Survival and staging characteristics for non-squamous cell malignancies of the maxillary sinus

OBJECTIVE: To characterize the clinical behavior of non-squamous cell cancer of the maxillary sinus. METHODS: Cases of non-squamous cell maxillary sinus malignancy during 1988 through 1998 were extracted from the Surveillance, Epidemiology, and End Results database. Data for histologic type of tumor, tumor stage, and survival were analyzed using the Kaplan-Meier method to determine mean, median, and 5-year survival statistics for the overall cohort and for individual histologic types of tumor. The effect of tumor stage on overall survival was assessed. To determine relative survival, the non-squamous cell group was compared with a second group of patients with squamous cell carcinoma, matched according to age at diagnosis, year of diagnosis, and T stage. RESULTS: One hundred eighty-eight cases of non-squamous cell malignancy were identified. The mean patient age was 57.8 years, and 143 patients (76%) presented with T3 or T4 tumors. There were 31 adenocarcinomas, 64 adenoid cystic carcinomas, 15 mucoepidermoid carcinomas, 22 melanomas, 45 sarcomas, and 11 undifferentiated carcinomas. The overall mean survival was 63.4 months, and 5-year survival was 45.6%. Adenoid cystic carcinoma exhibited the best mean survival (79 months), whereas melanoma and undifferentiated carcinoma exhibited poor mean survivals (30.3 and 12.8 months, respectively). T stage did not statistically affect overall survival (P =.86). Survival for patients with non-squamous cell cancer was substantially better than survival for the matched group with squamous cell carcinomas (mean survival, 41.5 months; 5-year survival, 27.4%). CONCLUSIONS: Patients with non-squamous cell carcinoma of the maxillary sinus typically present with advanced T stage but have significantly better survival than patients with similar-stage squamous cell carcinoma of the maxillary sinus. T stage has less effect than histologic type of tumor on prognosis in non-squamous cell carcinoma of the maxillary sinus.     

Paranasal sinus malignancy: a comprehensive update

A retrospective analysis of 60 cases of paranasal sinus cancer in patients admitted between 1970 and 1985 was undertaken. Forty-six tumors originated in the maxillary sinus, and 14 originated in the ethmoid sinuses. Computed tomography, magnetic resonance imaging, and endoscopic sinus examination aided in early diagnosis of sinus cancer. Computed tomography aided in staging tumors; Caldwell-Luc alone was inadequate for staging tumors invading deeper sites such as the orbits or pterygoid muscle. There were 15 early (T1 or T2) and 31 advanced (T3 or T4) maxillary sinus cancers. Multimodality therapy incorporated radiation, surgery, and chemotherapy. The 5-year survival rate was 49%. We prefer preoperative radiotherapy for advanced lesions and postoperative radiotherapy for early lesions. The use of preoperative radiation therapy has increased our globe salvage rate. All but one of the patients who developed recurrent disease showed recurrence at the primary site prior to developing regional or distant metastasis. Radiation therapy, combined with aggressive surgical management to remove all tumor, provided the best survival rates in advanced lesions.     

Comparison of survival rates of patients with nasopharyngeal carcinoma treated with radiotherapy, 5-fluorouracil and vitamin A ("FAR" therapy) vs FAR therapy plus adjunctive cisplatin and peplomycin chemotherapy

The overall survival rate (OSR) of 36 patients with nasopharyngeal carcinomas (NPC) treated at Kyushu University hospital between 1983 to 1992 was analyzed. As primary treatment, 16 patients received a combination therapy of 5-fluorouracil, vitamin A, and radiation (FAR therapy); two patients received radiotherapy only; 18 patients received FAR therapy plus adjunctive systemic chemotherapy consisting of cisplatin and peplomycin. The radiation dose to the nasopharynx was 6000 to 7050 cGy while that to the neck was 4000-6000 cGy. The 5-year OSR of all the patients was 49%. Histological type (moderately differentiated squamous cell carcinoma) and patient age (S 55) were found to be significant prognostic factors for a worse OSR. Although survival decreased with increasing T stage, no significant difference was observed. The 5-year OSR of the patients treated with FAR therapy was 53% and was 51% with FAR therapy plus chemotherapy. Compared to FAR therapy alone, adjunctive chemotherapy did not increase OSR of the patients with NPC.     

Long-term survival of patients with paranasal sinus carcinoma

The survival rate for all patients with a squamous cell carcinoma of the paranasal sinuses (n = 77) diagnosed in 1960-1985 in a population of approximately 1 million inhabitants was analysed without any selection of cases. This population is geographically restricted to the most northern part of Sweden. The 5-year survival rates of patients with T3 and T4 carcinomas were 42 and 14%, respectively (corrected survival), and the 10-year survival rates were 40 and 14%, respectively. In patients with tumours which initially were considered as resectable, the optimal treatment modality was a combination of radiotherapy and surgery.     

扁桃体癌治疗及预后因素分析

目的 回顾性分析扁桃体癌的治疗疗效,并探讨影响扁桃体癌的预后因素.方法 1997年4月至2008年4月中山大学肿瘤防治中心共收治经病理证实、无远处转移的扁桃体癌61例,其中末分化癌2例,低分化鳞癌26例,中高分化鳞癌33例.根据AJCC2002年第6版分期标准,Ⅰ期9例,Ⅱ期7例,Ⅲ期23例,Ⅳ期22例.27例患者行单纯放疗,23例行放疗联合化疗,6例行手术联合术后放疗,诱导化疗加手术联合术后放疗3例,放疗后外科挽救加化疗2例.结果 随访率为96.7%.Kaplan-Metier方法 计算全组5年总生存率为50.2%.16例Ⅰ-Ⅱ期患者中,8例行单纯放疗,5年生存率为50.0%,6例行手术联合术后放疗,5年生存率为83.3%,二者差异无统计学意义(P=0.318).45例Ⅲ-Ⅳ期患者,单纯放疗19例,5年生存率为51.5%,放疗联合化疗21例,5年生存率为36.4%,手术联合放疗为主的治疗5例,5年生存率为75.0%,三者差异无统计学意义(P=0.239).T1-T4期5年生存率分别为91.8%、46.8%、29.1%、0%(χ~2=30.168,P<0.001).Cox多因素分析显示T分期、治疗结束时原发灶和颈部转移淋巴结疗效为影响预后的独立危险因素(P<0.05).结论 局部早期(Ⅰ-Ⅱ期)扁桃体癌的治疗,基于器官功能保全原则,倾向于选择单纯放疗,局部晚期(Ⅲ-Ⅳ期)扁桃体癌的治疗模式与疗效的关系仍需进一步研究.T分期、治疗结束时原发灶和颈部转移淋巴结疗效为影响预后的独立危险因素.     

Comparison of survival rates of patients with nasopharyngeal carcinoma treated with radiotherapy, 5-fluorouracil and vitamin A (“FAR” therapy) vs FAR therapy plus adjunctive cisplatin and peplomycin chemotherapy

The overall survival rate (OSR) of 36 patients with nasopharyngeal carcinomas (NPC) treated at Kyushu University hospital between 1983 to 1992 was analyzed. As primary treatment, 16 patients received a combination therapy of 5-fluorouracil, vitamin A, and radiation (FAR therapy); two patients received radiotherapy only; 18 patients received FAR therapy plus adjunctive systemic chemotherapy consisting of cisplatin and peplomycin. The radiation dose to the nasopharynx was 6000 to 7050 cGy while that to the neck was 4000–6000 cGy. The 5-year OSR of all the patients was 49%. Histological type (moderately differentiated squamous cell carcinoma) and patient age (≥ 55) were found to be significant prognostic factors for a worse OSR. Although survival decreased with increasing T stage, no significant difference was observed. The 5-year OSR of the patients treated with FAR therapy was 53% and was 51% with FAR therapy plus chemotherapy. Compared to FAR therapy alone, adjunctive chemotherapy did not increase OSR of the patients with NPC.     

Functional and oncological results of non-surgical vs surgical treatment in squamous cell carcinomas of the oropharynx

INTRODUCTION AND OBJECTIVES: Squamous cell carcinomas of the oropharynx are aggressive tumours usually diagnosed at advanced stage. Their optimal treatment has not been established. The aim of this study was to compare the oncological and functional outcomes in patients with carcinomas of the oropharynx treated by radiotherapy (with chemotherapy in advanced stages) vs surgery (with radiotherapy in advanced stages). METHODS: A retrospective study on 50 patients with squamous cell cancer of the oropharynx treated by radiotherapy (with or without chemotherapy) at our institution between 1998 and 2008 was carried out. The oncological and functional results were compared with patients with same cancer location and stage treated by surgery (with or without radiotherapy). In both groups, the patients were classified as follows: 10% Stage I, 12% Stage II, 16% Stage III, 48% Stage IVa and 14% Stage IVb. RESULTS: The 5-year disease-specific survival was 33% in the radiotherapy group and 52% in the surgical group (P=.17). Five-year disease-specific survival for Stage I and II patients was 82% in the radiotherapy group and 70% in the surgical group. In Stage III and IV disease, 5-year disease-specific survival was higher in the surgical group (47% vs 17%). The functional results were similar; anatomical and functional preservation of the larynx was higher in the radiotherapy group but the successful return to oral food intake was higher in the surgical group. CONCLUSIONS: The prognosis of squamous cell carcinoma of the oropharynx is poor. Oncological results in Stages I and II were similar for radiotherapy and surgical treatments. In advanced stages, the prognosis was better in patients treated by surgery with or without radiotherapy. Functional results were similar in both treatment modalities.     

Decreasing incidence of malignant tumors of the paranasal sinuses in Sweden. An analysis of 141 consecutive cases at Karolinska Hospital from 1960 to 1980

We reviewed 141 cases of paranasal sinus tumors treated at Karolinska Hospital from 1960 to 1980. Of these tumors, 100 were located in the maxillary sinus, 32 in the ethmoidal sinuses, 8 in both the ethmoidal and maxillary regions, and 1 in the sphenoidal sinus. The male-to-female ratio was 2.1 to 1. Squamous cell carcinoma and adenocarcinoma were the most frequent types of tumors (55% and 13%, respectively). Treatment included surgery, irradiation, or both. The 5-year survival rate was 34% for squamous cell carcinomas and 64% for adenocarcinomas. When compared to a previous material of patients treated at the same hospital from 1940 to 1950, the proportion of poorly differentiated squamous cell carcinomas had increased significantly. The age-adjusted incidence rate decreased from 1.2 to 0.4 for male patients and from 0.7 to 0.3 for female patients between 1960 and 1980. We conclude that the incidence of malignant paranasal sinus tumors has decreased, and that squamous cell tumors now seem to be generally less differentiated than they were 50 years ago.     

喉声门上型低分化鳞状细胞癌57例临床观察

目的 探讨喉声门上型低分化鳞状细胞癌(简称鳞癌)的临床特点、治疗及预后。方法 回顾分析1980～1998年我院57例喉声门上型低分化鳞癌病例(1997年UICC分期：Ⅰ期4例，Ⅱ期5例，Ⅲ期18例，Ⅳ期30例)。单纯手术25例，单纯放射治疗9例，术前放射治疗加手术14例，手术加术后放射治疗7例，术前化学治疗加手术2例。喉全切除23例，喉部分切除25例；同期颈清扫31例(单侧17例，双侧14例)，上颈清扫12例。结果5年生存率47．4％(27／57)，颈部转移率63．2％(36／57)，双颈转移率24．6％(14／57)，远处转移率21．1％(12／57)，局部复发率10．5％(6／57)，颈部复发率28．1％(16／57)，喉部分切除的局部复发率12．0％(3／25)。生存率随分期下降，T1 T2与13 T4和N0 N1与N2 N3的生存率差异分别有显著性(χ^2=4．942，P=0．026；χ^2=4．306，P=0．038)。单纯手术与手术结合放射治疗的生存率差异无显著性，N2和N3患者的手术结合放射治疗相对优于单纯手术。结论 喉声门上型低分化鳞癌患者以晚期病变为主，易较早发生淋巴结转移，颈部转移和远处转移率较高，治疗仍以手术为主，喉部分切除术是可行的，T3病变的喉部分切除和颈部N分级较晚的患者应手术结合放射治疗。     

Final Results of a Randomized Trial Comparing Chemotherapy Plus Radiotherapy With Chemotherapy Plus Surgery Plus Radiotherapy in Locally Advanced Resectable Hypopharyngeal Carcinomas

After neoadjuvant chemotherapy, a routine conservative approach followed by salvage surgery was evaluated in terms of local control and survival in cases of advanced potentially resectable hypopharyngeal carcinoma. Between 1985 and 1989, 92 patients with T3 or T4-N0,N3 operable squamous cell hypopharyngeal carcinomas received three courses of neoadjuvant chemotherapy every 2 weeks involving a combination of cisplatin, 100 mg/m², on day 1 and fluoruracil, 1 g/m², on days 2 to 5, followed by total laryngopharyngectomy plus postoperative radiotherapy in 47 patients (arm A) or radiotherapy alone in 45 patients (arm B). Randomization was always performed prior to chemotherapy. The response rates of tumor and node to chemotherapy were, respectively, 67% in arm A versus 79% in arm B (P > 0.05) and 54% in arm A versus 73% in arm B (P > 0.05). Grade III or IV toxicity was similar, affecting 15% of patients and 7% of cycles in arm A versus 16% of patients and 6% of cycles in arm B. After a mean follow-up of 92 months, survival was statistically better (P = 0.04) in arm A (5-year overall survival, 37%; median survival, 40 months) than in arm B (19% and 20 months) because of a better local control rate (63% versus 39%; P < 0.01). Better results were obtained for mutilant surgery in terms of local control and overall survival, regardless of response to neoadjuvant chemotherapy.     

Squamous cell carcinoma of the paranasal sinuses: the Cleveland Clinic experience 1977-1986

Fifty-four of 103 malignancies of the paranasal sinuses treated at the Cleveland Clinic Foundation between 1977 and 1986 were squamous cell carcinomas. Six arose from the ethmoid sinus and 48 from the maxillary sinus. Of the maxillary sinus patients, 11 presented with T1 or T2 lesions, 20 with T3, 16 with T4, and 7 of these had nodal disease. Treatment was surgery and/or radiation therapy. There was local recurrence in 25 of 48 maxillary sinus patients and in 1 of 6 ethmoid patients. Overall 5-year survival was 38.2% in the maxillary sinus group: T1, 100.0%; T2, 85.7%; T3, 31.8%; and T4, 6.7%. Three of six patients with ethmoid tumors were cured. There was a statistical trend for better prognosis in those patients presenting with ethmoid primaries, with early lesions, treated with both radiation and surgery, and with history of inverting papilloma. There were complications of treatment in 10 patients, four of which resulted in death. Local control was the major problem for these patients; therefore, early detection and aggressive local treatment are desirable.     

内镜或内镜辅助下治疗鼻内翻性乳头状瘤恶变的临床分析

目的　分析内镜或内镜辅助下鼻内翻性乳头状瘤（sinonasal inverted papilloma,SNIP）恶变患者的治疗方法,探讨影响其预后的因素并分析最佳治疗策略。方法  回顾性分析2001年9月～2010年9月我科收治的采用内镜或内镜辅助治疗的经病理确诊的SNIP恶变患者共27例,术前行影像学检查并依照UICC第6版分期标准,T1级3例,T2级8例,T3级12例,T4级4例。27例患者均行内镜或内镜辅助下手术治疗,其中11例为单纯内镜或内镜辅助下手术治疗,术后对16例患者联合行放射治疗。结果　所有病例均经病理证实恶变为鳞状细胞癌。27例SNIP恶变患者总体5年生存率为77.8%,11例单纯手术治疗患者的5年生存率为75.0%,5例于术后局部复发。16例手术联合放射治疗患者的5年生存率为81.8%,5例于术后局部复发,2例患者术后局部复发伴颅内转移死亡。结论　内镜或内镜辅助下手术治疗SNIP恶变患者手术效果良好,并发症少,提高了患者的术后生活质量,术后联合放射治疗可提高患者远期生存率。     

上颌窦鳞状细胞癌60例临床分析

目的 总结上颌窦鳞癌的临床特点及治疗方法对其预后的影响.方法 回顾性分析中国医学科学院北京协和医学院肿瘤医院头颈外科1994年1月至2004年12月60例初治的上颌窦鳞癌患者的临床资料,按照治疗方式的不同分为单纯放疗组,术前放疗+手术(radiotheraphy+surgery,R+S)组以及同步放化疗+手术治疗(concurrent cherho-radio-therapy+surgery,CCR+S)组.其中单纯放疗组22例,R+S组29例,CCR+S组9例.结果 单纯放疗组5年的生存率为18.2%,综合治疗组总的5年的生存率分别为47.4%,其中R+S组的5年的生存率为51.7%,CCR+S组5年生存率为33.3%,综合治疗组与单纯放疗组之间比较,差异有统计学意义(x2=9.49,P<0.01),单纯放疗组与R+S组之间比较,差异有统计学意义(x2=15.62,P<0.01).R+S组与CCR+S组比较,差异有统计学意义(x2=4.28,P<0.05).结论 R+S综合治疗是上颌窦鳞癌的主要治疗方式,积极采取R+S综合治疗方式可有效延长患者的生存期提高生存率.CCR+S的治疗方式在上颌窦鳞癌治疗中的作用有待进一步观察.     

Retromolar trigone carcinoma treated by primary radiation therapy: an alternative to the primary surgical approach

OBJECTIVES: To review our experience in the treatment of retromolar trigone carcinoma with radiotherapy as the primary modality and to evaluate the different factors affecting locoregional control and survival. DESIGN: We retrospectively examined 46 patients with squamous cell carcinoma of the retromolar trigone treated primarily with radiotherapy from January 1, 1973, to June 31, 2002. Four had T1, 21 had T2, 17 had T3, and 4 had T4 lesions; 25 had N0, 15 had N1, 5 had N2, and 1 had N3 disease. The overall stage was I in 3, II in 18, III in 18, and IV in 7 patients. All patients received conventional once-daily fraction radiotherapy as the primary modality of treatment. Three patients received chemotherapy. Overall survival, cause-specific survival, and locoregional control were estimated using the Kaplan-Meier method. Log-rank statistics were used to identify significant prognostic factors for overall survival and locoregional control. RESULTS: The median follow-up was 43 (range, 5-217) months overall and 78 (range, 26-188) months for living patients. The 5-year overall survival and cause-specific survival rates were 47% and 78%, respectively. Favorable prognostic factors for cause-specific survival were a lower tumor stage (univariate and multivariate analysis) and a lower nodal stage (multivariate analysis). The 5-year local control rate was 49% after radiotherapy and 67% after salvage surgery. The 5-year regional control rate was 88%. Favorable prognostic factors were a lower nodal stage and a lower overall stage (univariate analysis). The 5-year locoregional control rate for all patients was 42% after radiotherapy and 70% after salvage surgery. CONCLUSIONS: Given the surgical salvage rate in our series and previous published experience, radiation therapy can be used with curative intent for small retromolar trigone carcinomas (T1-T2 lesions). For advanced stages without bone invasion, consideration for concurrent chemotherapy and radiation therapy might increase previous historical locoregional and survival rates.     

Pacientes con carcinoma localmente avanzado de hipofaringe. Resultados a lo largo de un periodo de 30 años

Introduction and objectivesThe treatment of locally advanced carcinomas of the hypopharynx may include surgery or several combinations of radiotherapy and chemotherapy as organ preservation strategies. The objective of the present study is to analyze the results of locally advanced hypopharyngeal carcinoma patients treated in a single centre over a 30-year period.MethodsRetrospective chart review of 278 patients with T3-T4 hypopharyngeal carcinomas treated between 1985 and 2015 at a tertiary institution.ResultsAs much as 15.5% of the patients received only palliative treatment. Surgery, usually followed by radiotherapy or chemoradiotherapy was offered to 38.1% of the patients, and radiotherapy or chemoradiotherapy alone was offered to the remaining 46.6% of the patients. Cause-specific survival at 5 years was 39.7% (95% CI 33.7-45.7) for the whole sample. Surgery achieved better local control of the disease, but these figures did not translate into an increase of cause-specific survival for T3 tumours. Five-year survival free of laryngeal dysfunction for patients who received conservative treatment was 36.4%. In a multivariate analysis, only T4 local extension, N2-3 category, and posterior hypopharyngeal wall location related significantly with cause-specific survival.ConclusionsThere were no significant differences in cause-specific survival related to treatment modality for T3 carcinomas. On the other hand, surgery achieved a significant increase in cause-specific survival for T4 hypopharyngeal carcinomas.     

Radiotherapy in maxillary sinus carcinomas: evaluation of 79 cases

PURPOSE: The aim of this study is to evaluate the outcome of patients with maxillary sinus carcinoma after radiotherapy regarding local control, prognostic factors and morbidity of treatment. MATERIALS AND METHODS: Between January 1983 and December 1996, 79 cases of maxillary sinus carcinoma without any evidence of distant metastases, were treated with radiotherapy. RESULTS: Fifty-two patients (65.8%) were male and 27 (34.2%) were female. The median age was 57. Histologically 62% were epidermoid carcinoma, 32.9% were non-epidermoid carcinoma and 5.1% were unclassified. Sixteen patients (20.5%) had T2, 25 (29.8%) had T3 and 38 (49.7%) had T4 tumour while 13 patients (16.5%) had lymph node metastases. Fifty-nine patients (74.4%) underwent surgical resection followed by postoperative radiotherapy and 20 patients (25.3%) received radiotherapy alone. The median follow-up was 71 months; 5-year overall survival and local control rates were 53% and 54% respectively. Prognostic factors influencing the overall survival were histologic type (epidermoid carcinoma, p = 0.02), advanced T stage (p = 0.04), postoperative residual tumour (p = 0.002) and lymph node involvement (p = 0.01) whereas the factors influencing local control were histologic type (p = 0.05) and postoperative residual tumour (p = 0.005). Late radiation morbidity were cataract (11.4%), loss of vision (8.9%), trismus (5.1%) and hearing loss (2.5%). CONCLUSION: In maxillary sinus carcinomas high rates of local control can be achieved with surgery and radiotherapy. Postoperative radiotherapy can have a positive impact on local control and overall survival especially in patients with early stage tumour of non-epidermoid histology and without residual disease after surgery.     

Die Kombinationsbehandlung mit Chemo-Strahlentherapie maligner Tumoren unter Berücksichtigung eines Zeitfaktors

Summary In a 8-year period 102 patients with advanced inoperable head and neck tumors and recurrences were treated with irradiation after so called partial synchronization with chemotherapy. During the first 2 years only 5FU was used for chemotherapy; later on the highly differentiated keratinizing squamous cell carcinomas were treated with bleomycin. For the other malignant neoplasias we used 5FU and adriamycin, preferring the latter. This chemotherapy followed by irradiation was tolerated with minimal complications and insignificant side effects. The breakdown of survival rates according to the tumor localization showed the best 5-year survival rates of patients with laryngeal/hypopharyngeal carcinomas (advanced tumors or recurrences, respectively). Thus, combined therapies seem to lead to a prolongation of life of reasonable quality and are hence a useful supplement to the therapeutical methods for advanced ENT malignant tumors.     

Clinical analysis of malignant submandibular tumor

The 14 cases of malignant submandibular tumor whose treatment outcome we analyzed between 1989 and 2008 included 5 of adenoid cystic carcinoma, 3 of squamous cell carcinoma, 2 each of mucoepidermoid carcinoma, and carcinoma ex pleomorphic adenoma, and 1 each of carcinosarcoma and large-cell carcinoma. One subject was diagnosed with T1, 7 with T2, 4 with T3, and 2 with T4. Lymph node involvement occurred in 5, -1 with N1 and 4 with N2. None had distant metastasis on the first visit. Seven were treated by surgery alone, 3 by surgery followed by radiotherapy, 2 by surgery followed by radio-and chemotherapy, and 1 by optimized supportive care. The surgical resection area was decided by tumor extension. Neck dissection was done in 9. Overall 5-year survival for all cases based on the Kaplan-Meier method was 57%. All with carcinoma ex pleomorphic adenoma, carcinosarcoma, or large-cell carcinoma remain alive. For those with adenoid cystic carcinoma 5-year survival is 80%, with mucoepidermoid carcinoma 50%, with squamous cell carcinoma 0%, and with carcinosarcoma 0%, respectively. The 5-year survival for stage I subjects was 100%, for stage II 83%, for stage III 50%, and for stage IV 0%. Surgical resection and postoperative radiotherapy were done in cases of minimal extraglandular extension or microscopically positive margins, with satisfactory results. Treatment efficacy for high-grade and advanced stage, however, requires more improvement.     

Ten years experience with combination therapy for tonsillar malignancies (author's transl)]

From 1968 to 1978, 125 patients with cancer of the tonsil have been treated by the Departments of Radiology and Otolaryngology at the University Hospital, Homburg-Saar. Although all patients were unirradiated, many had previously undergone a surgical procedure. Most of the cancers when seen were in advanced stages. The three-year and five-year survival rates were 38.6 and 23.5% respectively. Reticulum cell sarcomas, Schmincke's tumors and non-keratinized squamous cell carcinomas had better prognoses than keratinized squamous cell carcinomas. Our findings indicate that the volume of large tumors should be reduced by surgical means before irradiation since irradiation alone resulted in a higher relapse rate in the advanced cancers. Various methods for radiotherapy either before or after surgery for different tumor stages are discussed. The combination of chemotherapy with radiation to make use of the so-called "partial synchronisation effect" in cases of inoperable extensive primary tumors or relapses is described.     

Squamous cell carcinoma of the buccal mucosa. A review of 85 cases.

Of 85 cases of squamous cell carcinoma of the buccal mucosa, 61 were treated primarily and 24 secondarily. Sixty-one percent (39) were T3 lesions, and 59% (38) had regional metastases. Nearly half of the patients were more than 70 years of age. Thirty-one percent (19) of the primary patients were treated by surgery alone, 25% (15) by irradiation alone, and 36% (22) by various combinations. The absolute five-year cure rate was 45% for the whole group, and 54% for the primarily and 40% for the secondarily treated patients. For each individual T and N category, the results of surgery were superior over those of radiotherapy. Intra-arterial chemotherapy followed by radiotherapy is to be considered in advanced cases, where composite resection on general grounds is not contemplated. There was a 14% incidence of second primary cancers; these were mainly located in the oral cavity.