［第70回日耳鼻総会シンポジウム:頭頸部悪性腫瘍における三者合併療法］上顎癌の三者併用療法

抄録

Since 1963, the simultaneous combined therapy of (1) surgery,(2) radiothe- rapy and (3) regional chemotherapy has been practised in malignant neoplasms of the nose and paranasal sinuses. By combining the merits of the three me- thods, we examined whether the curtailment in the total dose of radiotherapy was possible or not, and whether these malignant tumors could be treated with- out total resection of the maxilla.
In our series we used 5-Fluorouracil (5-FU) alone or together with 5-Bro- modeoxyuridine (BUDR) as radiation-sensitizing agents. In order to eradicate of as much as 10, 000 rads must be administered. However, when 5-FU and BUDR are infused simultaneously with telecobalt therapy, and the necrotic tumor mass in the antrum is sucked out every day, the eradication of the tumor mass is achieved within the total dose of 4, 000 rads.
In treating the tumors which had extended to the ethmoid sinuses, this combined therapy was rather insufficient in the rate of tumor disappearance. In order to compensate the insufficient drug concentration in these regions, the cleaning of the ethmoid sinuses was done from the antrum and in some cases mixed gas of 5% CO₂ and 95% O₂ was inhaled during radiotherapy to increase radiation effects.
Even if the tumor still existed after the combined therapy, the partial resection of the maxilla or the intracavitary irradiation of Cesium-137 tubes was enough to eradicate the residue of the tumor.
Thus, this method of treatment showed the definite improvement in saving the extent of surgery. No total resection of the maxilla has been required in the last four years. Consequently, a great number of patients were enabled to return to their former work soon after the completion of the therapy.