AN CLINICAL EVALUATION OF THE COMBINED THERAPY FOR MAXILLARY SINUS CARCINOMA WITH IRRADIATION AND THE INTRAARTERIAL INFUSION OF 5-FU

Therapeutic results of 130 primary cases of maxillary sinus carcinoma from1967 to 1969 and 80 primary cases in 1972 and 1973, were analysed in December 1975.The 2-year and the 5-year crude survival rates for the former were 42% and 30%, and the 2-year crude survival for the latter was 53%. The treatment policy over these periods consisted of combined irradiation and intraarterial infusion given as the first step and maxillectomy performed in only recurrent cases. Therefore, a numerical comparison could be made between survival rate in the initial combined therapy alone and that in the following maxillectomy.The survival rates of both groups from 1967 to 1969 were almost equal, but, in 1972 and 1973, the therapeutic weight of the initial combined therapy became much heavier than that of the following operation. A randomized study, carried out from 1967 to 1969, concerning 25 cases treated by intraarterial infusion of 5-FU alone, 35 cases by intraarterial infusion with other combined drugs and 45 cases by irradiation alone, resulted in the significantly better survival rate and the local nonrecurrence rate of the 5-FU intraarterial infusion group than that of the other groups.In a trial undertaken in 1972 and 1973, 63 cases, 70% of the total cases, were treated by the combination of intraarterial infusion of 5-FU and irradiation with a total irradiation dose of 5000 rads in 10 fractions during 5 weeks or 3500 rads in 7 fractions during 3.5 weeks.There was no significant difference of the rates concerned between the two groups. At the same time, therapeutic results of the group in which tumor tissue was removed from the maxillary sinus by curettage were compared with those of group treated without curettage and no significant difference crude survival rates was found between the two groups.However, the 2-year non-recurrence rate by initial treatment combined with curettage was significantly better than that without curettage.This could be evaluated as a worth treatment for preservation of both the figure and the function.On the other hand, this mode of treatment left us such problems as difficulty in following maxillectomy and increase in occurrence of distant metastases. The authors concluded that in the series of trials for the principle treatment policy of maxillary sinus carcinoma, the best results were obtained by initial treatment by 5000 rads irradiation of Co-60 gamma-ray in 25 fractions during 5 weeks combined with continuous intraarterial infusion of 5-FU in the amount of 2000mg during 4 weeks, and antrostomy in all cases and curettage, if necessary.The following treatment composed of maxillectomy as a rule and the intracavital or external irradiation additionally depending upon the situation