Failures (Cause and Time) of Radiotherapy in Oral Cancer

A Computerized Cancer Patient Information System

The purpose of this study was to realize a computer system for cancer data automatic processing. A clinical research in oncological practice is usually time consuming and often not reliable or deceiving because of a number of various errors. Until now, only a few information systems have been specifically designed for cancer data processing, and these have a limited capacity of autonomous data elaboration. Our system, based on an original computer program, can compile, store and process essential data on cancer diseases, with a high degree of reliability and high speed of elaboration. Input and output of this system are simplified and user oriented, without limitations for the subject at study on clinical research, and no particular training of the physicians involved is necessary.

Curietherapy of Oral Cancer

This work concerns 406 oral carcinomas treated with curietherapy (interstitial applications and surface molds) from January 1959 to December 1970. There were 65 (16.0%) carcinomas of the mucosal surface of cheeks, 15 of the retromolar areas, alveolus and gingiva, and hard palate (3.7%), 211 of the mobile tongue (51.9%), and 115 of the floor of mouth (28.4%). There were 132 (32.5%) T1 cases, 245 (60.3%) T2 and 29 (7.2%) T3. In 376 cases with adequate follow-up (92.6%) there were 93 (24.7%) local relapses: 83 isolated and 10 associated with a lymph nodal relapse; 49.5% of the local relapses were peripheral with respect to the treated volume (46/93). The incidence of local relapses only slightly differed for initially T1 and T2 cases (respectively 21.8% and 22.7%), whereas it was more than twice as much for initially T3 cases (53.6%). The overall incidence of radionecrotic complications was 22.0% (83/376 cases with adequate follow-up). Altogether the disease-free survival was 41.1% and 31.4% at 5 and 10 years, respectively. We think that local control of practically all treatable oral carcinomas can be obtained with a combined treatment.

Oral and Pharyngeal Cancer: Combined Approach for Multimodal Therapy

Five-year results in 60 oral and pharyngeal cancer patients treated with combined apporach chemoradiotherapy (39 patients) and chemoradiotherapy plus lymph node surgery (21 patients) are reported. Complete remission (CR) was achieved in 16/39 (41%) patients treated with chemoradiotherapy alone, and in 16/21 (76%) patients who had chemoradiotherapy plus surgery. The number of CR was statistically (chi-square test) higher (p < 0.025) in the second group. The 5-year actuarial survival was 39.7% in the group of patients treated with chemoradiotherapy plus surgery. After 5 years 53% of the patients who reached CR are living free of disease in the first group and 76% in the second group.

Surgery versus combined therapies for cancer of the anterior floor of the mouth

We report the results of treatment in a consecutive series of 75 patients operated on at the Istituto Nazionale Tumori of Milan, from January 1965 to December 1979, for cancer of the anterior floor of the mouth. Most of the tumors were advanced: 39 were treated with simple resection, and 36 underwent combined treatment, consisting of surgery associated with either chemotherapy or surgery. Three- and five-year observed survival rates of the whole series were good (41% and 25%, respectively), considering the tumor stage of these patients, but the determined survival rates were particularly high (56% and 46%, respectively). No real advantage was found in the use of multiple planned sequential therapies over surgery alone, and deaths from intercurrent diseases seemed to be more frequent in the patients who underwent combined therapies. We conclude that for patients in poor general condition, such as those with carcinomas of the anterior floor of the mouth, aggressive and complex treatments should be considered with caution in controlled clinical trials.

Results of radiation therapy in oral squamous cell carcinoma

Between 1967 and 1976, 153 patients with previously untreated squamous cell carcinoma of the oral cavity received radiation therapy, either interstitial irradiation or external beam therapy (usually 60Co). Five-year survival rates without evidence of disease were 90 per cent in stage I, 50 per cent in stage II, 21.3 per cent in stage III, and 2.3 per cent in stage IV. Thirty-one patients with clinically non-metastatic neck nodes not prophylactically irradiated had a high incidence of later metastatic neck disease compared with patients who received elective irradiation of the neck.

Results of 60CO-Teletherapy in Oral Cancer

Our study reports 282 oral cancer cases treated with 60Co-teletherapy (TCT), taken from 736 oral carcinomas treated with radiotherapy on the primary tumor from January 1959 to December 1970. They were mainly locally advanced cases which often had regional node involvement. In fact, during that period, the more advanced cases were submitted to TCT. There were only 9 (3.2 %) patients with T1 lesions, while there were 134 (47.5 %) T2 and 139 (49.3 %) T3, X4 cases; there were respectively 106 (37.6 %) and 44 (15.6 %) N1 or N2 and N3 cases. Almost half of the patients were ≥ 66 years old at onset of the treatment (138/282 cases, or 47.2 %); the women were a small minority (18/282, or 6.4 %). There were 58 (20.6 %) carcinomas of the mucosal surface of the cheeks, 60 cases arising from the retromolar areas, the upper-lower alveolar processes and the hard palate (21.3 %), 72 carcinomas of the mobile portion of the tongue (25.5 %) and 92 arising from the floor of the mouth (32.6 %). All the patients considered in the study were treated with conventional techniques by doses, field dimensions and fractionation.

The overall results were objectively disappointing, even though they should be evaluated keepping in mind the nature and the gravity of oral carcinomas submitted to TCT. Actuarial survival at 5 and 10 years from the onset of treatment was respectively 11.6 % and 6.4 %. None of the N1, N3 cases survived beyond the fourth year from onset of the treatment. Long-term survival differs very little in relation to the site of origin in the oral cavity.

Nowadays, TCT alone may have only a palliative role in the treatment of oral cancer, reserving it for those cases which, due to their extreme gravity or the various contraindications, do not permit more aggressive treatments. In a combined therapeutic approach the aim of TCT today is to control the minimum disease foci. Its association with surgery appears to be most effective.