Analysis of the Long-Term Results of our Combination Therapy for Maxillary Cancer, with Particular Reference to Treatment of T4 and N1–3 Maxillary Cancer

Abstract

To evaluate how far the long-term survival rate could be improved by maximum combination of chemotherapy, radiotherapy, and surgery, we have performed a trial combination therapy consisting of Linac X-ray irradiation (200 rads X 30) and intraarterial infusion chemotherapy (5-fluorouracil 250 mg X 15), followed by sufficiently extensive maxillectomy and primary reconstruction. The 5-year crude and relative survival rate of 70 patients were 64.2 and 72.1% respectively. The 5-year crude survival rate in cases with squamous cell carcinoma was 73.1%. Twelve out of 70 patients died of cancer. Local recurrence was seen in 6 cases and the most frequent cause of death was distant metastasis which was seen in 25% of T4N0 cases and in 57% of T2-3N1-3 cases. The elderly patients over 71 years occupied 29.1% of the total cases. The 3-year and 5-year crude survival rates in these elderly patients were 75 and 50% respectively. Death due to cancer was seen only in 3 patients and the most frequent cause of death was due to senility and other unrelated causes. As far as squamous cell carcinoma is concerned, the post-therapeutic courses of our combination therapy have been satisfactory. However further revision of the trial therapy was deemed necessary in T4 and N1-3 maxillary cancer. By covering the entire wound surface after total and extended total maxillectomy by a thick flap, the post-operative facial deformity and functional impairment due to scar contracture of the wound could be effectively prevented.(ABSTRACT TRUNCATED AT 250 WORDS)