The effects of intra-arterial bleomycin therapy on squamous cell carcinoma of the oral cavity. Biopsy and autopsy examinations.

The results of a clinico-pathologic study of 7 cases of advanced squamous cell carcinoma of the oral cavity are presented, which were treated by intra-arterial perfusion of bleomycin. In 5 cases, no histologically vital residual tumour could be found locally after therapy. The tumour area shows advanced fibrosis, and ulcerated areas have re-epithelized. The tumour cells are devitalized by keratinisation, while simple necrosis plays a minor role. Following the keratinisation there is a marked resorptive granulomatous inflammation with giant cells typical of a foreign body reaction and fibrous organisation. The special type of reaction of the tumour cells with keratinisation seems to be important for biopsy examinations and for therapeutic considerations. It explains the therapeutic success in highly differentiated squamous cell carcinomas with a tendency for keratinisation. For the first time a "cell-specific, cytocidal" therapy seems to be possible. Previous or simultaneous therapy with methods which might cause a de-differentiation of the tumour, seems to be harmful. Also with intra-arterial perfusion the lung must be considered as the target for the most serious side effects. In one case a bleomycin-induced lesion of the lung was the cause of death, in 4 cases a bronchopneumonia. Although in all cases the therapeutic chances and the prognosis were poor, 4 patients were cured of the tumour. One patient has lived without recurrence or metastases of the tumour for 20 months.