RESEARCH FOR IMPROVEMENT OF TUMOR CONTROL AND QOL IN THE TREATMENT OF ORAL CANCER BY HYPERFRACTIONATED RADIOTHERAPY WITH AND WITHOUT CHEMOTHERAPY

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Ninety two patients with previously untreated and biopsy-proven squamous cell carcinoma of the oral cavity were treated by hyperfractionated radiotherapy (HF) with or without chemotherapy (CT) to improve treatment results and quality of life (QOL). Fifty six patients among them were analyzed because an uniform fraction size was used through out their treatment. Ultimate local control rates of 1.2Gy fraction group was 39%, and that of 1.4Gy fraction group was 56%. Among patients received neoadjuvant CT, local control rates of 1.2Gy fraction group was 23%, and that of 1.4Gy fraction group was 100%. Among NO patients, 19/25 patients were alive in 1.2Gy fraction group and 17/22 in 1.4Gy fraction group. In both fraction groups N+ patients were not controlled locally. Among 39 patients who were alive more than 2 years after radiotherapy, 21 had late radiation damages. Those were exfoliation of teeth, bone exposure, and bone necrosis. Nine patients in 21 had late damage after salvage operation.In early stage patients a local conrol rate was about 50% and a cause-specific suvival rate 70-80%. This finding indicated that "operation first" intent should be a better selection sense of treatment. On the other hand, combination of operation and radiotherapy and combination of CT and radiotherapy should be more discussed in advanced cases because regional control was not achieved even in locally-controlled patients. High incidence of late radiation damage must be a big problem on the usage of HF especially for patients with an oral cancer.