Patients and Methods
Between 1993 and 1998, 52 patients with advanced oral-cavity tumours were treated. There were 44 males and 8 females at a mean age of 63 years. The most frequent tumour sites were the floor of the mouth (16) and mandibula (10), and 15 patients had polytopic manifestations. Thirtynine patients (75%) had a T4-stage tumour (see Figure 1), 49 were nodalpositive (94%) and 33 patients had a G3-tumour. In 60% of the cases, difficulties in swallowing led to the final diagnosis; in a further 27%, pain was reported. In the patient history, at least 87% of patients either were smokers or consumed alcohol; in 46%, a combined misuse was apparent. Radiotherapy was performed up to a total dose of 36Gy at single doses of 2Gy, five fractions a week. Radiotherapy was combined with one cycle of cisplatin (12.5 mg/sqm, days one to five) chemotherapy. Radical surgery was performed approximately three weeks after completion of radiochemotherapy. The tumour was resected with a security margin of 1cm; lymph nodes were removed with a neck dissection. Forty-eight patients underwent radical surgery: in 41 cases with R0-status, two patients had an R1-resection and five patients had an R2-resection. Patients with R1- or R2-status, N2 nodal involvement or lymphangiosis carcinomatosa continued radiation therapy up to a total dose of 66–70Gy. Twenty-two patients continued radiotherapy after surgery; 30 patients had only follow-up examinations. All of the patients were followed up in the author’s institution and in the facial surgery department. Quality of life was scored in orientation to the Eastern Co-operative Oncology Group (ECOG) score by an individual scaling of the general performance status and the capability to speak and swallow.

Results
Three years after therapy, 33 of 52 patients (63.5%) were alive, and after five years 19 of 33 evaluable patients (57.6%) were still alive. There was a steep decline in survival rate between the first and the second year in follow-up, from 83 to 67% overall survival.