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INTRODUCTION
The treatment of squamous cell carcimomas of the
oral cavity is not satisfactory in terms of patient
survival. This is a reason for the many dierent
treatment plans commonly used consisting of varying
combinations of surgery, radiation and chemotherapy. Systemic chemotherapy regimens with cisplatin
and 5-uorouracil appear to be very ecient locally
(Rooney et al., 1985) and in the subsumed prevention
of metastatic spread (Jaulerry et al., 1992). But the
advantage of induction chemotherapy for the patients
is still considered controversial (Stell and Rawson,
1990; Munro, 1995), being associated with severe
toxicity and morbidity potentially relevant to the
survival rate. The concept of `down staging' of a
tumour could not be conrmed and radical surgery is
still indispensible (Poulsen et al., 1996).
Another problem of primary chemotherapy was
the development of resistant cell lines which could be
overcome by higher doses (Teicher et al., 1987). The
reduction of peripheral toxicity combined with high
local ecacy was a further aim (Baker and Wheeler,
1983), especially important in oral cancer patients
who often suer from other intercurrent illnesses. For
50 years regional chemotherapy using the arterial
route in the head and neck region, tried to full these
claims and various cytostatic agents and technical
means were used. Most indications were palliative
treatment of advanced cancer stages and recurrences
(Sullivan et al., 1953; Bitter, 1976; Eckardt and
Kelber, 1994). Development of ne catheter delivery
302
0
1
2
3
4
Nodes (N)
(%)
Tumour
stages
(%)
61.1
22.2
11.1
0
5.6
70.1
15
13.4
1.5
0
/
11.1
25
0
63.9
/
17.9
30.8
1.5
19.8
38.9
16.6
38.9
5.6
/
47.8
22.4
26.9
2.9
/
/
11.1
11.1
8.3
69.5
/
10.5
23.9
11.9
53.7
RESULTS
There was a high overall response rate of 91.7% in
regimen A and of 98.5% in regimen B (Fig. 2).
Tumour progression was observed in only 8.3% and
1.5% of cases respectively. The synergy of cisplatin
and 5-uorouracil had a higher impact on partial and
complete remissions (55.6% and 25%) when compared with the high dose cisplatin therapy (64.2%
and 3%). Therefore, the rate of stable disease was
much higher in scheme B (31.3%). More than 75% of
these patients had only a single cycle. Repeated
courses were used for cases with very large tumours
Fig. 1 Distribution of therapy-dependent prognosis index TPI for the examined patient population. White columns: regimen with i.a.
cisplatin and i.v. 5-uorouracil. Black columns: regimen with i.a. cisplatin and i.v. sodium thiosulfate.
Fig. 2 Grades of remission after rst cycle of i.a. chemotherapy. White columns: regimen with i.a. cisplatin and i.v. 5-uorouracil. Black
columns: regimen with i.a. cisplatin and i.v. sodium thiosulfate.
DISCUSSION
Chemotherapy cannot be the sole therapy for oral
cancer (despite initially high remission rates) if
curative treatment is planned. Radical surgery is
indispensable (Poulsen et al., 1996) and is not
compromised by preceding systemic chemotherapy
(Lore et al., 1989). These assertions are valid for i.a.
chemotherapy, too, which has enjoyed a renaissance
recently. Its advantage is a higher possible local dose
of the cytostatic agent compared to the systemic
route if a competitive peripheral neutralisation is
used (Robbins et al., 1992; Robbins et al., 1994a).
Animal experiments and clinical investigation show a
better eect from the i.a. route compared to the i.v.
route (Bitter, 1976; Harker and Stephens, 1992). The
results conrm the high initial local eectiveness of
i.a. cisplatin (Mortimer et al., 1988), especially when
in high dose (Robbins et al., 1994a, b). The comparison of two unselected groups regarding staging
and number of non-operable patients seemed possible
(as TPI and the percentage of patients actually
operated on showed) but the main task of the present
study was ecacy and practicability of i.a. chemotherapy. Overall, response was better in regimen
B. To date, the higher complete remission grades in
the regimen A do not seem to be decisive, because
they have to be seen in the context of a multimodality therapy and are countered by much greater
side-eects when compared with regimen B (Table 2),
although less than conventional systemic chemotherapy (Bachaud et al., 1993). It has to be stressed that,
in this study, remissions were assessed clinically and
not histologically. Nevertheless, the results of this
study demonstrate a connection between high-grade
Table 2 Side-eects of intraarterial chemotherapy. Group A: regimen with i.a. cisplatin and i.v. 5-uorouracil. Group B: regimen with i.a.
cisplatin and i.v. sodium thiosulfate. Grades according to WHO (Miller et al., 1981)
Grade Nausea
(%)
A
I
II
III
IV
Diarrhaea
(%)
Anaemia
(%)
Leukopaenia
(%)
Thrombocytopaenia
(%)
Sideroemia
(%)
Hypokalaemia
(%)
Serum
creatinine
(%)
Hepatic
enzymes
(GOT, GPT,
GGT) (%)
1.5
0
0
0
13.9
8.3
0
0
4.5 13.9
1.5 8.3
1.5 2.8
0
0
4.5
0
0
0
8.3
5.6
0
0
0
1.5
1.5
0
22.2
0
0
0
17.9
0
0
0
16.7
0
0
0
22.4
0
0
0
B
10.5
0
0
0
Regimen A
Dead
Living
Dead
Living
0
1
2
3
4
3
2
7
1
1
0
2
6
7
7
1 (1.5%)
6 (8.9%)
7 (10.4%)
0
0
1
15
20
13
4
(8.3%)
(5.6%)
(19.4%)
(2.8%)
(2.8%)
Regimen B
(5.6%)
(16.7%)
(19.4%)
(19.4%)
(1.5%)
(22.4%)
(29.9%)
(19.4%)
(6%)