A combined treatment for advanced oral cavity cancers.

Effects of preoperative chemotherapy with three courses of a combination of bleomycin, vincristine, mitolactol, prednisone, and methotrexate, with a leucovorin rescue, followed by surgery were studied in 43 patients with advanced squamous cell carcinoma of the oral region. Before chemotherapy 34 patients (79%) had Stage III or IV carcinomas whereas nine patients had Stage II lesions. The clinical response was very encouraging: 20 patients (46%) achieved a clinical complete response and 23 patients (54%) were judged as partial responders. Side effects of this chemotherapy were minimal and reversible. Between 15 and 22 days after the last course of chemotherapy patients went to surgery. Wound healing complications did not occur. The surgical specimens were tested microscopically. The microphotographs showed small tumor rests with giant cells bordered by fibrous scar tissue and separated from the healthy tissues. With a median follow-up of 36 months (range, 21-58 months) 74% of patients are alive and 70% remain disease-free. Eleven patients died but only five (11%) because of the failure of therapy. This combined therapy appears both safe and promising treatment for advanced squamous cell carcinomas of the oral cavity. A further follow-up study needed to confirm the promising 5-year results.