Treatment of advanced cancer of the lower lip--the use of intraarterial or intravenous chemotherapy as basal treatment.
Since the linear accelerator was installed in Sydney Hospital in 1964, 27 patients who presented with previously untreated but advanced deep carcinoma of the lower lip have been treated with initial megavoltage or orthovoltage radiotherapy with or without follow-up surgery. In 17 of these, the tumor appears to have been eradicated, but in the other ten (approximately one-third), the tumor was not controlled. These results are similar to those reported from other major centers. Since January, 1974, six patients with the most advanced lesions have been treated with "basal" chemotherapy (in four cases given intra-arterially and in two cases given intravenously) prior to radiotherapy. Follow-up surgery in the form of block dissection was required in one patient, and wedge resection of a residual focus of tumor was required in a second patient, but all six patients remain well and free of disease, with from three to six years follow-up to date. A further seven patients with advanced recurrent lesions were also treated using "basal" chemotherapy as the initial treatment. In three of these the carcinoma remained uncontrolled, but in four the tumor appears to have been controlled with subsequent follow-up radiotherapy being used in two cases, surgery in a third, and intermittent chemotherapy in the fourth. The numbers of patients treated in this series are insufficient to allow conclusions to be drawn concerning present management methods. However, the trend of the results to date suggests that for advanced lesions, improved survival may well result from the combination of basal chemotherapy with subsequent radiotherapy and/or surgery.