High-dose preoperative radiotherapy in primarily inoperable carcinomas of the oropharynx

Despite the great progress made by tumor therapy in recent years, it has not yet been possible to obtain a decisive improvement in the five-year survival of about 20% and the five-year recurrence-free survival of about 30% of patients suffering from advanced T3 oropharynx carcinomas. A new way to improve the poor prognosis of these patients is only offered by the possibilities of modern radiotherapy with ultrahard X-radiation as well as by the progress of microsurgery. Up to now, the recurrence-free survival of our patient's group suffering from primarily inoperable T3 oropharynx carcinomas has reached 60% (increase of about 40%). This was achieved by preoperative high-dose irradiation and subsequent implantation of myocutaneous skin flaps with the vascular bundle supplying the flap with blood. As is shown by the communications of literature and our own experience, about 80% of all recurrences will appear within the first 24 months after the end of therapy. In our preoperatively high-dose irradiated group, the observation period is meanwhile 48 months, and the recurrence-free survival is still by 40% higher than that of the control groups. Although a new formation of local recurrences cannot be excluded for the further observation time and despite the small number of patients, the rate of recurrence-free patients suffering from tumors of stage T3N+ signifies a most promising therapeutic approach. (orig.)