特集　（２）　ハイパーサーミアが著効を示した症例　温熱併用放射線化学療法が著効を示した下顎へん平上皮癌の１例

In combination with chemo- and radiotherapy, hyperthemia has lately attracted considerable attention as a reliable mode of anti-cancer treatment. We experienced and reported a case of mandibular squamous cell carcinoma that was most effectively treated by hyperthermia combined with chemo-radiotherapy, as a preoperative therapy.<BR>In August 1989, a 27-year-old male patient experiencing pain in the left mandibular third molar region, visited a dental clinic, and the tooth was extracted, with a diagnosis of pericoronitis. Subsequently, however, difficulty of mouth opening appeared and persisted. The dentist cosulted with a department of oral and maxillofacial surgery of a dental college hospital. Although antibiotics were administered for mandibular chronic osteomelitis, the symptom was persistent. Biopsy from the extraction wound was then performed, and the diagnosis of squamous cell carcinoma was establised.<BR>In July 1990, the patient was referred to our department. Radiological examinations revealed destructive change from the mandibular body of the left lower molars to the mandibular ramus, and the tumor extended deeply into the infratemporal fossa. After hospitalization, external irradiation (30 Gy), and administration of PEP (60 mg) and CDDP (20 mg) were carried out in combination with microwave hyperthermia (8 times, 60 minutes each time). After confirmation of the excellent effects of the multimodal preoperative treatment, a radical operation, consisting of left radical neck dissection, hemimandibulectomy, dissection of infratemporal fossa, and reconstruction by PMMC flap and titanium metal plate, was performed.<BR>Comparing the CT image from the time immediately after the preoperative treatment with that of the patient's first visit to our clinic, the tumor mass around the mandibular ramus remarkably reduced, and the retromaxillary fat space was restored. Furthermore, because of clearness of the contour of the masticatory muscles and disappearance of the intratumor vascularity in, diagnostic imaging, the tumor was considered to have been almost controlled. The histopathological findings of the operation material revealed that almost all the tumor tissue had been replaced by fibrous tissue. For the reasons, we concluded that the chemoradiotherapy combined with hyperthermia was remarkably useful.