[Withdrawal therapy of patients with alcoholism and nicotine dependence with carcinomas in the area of the head and neck. Luxury or necessity?].
OBJECTIVE
Alcohol and nicotine abuse play a major role in the etiology of oral squamous cell carcinomas. In the present study, we investigated the number of patients with oral/oropharyngeal carcinomas who regularly consume alcohol and nicotine and what type of specific treatment should be prescribed for the addiction.


METHODS
A total of 105 patients (90 men, 15 women) with oral/oropharyngeal squamous cell carcinomas were studied based on catamnestic data as well as a special questionnaire designed to assess drinking and smoking habits (40 g alcohol/day for men and 20 g alcohol/day for women was taken as the standard measure for those considered at risk for alcoholism). For smokers, the number of packs smoked per year was determined and compared to clinical data (i.e., tumor size, location) and laboratory data (gamma-GT). Particular attention was given to the addiction behavior before and after tumor therapy (recorded at least 1 year after successful tumor treatment).


RESULTS
At the time of diagnosis, 83.1% regularly drank alcohol (71.9% reported drinking over 40 g/ 20 g of alcohol per day). Another 17.9% stopped drinking after therapy. Of the alcoholics 59.8% had been exposed to a daily consumption level above the threshold amount for more than 20 years. Some 70% of the patients reported that they exclusively drank beer. Tobacco consumption came from cigarette smoking 92.7% and 89.7% reported that they smoked before therapy--after therapy only 37.8% smoked. Carcinomas of the floor of the mouth indicated a prevalence toward alcohol and nicotine abuse. Of the patients with a T3 and T4 carcinoma 84% had daily alcohol consumption levels over the threshold value stated above. None of the 105 patients underwent specific alcohol treatment therapy.


CONCLUSIONS
In light of the high prevalence of carcinomas of the oral cavity in patients with alcohol and nicotine addiction, mandatory withdrawal therapy should be offered in the form of postoperative treatment to prevent recurrence or the development of second primary tumors, as well as to improve the quality of life and encourage social rehabilitation. Before further treatment, for example, with retinoids, a successful withdrawal treatment should be completed.
Dammer
R
R
Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Regensburg.
Neiderdellmann
H
H
Friesenecker
J
J
Fleischmann
H
H
Herrmann
J
J
Kreft
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000534:rehabilitation*; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000209:etiology / Q000534:rehabilitation*; D009959:Oropharyngeal Neoplasms / Q000209:etiology / Q000534:rehabilitation*; D010348:Patient Care Team; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation