Combined modality treatment of oral and oropharyngeal cancer including neoadjuvant intraarterial cisplatin and radical surgery followed by concurrent radiation and chemotherapy with weekly docebaxel -: three year results of a pilot study

Background: A new four-modality treatment of primary oral and oropharyngeal squamous cell carcinomas was evaluated with regard to feasibility, tolerance, and survival. Patients and methods: Seventy three operable patients (100%) with histologically proven untreated stage I to stage IV disease received at least one cycle of neoadjuvant intraarterial chemotherapy with 150 mg/m(2) cisplatin neutralized with sodium thiosulphate, followed by radical operation for the tumour with a simultaneous selective neck dissection (clinically negative neck), or modified radical neck dissection (nodal involvement), followed by adjuvant chemoradiation over 5 weeks (51.9 Gy, systemic docetaxel 25 mg/m(2), once every week). Results: Ninety-six per cent of patients were operated on, 68% had postoperative radiation, 57% concomitant chemotherapy; 44% fulfilled the complete protocol. There have been I I local or regional recurrences to date, three of which were treated by salvage surgery. Eighteen patients died, in nine of them death was tumour-related. Seventy five per cent lived after a median observation time of 33 months. Cumulative survival was 74% calculated for 4 years. Conclusion: The presented multimodality regimen proved feasible and showed better survival for the whole population and for all tumour stages when compared with the treatment-dependent prognosis index of the DOSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region). (C) 2002 Published by Elsevier Science Ltd. on behalf of European Association for Cranio-Maxillofacial Surgery.