The regional cancer chemotherapy for head and neck. On its combination with surgery and radiotherapy

Abstract

Because there is no anticarcinoma agent which is one hundred per cent effective, various method of administration have been deviced to make those agents which are available more effective.One of them is intraarterial administration of the agent by the regional blood supply of the tumor.This is the best way, because it will be able to bring the large dose of drugs to the tumor and it produces least leucopenia.But the regional chemotherapy by itself cannot substitute the surgery or radiotherapy. The way to combine these modalities differs according to the location, extension or sensitivity of the tumor.To the carcinoma of the paranasal sinuses, better results were shown by intermittent infusion of radiosensitizing agents to the internal maxillary artery and simultaneous external irradiation followed by surgery, if necessary. The advanced intraoral carcinoma was treated by continuous infusion of radiosensitizing agents combined with interstitual radiotherapy such as radium needling.The carcinoma of the larynx which had not been cured by external irradiation alone was perfused by anti-carcinoma agents to eradicate the dissemination of carcinoma cells prior to extirpation of the tumor.In order to make combination therapy more effective, infusion of radiosensitizing agents and irradiation had to be given simultaneously. Besides, more care had to be taken of local and systematic condition of the patient, because the tumor went down to necrosis more rapidly than irradiation alone and the existance of this necrotizing tissue made the therapy less effective.By combining irradiation with regional chemotherapy, the surgical procedure as well as the dose of irradiation was able to be minimumized.Thus, in a number of cases of the paranasal sinuses, the orbital contents and/or the hard palate which had been thought to be removed were saved at the time of operation.COPP and 5-FU were used as the radiosinsitizing agents; the former is given 25mg daily andthe latter 250mg. The daily tumor dose averaged 200rads. Of the group in which tumor disappeared by the combination therapy of infusion times (T) and the radiation dose (D) appeared as follows: D= 12000T-0.25. From the cases of good prognosis for about one year, the relationship between T and D was obtained as D=14000T-0.22. In cases in which complications or the recurrence of the tumor appeared, the function was shown as D=9000T -0.19. These functions showed that the radiotherapy was more effective than the regional chemotherapy.