Aspects of combined radio-chemotherapy in advanced head and neck cancer

Of all primary radiotherapeutic modalities, the combination of percutaneous and interstitial radiation is the most effective one. With this treatment, a five-year survival rate of 54% is achieved in advanced T3 and T4 tumours of the oropharynx. The primary combined chemoradiotherapy is up to now carried out in three application forms of the cytostatic substance: intraarterially, intravenously, and intratumourally. The intravenous application shows, in comparison to the intraarterial one, the best results; it is not only easier but less costly as well. With the intratumoural mitoxantrone instillation in combination with radiotherapy, good palliative results have been achieved. From 1981 to 1986 we have treated 103 patients with advanced squamous cell carcinoma of head and neck with a combined treatment of cisplatin and radiotherapy. The five-year survival rate of 72 patients with a minimum follow-up of two years was 50%; for patients with T2 tumours it amounted to 69% and for T3-T4 tumours 47%. The combined treatment of cisplatin and percutaneous radiotherapy shows similar tumour results as the combined treatment of percutaneous and interstitial radiotherapy. From these results a clinical sensitivity factor of 1.4 for cisplatin can be implied. (orig./MG)