1. Combined use of radiation and surgery: Sufficient amount of radiation to completely destoroy the tumor cells is approximately 10,000 rads. Partial laryngectomy following such amount of radiative dosis can not be performed, because of the markedly delayed wound healing. No disturbance as to wound healing has been observed in patients with preoperative irradiation amounting to 4,000 to 5,000 rads. Survived tumor cells, however, are sometimes recognized in the subepithelial scar tissue of the specimen in spite of the macroscopic cure of the epithelium.
2. Combined use of chemotherapy and surgery: The arterial structure of the larynx and the cellular character of the laryngeal cancer had been obstacles against chemotherapy before Bleomycin was discovered. The electronmicroscopic findings show the direct effect of Bleomycin to the tumor cells themselves. Delayed wound healing has not been observed in patients treated by preoperative administration of Bleomycin without radiotherapy. Increased effect of Bleomycin was observed in some patients used in the hyperbaric oxygen tank. The influence of oxygen on the distribution of injected Bleomycin was also studied by animal experiments in the oxgen tank and with H2O2.
