Salvage of stage IV intraoral squamous cell carcinomas with preoperative 5-fluorouracil.

A regimen for improving the salvage rate for Stage IV squamous cell carcinoma of the tongue, alveolar ridge and floor of mouth is presented. This method utilizes pre-operative sensitization of the tumor and regional lymph nodes by the topical application of 5-fluorouracil (5-FU) in the form of Efudex (Roche). The drug must be used topically at the tumor skin or tumor-mucous membrane interface to utilize the sensitizing properties of skin or mucous membrane. Further response is obtained by direct injections of 5-FU into the tumor. Later intravenous (IV) drip of 5-FU can be used particularly at the time of surgical resection. During the period of preparation until sensitized to 5-FU, patients must be restored to positive nitrogen balance and concurrent infections are controlled. Because of the importance of nutrition in restoring immunity, a feeding gastrostomy for these patients is recommended. The definitive surgery must include all bone that is involved, as 5-FU alone will not sterilize the bone. Of 15 patients who underwent the regimen outlined in this study, 12 of the patients with Stage IV intra-oral squamous cell carcinoma have had their primary tumor controlled for 17 months to 5 years at the time of this report.