ROLAND JACOB, MD; HANS-JURGEN WELKOBORSKY, MD, DDS; WOLF MANN, MD
MAINZ, GERMANY

RON AMEDEE, MD
ORLEANS, LOUISIANA

Individual treatment for patients with squamous cell carcinoma is most desirable. Tumor biological parameters can provide relevant criteria to obtain this goal. In a prospective trial, we grouped 30 patients into 2 therapeutic regimes, based on the results of tumor biological examination, provided the primary tumor was resected with clear margins. Tumor biological parameters were DNA-cytometric examinations (2cDI, 5cER), morphological tumor front grading, immunohistochemical examination of proliferation markers (Ki67-MIB 1, PCNA), wild-type p53, Bcl-2, and nm23. Patients with Ti through T4, NO or Ni tumor stages were treated by surgery only (group 1) or surgery followed by radiotherapy (group 2). Tumors were classified as "low malignant" and treated by surgery only (group 1) if they had 2cDI <3.5; 5cER <11%; tumor front grading <18 out of 24; Ki67-MIB 1 <29%; PCNA <37%; p53 >40%; Bel>50%; and nm23 >35%. All other tumors were classified as "high malignant" and treated by surgery and radiotherapy (group 2). The results of this preliminary study are presented. The average follow-up was 14 months. Thirteen patients were included in group 1, and 15 patients were included in group 2. Two patients with "high malignant" tumors refused radiotherapy and were regarded independently (group 3). From the oncological point of view there is no difference between group 1 and group 2. So far, there has been no mortality. Disease-free survival was 11 of 13 in group 1, 13 of 15 in group 2, and 1 of 2 in group 3. The functional results (speech, swallowing, airway) in group 1 were superior to those in group 2. The results of this preliminary study suggest that better functional results can be obtained when patients are treated with consideration of results from tumor biological examinations and that the oncological results are not negatively affected.