[Results of primary antineoplastic chemotherapy in advanced keratinizing squamous epithelial carcinomas of the head and neck region].

From 1975 to 1980 121 patients with advanced carcinoma of oral cavity, oropharynx and hypopharynx were treated by a primary systemic chemotherapy with vincristine/MTX-folinic acid/intrinsic factor/thymidine--bleomycin/inosine. A complete remission and partial remission of more than 50% was obtained in 81% of tumors of oral cavity, while the remission of the carcinoma of oropharynx with 73% and of hypopharynx with 50% is caused by a lower sensitivity rate of the less keratinizing tumors. The chemotherapeutic results after preceding operation and radiation underline by a lower rate of remissions the only palliative aspect and the necessity of antineoplastic chemotherapy to the first step before operation and radiation. The results of remission followed by primary antineoplastic chemotherapy bring better conditions for the operation and supplementary radiotherapy: the high number of complete remissions allows a tender operation in the field of the former carcinoma with histological security, the partial remission of more than 50% guarantees a more exact determination of the border of tumor and of the distance of security by reduction and demarcation of the tumor, its devitalisation brought by keratinisation, the stop of invasive growth and by the increase of the surrounding connective tissue. Because of the short remission of metastasis of lymph nodes a radical neck dissection and sanitation of the floor of the mouth is an oncological necessity in case of metastasis. The estimated median survival time was 21 months in advanced carcinomata of oral cavity and as for keratinizing squamous cell carcinoma of oropharynx. A lower mean survival period will be expected by the less keratinizing squamous cell carcinomata of the oro- and hypopharynx with 11 or 10 months. Fixed lymph nodes and distant metatasis bring a decrease of the estimated median survival time with a statistical significance.