Fast neutron teletherapy for advanced carcinomas of the oral cavity and soft palate

A final report is presented on the local control rate and length of survival for 100 patients with advanced squamous cell carcinomas of the head and neck region who received fast neutron teletherapy at the University of Washington during the period 1973 through 1977. Sixty‐two patients were treated with neutrons alone and 38 were treated with a combination of neutrons and photons as part of a mixed beam fractionation scheme. The overall initial complete remission rate was 68% for the mixed beam group and 44% for the group treated with neutrons alone. Initial complete remission rates for the two groups of patients are given as a function of T‐stage and N‐stage and acturarial curves are presented which show the time course of local control and survival for the two treatment groups. For T3 and T4 lesions the initial complete remission rate appears to be greater using the mixed beam form of treatment than using neutrons alone. Treatment to high‐dose levels using neutrons alone gave rise to significantly greater morbidity—both acute and late effects—than resulted from the mixed beam form of treatment. Local control rates and survival rates are compared with similar groups of patients treated with neutrons at other institutions.

Phase I pilot study on fast neutron teletherapy for advanced carcinomas of the head and neck region: Final report on local control rate and survival

Laramore

Griffin

Tesh

et al. 1983

A combined treatment for advanced oral cavity cancers

Olasz

Szabó

Horváth

1988

Effects of preoperative chemotherapy with three courses of a combination of bleomycin, vincristine, mitolactol, prednisone, and methotrexate, with a leucovorin rescue, followed by surgery were studied in 43 patients with advanced squamous cell carcinoma of the oral region. Before chemotherapy 34 patients (79%) had Stage III or IV carcinomas whereas nine patients had Stage II lesions. The clinical response was very encouraging: 20 patients (46%) achieved a clinical complete response and 23 patients (54%) were judged as partial responders. Side effects of this chemotherapy were minimal and reversible. Between 15 and 22 days after the last course of chemotherapy patients went to surgery. Wound healing complications did not occur. The surgical specimens were tested microscopically. The microphotographs showed small tumor rests with giant cells bordered by fibrous scar tissue and separated from the healthy tissues. With a median follow-up of 36 months (range, 21-58 months) 74% of patients are alive and 70% remain disease-free. Eleven patients died but only five (11%) because of the failure of therapy. This combined therapy appears both safe and promising treatment for advanced squamous cell carcinomas of the oral cavity. A further follow-up study needed to confirm the promising 5-year results.

Primary radiation therapy in the treatment of squamous cell carcinoma of the soft palate

Horton

Tran²,

Greenberg

et al. 1989

Self Cite

From 1970 to 1986, 45 patients received primary radiation therapy for squamous cell carcinoma of the soft palate at the University of California Los Angeles (UCLA) Center for the Health Sciences and Wadsworth Veteran's Administration Hospital. Seven patients were lost to follow-up or had prior irradiation, and were excluded. Thirty-eight patients received a median dose of 70 Gy (62.5 to 80 Gy) to the primary site. After a median follow-up of 48 months, initial control of disease at the primary site was accomplished in 74% of the patients. The initial control by stage was as follows: TI, 83%, T2, 67%; and T3, 63%. After surgical salvage, local control increased to 92%, 80% and 75% for stages T1, T2, and T3, respectively. Twenty-nine percent (11 of 38) of the patients had cervical node metastases at presentation. Radiation provided regional control in 96% (26 of 27) with N0 disease and 86% (six of seven) with N1 disease at diagnosis. Sixteen patients (42%) had an additional malignancy of the upper aerodigestive tract. Because the incidence of second malignancies after treatment is high and surgical salvage of treatment failures is possible, close follow-up is essential in the management of this tumor. We conclude that radiation therapy is an effective modality for the treatment of squamous cell carcinoma of the soft palate. Primary radiation therapy may offer many patients the chance to avoid surgical procedures that are both cosmetically and functionally debilitating without compromosing treatment outcome.