Chemotherapy with Maxillary Debridement

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Chemotherapy has been incorporated into numerous different treatment regimens with varying agents, methods of delivery, and combinations with radiation and/or surgery. In the 1970s several groups in Japan began trying a combination of chemotherapy, radiation therapy and routine tumor debridement or cryosurgery within the maxillary sinus. The regimens included 5-fluorouracil (5-FU) or cisplatin with delivery through intravenous,3436 selective intra-arterial,33 and topical methods.35 Responses to these treatments were encouraging. Four- to 5-year survival rates for squamous cell carcinoma were in the 46 to 65 percent range for all histologic types combined (see Table 11 -2). Sakata initially tried a

Xray Adult Teeth Children
Figures 11-8 and 11-9. Lateral and palatal views of a skull delineating the osteotomies required for an "infastructure" maxillectomy.

regmen of 5-FU, bromodeoxyuridine, low-dose radiation therapy, and daily tumor débridement and reported a 5-year survival of 46 percent. Modifications of this regimen without chemotherapy or without daily débridement led to significantly worse survival. However, the additions of (1) cisplatin to the 5-FU, (2) a more aggressive surgical maxillectomy, and (3) higher dose radiation therapy both pre- and post-operatively ultimately yielded the best survival results.36 Difficulties of these routine débridements included significant pain as well as risk of injury to adjacent structures such as the orbit and brain.

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