followed for 5 years. Sevety-nine patients were evaluated at the end of the study period. The results reveal that better survival was achieved with preoperative irradiation but the quality of life was better in the chemotherapy group. Intra-arterial chemotherapy for this type of tumor is technically difficult because of the anatomical situation. It is difficult to maintain a sufficient high concentration of the drugs in the tissue. This aspect may have played a role in these findings.
5. Superselective Intra-Arterial Carboplatin Infusion with Concurrent Radiotherapy for Locoregionally Advanced Squamons Cell Carcinoma of the Oral Cavity and the Oropharynx
Oya, R., Ikemura, K. Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Japan In order to obtain improved treatment results for locoregionally advanced squamous cell carcinoma of the oral cavity and the oropharynx, superselective intra-arterial infusion of carboplatin (350 mg/m 2) with concurrent radiotherapy (30 Gy) and tegafur, which was administered per os, was performed on fourteen stage III and IV patients. Seldinger's transfemoral technique was used, and the angiographic images of the external carotid artery were obtained, followed by a one-shot infusion of carboplatin into the vessels to feed the tumor. The clinical responses to this therapy were able to be evaluated in twelve patients. At the primary sites, nine (75%) patients showed a complete response. Histologically, five of seven (71%) CR patients showed a complete disappearance of cancer cells. Clinical responses of metastatic lymph nodes were two (26%) complete responses, two partial responses and three with no change. Histologically, three of five (60%) of these patients showed a complete disappearance of cancer cells. Blood toxicity (thrombocytopenia, leukocytopenia) was slight to moderate in most of the patients; however, two patients showed severe toxicity. Supportive
6. Preoperative Combined Cisplatin-based Chemotherapy and Radiotherapy for Squamous Cell Carcinoma of the Oral Cavity - Evaluation of more than 5-year follow up cases
Shimooka, 1t., Kirita, T., Kamikaidou, iV.., Yamamoto, K., Ohgi, K., Yamanaka, Y.., Sugimura, M. Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan Radiation therapy combined with Cisplatin-based chemotherapy has been reported to enhance tumor response in squamous cell carcinoma of the oral cavity. We report the long-term treatment results for oral carcinomas treated with Cisplatin-based chemo-therapy and radiotherapy as a preoperative treatment plus radical surgery in our institution. Between May 1989 and Jan. 1992, 29 patients with advanced squamous cell carcinoma of the oral cavity were treated preoperatively with Cisplatin-based chemotherapy in combination with simultaneous radiation (30-40 Gy) and 26 weeks later, curative surgery was performed. Twenty-seven patients (93.1%) had stage III or IV disease, two had stage II disease. All patients were follow-up for minimum of 5 years, with a median follow-up time of 87 months (range, 63-113 months). The 5-year actuarial local control rate was 93.1%, and local control was achieved in 17 of 18 (94.4%) patients with T2 lesions, 5 of 5 (100%) patients with T3 patients, and 5 of 6 (83.3%) patients with T4 lesions. At 5 years, the overall survival for all patients was 82.8%, and the disease-free survival was 86.2%. The actuarial incidence of primary and neck failure was 6.9% and 3.4%, respectively. The likelihood of having distant metastasis at 5 years for all patients was 6.9%. The actuarial incidence o f having a second malignancy was also 6.9%. This preoperative combined simultaneous chemoradiotherapy plus radical surgery can provide excellent long-term, disease-control rates for patients with advanced oral squamous cell carcinoma.
7. Concomitant Chemoradiotherapy with THP-ADM, 5-FU, and CBDCA for Head and Neck Cancer Monitored by 18FDG-PET
Kitagawa, E, lshii, Y.., Azuma, H., Ogasawara, T. Department Dentistry and Oral Surgery, Fukui Medical School, Japan We studied the effect of neoadjuvant chemoradiotherapy for squamous cell carcinoma of the head and neck. The study group consisted of 20 patients with squamous cell carci-
024-DClinicalmanagement of malignant neoplasm
4. Preoperative Intra-arterial Chemotherapy versus Preoperative Irradiation in the Treatment of Lingual/ Sublingual Carcinomas. A Prospective, Randomized, Multicentre Study
therapy is very important considering blood toxicity. Development of mucositis was severe in all the patients. As this therapy had a remarkable clinical and histological antitumor effect, we think it is a good treatment method for organ preservation of patients with advanced oral and oropharyngeal carcinomas.
Szabo, G.* Kreidler, J.** Hollmann, K.***, Nemeth, Z.* Department of Oral and Maxillofacial Surgery, *Budapest, Hungary, **Ulm, Germany, ***Vienna, Austria This study included 136 patients with T2-T4 SCC'g in the tongue or sublingual area, who had previously not been treated. They were divided at random, prior to radical surgery, in two groups. One group received intraarterial cytostatic treatment (cisplatin/Ebewe-Epirubicin) while the other group received preoperative irradiation. The patients were followed for 5 years. Sevety-nine patients were evaluated at the end of the study period. The results reveal that better survival was achieved with preoperative irradiation but the quality of life was better in the chemotherapy group. Intra-arterial chemotherapy for this type of tumor is technically difficult because of the anatomical situation. It is difficult to maintain a sufficient high concentration of the drugs in the tissue. This aspect may have played a role in these findings.
5. Superselective Intra-Arterial Carboplatin Infusion with Concurrent Radiotherapy for Locoregionally Advanced Squamons Cell Carcinoma of the Oral Cavity and the Oropharynx
Oya, R., Ikemura, K. Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Occupational and Environmental Health, Japan In order to obtain improved treatment results for locoregionally advanced squamous cell carcinoma of the oral cavity and the oropharynx, superselective intra-arterial infusion of carboplatin (350 mg/m 2) with concurrent radiotherapy (30 Gy) and tegafur, which was administered per os, was performed on fourteen stage III and IV patients. Seldinger's transfemoral technique was used, and the angiographic images of the external carotid artery were obtained, followed by a one-shot infusion of carboplatin into the vessels to feed the tumor. The clinical responses to this therapy were able to be evaluated in twelve patients. At the primary sites, nine (75%) patients showed a complete response. Histologically, five of seven (71%) CR patients showed a complete disappearance of cancer cells. Clinical responses of metastatic lymph nodes were two (26%) complete responses, two partial responses and three with no change. Histologically, three of five (60%) of these patients showed a complete disappearance of cancer cells. Blood toxicity (thrombocytopenia, leukocytopenia) was slight to moderate in most of the patients; however, two patients showed severe toxicity. Supportive
6. Preoperative Combined Cisplatin-based Chemotherapy and Radiotherapy for Squamous Cell Carcinoma of the Oral Cavity - Evaluation of more than 5-year follow up cases
Shimooka, 1t., Kirita, T., Kamikaidou, iV.., Yamamoto, K., Ohgi, K., Yamanaka, Y.., Sugimura, M. Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan Radiation therapy combined with Cisplatin-based chemotherapy has been reported to enhance tumor response in squamous cell carcinoma of the oral cavity. We report the long-term treatment results for oral carcinomas treated with Cisplatin-based chemo-therapy and radiotherapy as a preoperative treatment plus radical surgery in our institution. Between May 1989 and Jan. 1992, 29 patients with advanced squamous cell carcinoma of the oral cavity were treated preoperatively with Cisplatin-based chemotherapy in combination with simultaneous radiation (30-40 Gy) and 26 weeks later, curative surgery was performed. Twenty-seven patients (93.1%) had stage III or IV disease, two had stage II disease. All patients were follow-up for minimum of 5 years, with a median follow-up time of 87 months (range, 63-113 months). The 5-year actuarial local control rate was 93.1%, and local control was achieved in 17 of 18 (94.4%) patients with T2 lesions, 5 of 5 (100%) patients with T3 patients, and 5 of 6 (83.3%) patients with T4 lesions. At 5 years, the overall survival for all patients was 82.8%, and the disease-free survival was 86.2%. The actuarial incidence of primary and neck failure was 6.9% and 3.4%, respectively. The likelihood of having distant metastasis at 5 years for all patients was 6.9%. The actuarial incidence o f having a second malignancy was also 6.9%. This preoperative combined simultaneous chemoradiotherapy plus radical surgery can provide excellent long-term, disease-control rates for patients with advanced oral squamous cell carcinoma.
7. Concomitant Chemoradiotherapy with THP-ADM, 5-FU, and CBDCA for Head and Neck Cancer Monitored by 18FDG-PET
Kitagawa, E, lshii, Y.., Azuma, H., Ogasawara, T. Department Dentistry and Oral Surgery, Fukui Medical School, Japan We studied the effect of neoadjuvant chemoradiotherapy for squamous cell carcinoma of the head and neck. The study group consisted of 20 patients with squamous cell carci-