Background:Lip and Buccal mucosa cancers are one of the most common malignancies in our practice. Some advanced cases can be technically difficult to operate upfront and are usually taken up for pre-operative chemo/radiotherapy. Tumouricidal doses of chemotherapy has its own systemic toxic effects. Electro-chemotherapy is a local treatment. Bleomycin (15IU/m2) administered intravenously gets distributed in circulation over 8-10 minutes. Electrodes deliver impulses to the tumour, open up the cell membrane channels temporarily resulting in drug concentration and improved cell kill. Added to this, radiotherapy results in good cytoreduction which in-turn improves the likelihood of negative margins and improved loco-regional control.
Aim:To assess the feasibility of treating locally advanced lip and buccal mucosa cancer with electro- chemotherapy using bleomycin followed by pre-operative radiotherapy.
Methods:We selected 26 cases of squamous histology of oral cavity, stage IV, surgeon deemed inoperable. All patients were treated with electro-chemotherapy using intravenous bleomycin at a dose of 15 IU/m2. Patients were assessed for toxicities and clinical response from electro chemotherapy two weeks after the procedure and were then proceeded to radiotherapy up to 50Gy (2Gy/#). Toxicities were re-assessed weekly during radiotherapy and at the end of treatment.
Results:Males comprised 57.6% and age group 51-70 were 59%. Stage IVA cases were 88.4%. 53.8% had well differentiated histology. No procedure related complications were observed. No patient developed systemic toxicity to bleomycin. Two weeks post procedure, electrode site skin scarring was observed in 76.9% cases, which reduced by end of radiotherapy to 19.2% cases. Toxicities like radiation mucositis-grade III (23%), post-RT hyperpigmentation (26.9%) and ulceration over treated site (15%) were observed. Partial response was noted in all cases, 2 weeks post electro-chemotherapy.
Conclusions:Electro-chemotherapy with bleomycin followed by radiotherapy is feasible in carefully selected advanced cases of oral cavity. No cases reported any form of systemic toxicity. Local toxicity was manageable.