| Oral cancer is a major malignant tumor that seriously affects the human health. It is especially difficult to cure it when it is in the middle or late stage. Nowadays radiotherapy and repair by tissue flap grafting after excision are major therapeutic measures for it in oral and maxillofacial surgery. The extensive use of skin flaps can help patients to restore their normal appearance and function after radical operation. If combined with radiotherapy, it is another one of effective comprehensive measures for reducing local recurrences and raising survival rates. However fewer studies have been made on how to reasonably arrange the sequence between radiotherapy and operation, by which we can both raise cure rate of oral cancer and not affect survival rate of tissue flaps or local side reaction. This project deals with it. All the cases of oral cancer are classified at random into four groups?the therapeutic group and Control Groups A, B, and C. The therapeutic group is given sandwich radiotherapy, which consists of preoperative radiotherapy, operation and postoperative radiotherapy; Control Group A is offered operative treatment only; Control Group B is supplied with preoperative radiotherapy: Control Group C is provided with postoperative radiotherapy. Follow-up surveys are made after treatment. The survival of tissue flaps, acuteirradiation reaction, chronic irradiation reaction and patients' long-term survival are all observed and approached.Subjects and MethodsThe subjects are 113 cases of oral cancer operated on from January, 1993 to January, 1999. Their confirmed diagnoses are established and they are classified at random.1. The therapeutic group: For this group, 26 cases, aged from 35 to 83, are given sandwich radiotherapy, of whom 22 are repaired with tissue flaps.2. Control groups: For Group A, 27 cases, aged between 17 and 72, are offered operations only, of whom 5 are repaired with tissue flaps. For Group B, 11 cases of ages 40 to 72 receive radiotherapy for three or four weeks and then are operated on. Among them, 8 are repaired with tissue flaps. For Group C, 49 cases at the ages of 40 to 62 undergo operations first and after four or six weeks get radiotherapy, of whom 28 are repaired with tissue flaps.3. Therapeutic methods: For radiotherapy, 60 Cor is used and the linear accelerator is set on the position of balanced penetration across the cheeks or penetration into tumor tissue by locally thrusting 192 Ir needles. The range of irradiation includes the primary focus and adjacent affected region. Some patients' necks are located for an irradiation field. For operative treatment, combined radical operations of cheek, jaw and neck, of jaw and neck, of tongue, jaw6and neck, etc. are performed. After radical operation, 63 cases with defects are immediately repaired with tissue flaps. Of the tissue flaps, 41 are for intraoral repair, 18 for extraoral plerosis and 4 folded for intra-and extraoral repair.4. Follow-up surveys: A) Follow-up frequency: All the cases are followed up after treatment, once for the first six months and after that, once for every three months, lasting more than two years. B) Follow-up items: local control of tumors, survival rate, analysis of death causes, survival state of tissue flaps, and during radiotherapy dynamic observation of short- and long term reaction of tissue valves and the normal tissue around the irradiation field.5. Statistical treatment: A comparison is made between the therapeutic group and control groups. Measurement data are tested by T value and X2, and treated by Ridit analytical method. PO.05 is considered to be of statistical significance; P<0.01 is judged to be of noticeable statistical significance.Results1. Local control rates of tumor: 96.2% (3/26) in the therapeutic group; 74.1% (20/27) in Control Group A; 81.8% (9/11) in Control Group B, 75.5% in Control Group C. The differences in local control rates between the therapeutic group and Control Groups A, C are of noticeable significance whereas those bet...
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