Abstract
Induction chemoradiotherapy was preoperatively applied to 64 primary oral squamous cell carcinomas aiming at reductive excision with preservation of the oral functions. The subjected tumors were composed of 2 Ti, 27 T2, 22 T3 and 13 T4. The tumors were treated with both 60Co and PLM in 5, PLM+5-FU in 44, 5-FU+CDDP in 1 and PLM+5-FU+CDDP in 14 cases. Clinically, CR was observed in 22, PR (90 90 % remission) in 17, pR' (≥50 %) in 22 and NR (<50%) in 3 cases. Histopathologically, cells of 16 tumors exhibited a Grade N degenerative change, and Grade III, IIb, ha and grade I degeneration were observed in 4, 33, 4 and 1, respectively, having a correlation to the tumor remission rates. Conservative surgery was performed evaluating the tumor response, and surgical extent was divided into 4 grades. Excision of grade I (only observation without surgery or excisional biopsy) and grade II (marginal tongue resection, limited mouth floor or cheek excision and alveolectomy) was applied to 15 cases each, further, operation of grade III (within 1/3 tongue ectomy with limited removal of the surrounding tissues, limited pull through excision, skin-conservated wide cheek excision and above canal mandibulectomy) and grade N (each extended radical excision) was indicated to 22 and 12 cases, respectively. The extirpated defects were immedi-ately supplemented with deltopectoral skin flap and major pectoral musculocutaneous flap in 23 and 4 cases, respectively. Speech was impaired in 15 among 36 tongue and mouth floor tumor cases. Gustatory impairment increased after induction therapies exhibiting recoveries to near the original levels within a year. Resting salivary flow rate subsequently decreased and finally lowered to about 50 % of the original accompaning increase of the viscosity and contrary decrease of secretory IgA level. No local recurrence was resulted except for 10 cases where 6 were secondarily controlled, and 5 year survival rate was estimated as 69.4 %. In conclusion, aggressive induction therapy with synchronous chemo and radiotherapy makes conservative surgery possible, and will minimize cosmetic and functional disabilities. However salivary gland damage and gastatory impairment remain unsolved.
