Weidauer H, Singer R
Laryngol Rhinol Otol (Stuttg). 1981 Apr;60(4):151-61.
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.
1975年至1980年期间，121例口腔、口咽和下咽晚期癌患者接受了长春新碱/甲氨蝶呤 - 亚叶酸/内因子/胸腺嘧啶 - 博来霉素/肌苷为主的全身化疗。口腔肿瘤81%获得了完全缓解和超过50%的部分缓解，而口咽癌缓解率为73%，下咽癌为50%，这是由于角化程度较低的肿瘤敏感性较低所致。术前和放疗后的化疗结果显示缓解率较低，这突出了其仅有的姑息性作用以及在手术和放疗前进行抗肿瘤化疗作为第一步的必要性。原发性抗肿瘤化疗后的缓解结果为手术和辅助放疗带来了更好的条件：大量的完全缓解使得在前癌灶区域能够进行安全的轻柔手术，超过50%的部分缓解通过肿瘤缩小和边界划定保证了更精确地确定肿瘤边界和安全切缘距离，肿瘤通过角化实现失活、侵袭性生长停止以及周围结缔组织增多。由于淋巴结转移缓解期较短，发生转移时行根治性颈清扫和口底清扫是肿瘤学上的必要措施。口腔晚期癌以及口咽角化性鳞状细胞癌的估计中位生存时间为21个月。口咽和下咽角化程度较低的鳞状细胞癌平均生存时间预计较短，分别为11个月或10个月。固定淋巴结和远处转移使估计中位生存时间降低，具有统计学意义。
