原发性鼻腔鼻窦恶性黑色素瘤八例临床分析

目的：探讨原发性鼻腔、鼻窦恶性黑色素瘤的诊断和治疗方法。方法：对8例该类患者的临床资料进行回顾性分析。结果：病理形态以多种细胞类型和组织形态混合存在为主要特点，无色素型黑色素瘤S－100蛋白均阳性。所有患者均得到手术治疗且切缘阴性。术后加放疗6例，复发3例，复发灶与原发病灶同侧，复发时间在术后1年左右。1年和2年生存率分别为75％和62％。2例生存期超过5年，均系手术加放疗者。结论：S－100蛋白是无色素型黑色素瘤的重要标志物，术后放疗的患者生存期较长，手术切缘阴性并不提示良好的预后。     

原发鼻腔非霍奇金淋巴瘤的治疗选择和疗效

目的 分析原发鼻腔非霍奇金淋巴瘤（NHL）放疗和化疗的近期疗效以及治疗方法对预后的影响。方法 129例经病理证实的原发鼻腔NHL患者中,经形态学诊断为鼻腔NK／T细胞淋巴瘤者116例。做免疫组化57例,其中52例为NK／T细胞来源,占91．2％;5例为B细胞来源,占8．8％。根据Ann Arbor分期,ⅠE期102例,ⅡE期22例,ⅣE期5例,ⅠE和ⅡE期患者中,单纯放疗22例,单纯化疗7例,综合治疗95例,ⅣE期以化疗为主。结果 5年总生存率（OS）和无病生存率（DFS）分别为68．0％和55．8％,ⅠE期和ⅡE期患者的5年OS分别为71．7％和70．6％（P=0．77）,DFS分别为60．9％和47．0％（P=0．09）。首程治疗后达CR患者的5年OS为83．1％,而未达CR患者的5年OS为18．0％（P=0．000）,相应5年DFS分别为68．0％和15．5％（P=0．000）。124例ⅠE和ⅡE期患者中,67例患者接受单纯放疗或放疗后化疗,放疗后完全缓解率（CR）为74．7％,其余57例为化疗后放疗或单纯化疗,化疗后CR率仅19．3％（P=0．000）,46例化疗后未达CR的患者中,42例仍局限于局部区域,31例经放疗达到CR,ⅠE和ⅡE期患者中,先放疗组（放疗＋化疗或单纯放疗）、化疗后放疗组的5年OS分别为76．0％和74．4％,DFS分别为65．0％和56．2％（P〉0．05）,ⅠE和ⅡE期单纯化疗7例,3例存活,4例死亡,中位生存时间15个月,1年生存率为26．7％。结论 中国人原发鼻腔NHL主要为NK／T细胞来源,放疗的近期疗效显著优于化疗,化疗加入放疗并未改善生存率,ⅠE和ⅡE期患者应以放射治疗为主要治疗手段。     

鼻腔原发性恶性黑色素瘤治疗方法的探讨

鼻腔原发性恶性黑色素瘤治疗方法的探讨陈俊强，林祥松鼻腔原发性恶性黑色素瘤（以下简称鼻腔恶黑）长期以来被认为时常规分割放疗抗拒，手术切除是首选治疗方法，但由于恶性度高，术后易复发而影响远期生存率。本文分析单纯手术、单纯放疗及手术加放疗的不同治疗情况，现...     

142例恶性黑色素瘤的分期治疗

目的探讨恶性黑色素瘤分期治疗的意义。方法收集1961—1999年住院治疗的恶性黑色素瘤142例，按照1997年TNM分期标准，Ⅰ期20例（14．1％）、Ⅱ期36N（25．3％）、Ⅲ期64例（45．1％）、Ⅳ期22例（15．5％）；Ⅰ期手术治疗、Ⅱ期手术＋放疗、Ⅲ期化疗＋手术或放疗、Ⅳ期以化疗为主要综合治疗。结果Ⅰ期5年生存率高达97％，Ⅱ期5年生存率47％～74％，Ⅲ期5年生存率13％～41％，Ⅳ期3年生存率0～10％。结论分期治疗恶性黑色素瘤有助于提高患者的5年生存率及降低医疗费用。     

Ⅱ期非霍奇金淋巴瘤治疗方法的选择(附268例分析)

目的 探讨Ⅱ期非霍奇金淋巴瘤（non-Hodgkin‘s lymphoma,NHL)有效的治疗方法。方法 对268例Ⅱ期NHL患者分别采用单纯放疗、综合治疗（包括放疗＋化疗、化疗＋放疗＋化疗和化疗＋放疗）等单纯化疗治疗。结果 Ⅱ期高度恶性NHL经化疗＋放疗＋化疗治疗后,1,2,3,4,5,6年生存率分别为95．1％、87．8％、87．8％、85．4％、82．9％和53．6％,6年复发率为26．8％,与单纯放疗、放疗＋化疗和化疗＋放疗组相比,生存率有明显提高（P＜0．01）,6年复发率降低（P＞0．05）。Ⅱ期中度恶性NHL患者经化疗＋放疗＋化疗治疗后,1,2,3,4,5,6年生存率分别为89．3％、75．0％、67．8％、60．6％、57．1％和46．4％,6年复发率为35．7％,与单纯放疗、放疗＋化疗和化疗＋放疗组相比,生存率有所提高（P＞0．05）,6年复发率降低（P＞0．05）。Ⅱ期期低度恶性NHL患者经单纯放疗及综合治疗后,1,2,3,4,5,6年生存率及6年复发率相近。结论 对Ⅱ期中,高度恶性NHL患者应采用化疗＋放疗＋化疗治疗,尤其对于高度恶性者,Ⅱ期低度恶性NHL患者应采用单纯放疗。     

原发鼻腔鼻窦黏膜恶性黑色素瘤94例临床分析

目的 探讨鼻腔鼻窦黏膜恶性黑色素瘤的进展规律及疗效。方法 回顾分析2000—2012年间94例鼻腔鼻窦黑色素瘤资料。男50例、女44例,发病年龄26~85岁(中位数60岁)。原发鼻腔86例、上颌窦7例、鼻咽部1例。颈部淋巴结转移10例(7例疗前、2例疗中、1例疗后),无远处转移。采用手术±放疗方法。采用Kaplan-Meier法计算生存率并Logrank法单因素预后分析,Cox模型多因素预后分析。结果 全组1、3、5年样本数量分别为80、54、50例,1、3、5年疾病相关生存率分别为71%、33%、22%。单因素分析发现影响预后因素为年龄>55岁(P=0.034)、累及后鼻孔(P=0.011)、累及上颌窦(P=0.009)、累及硬腭(P=0.003)、颈部淋巴结转移(P=0.001)、治疗方式(P=0.038)。多因素分析发现影响预后因素为累及后鼻孔(P=0.027)、累及眼眶(P=0.005)、累及硬腭(P=0.003)。结论 鼻腔鼻窦黏膜恶性黑色素瘤的远处转移和局部复发率较高,需多学科多手段联合治疗;颈部淋巴结转移率较低;临床分期的合理性有待进一步研究。     

头颈部原发性黏膜恶性黑色素瘤患者PD－L 1表达及其临床相关因素分析

目的：探讨头颈部原发性黏膜恶性黑色素瘤患者程序性细胞死亡配体1（PD－L1）表达及其临床意义。方法：研究采用免疫组化检测45例头颈部原发性黏膜恶性黑色素瘤样本PD－L1表达,分析其表达与患者临床病理学特征及疾病预后的关系。结果：所有患者均接受手术切除治疗联合干扰素治疗。随访患者5年生存率为44．4％（20／45）,平均生存期为51个月,无复发生存期为23个月。免疫组化染色证实57．8％（26／45）肿瘤样本为 PD －L1高表达,显著多与临近非肿瘤组织（P＝0．0037）。PD－L1表达与患者年龄（P＝0．09）、性别（P＝0．16）、肿瘤分布（P＝0．08）无关,而PD－L1阳性患者的无复发生存期显著短于阴性患者（P＝0．027）。多变量分析证实PD－L1高表达是头颈部原发性黏膜恶性黑色素瘤患者预后不良独立标志物。结论：PD－L1高表达与头颈部原发性黏膜恶性黑色素瘤进展和预后不良密切相关,可以作为该疾病的预后标志物。     

蝶窦原发恶性肿瘤16例治疗分析

目的 分析原发蝶窦恶性肿瘤治疗结果。方法 回顾分析2000—2013年我院收治的原发蝶窦恶性肿瘤16例。初诊无颈部淋巴结发生转移。Ⅳ_A期1例, Ⅳ_B期15例。治疗方法包括手术+放疗11例、单纯手术1例、单纯放疗3例、单纯化疗1例。手术全部为减瘤手术。放疗中位剂量69.96 Gy (56.00~ 80.56 Gy)。结果 全组3年LC、DMFS、DFS、DSS分别为67%、69%、44%、58%, 减瘤术+放疗组分别为67%、55%、30%、41%。全部保留眶内容物及颅底。全组LR率25%, 远处转移率37%, 淋巴结复发率6%。预后分析未见与LC率及DSS相关因素。结论 蝶窦肿瘤经减瘤手术+术后放疗在保留眼眶及颅底前提下能取得良好疗效。蝶窦肿瘤治疗后淋巴结复发率低, 临床不建议常规颈部淋巴结预防照射。     

原发性鼻腔鼻窦恶性黑色素瘤八例临床分析

探讨原发性鼻腔，鼻窦恶性黑色素瘤的诊断和治疗方法。方法：对８例该类患者的临床资料进行回顾性分析。结果：病理形态以多种细胞类型和组织形态混合存在为主要特点，无色素型黑色素瘤Ｓ－１００型蛋均阳性，所有患者均得到手术治疗组切缘阴性。术后加放疗６例，复发３例，复发灶与原病灶同侧，复发时间在术后１年左右，１年和２年生存率分别为７５％和６２％。２例生存期超过５年，均系手术加放疗者。结论：Ｓ－１００蛋白是无色素     

129例原发鼻腔非霍奇金淋巴瘤的预后分析

背景与目的：原发鼻腔非霍奇金淋巴瘤（non-Hodgkin’s lymphoma,NHL）预后较差．远处转移和局部复发率均较高．目前本病尚无标准治疗原则。本研究主要探讨影响原发鼻腔NHL的预后因素。方法：1996年1月至2002年12月共收治129例经病理证实的原发鼻腔NHL。116例经病理形态学诊断为鼻腔NK／T细胞淋巴瘤。根据Ann Arbor分期,ⅠE期102例,ⅡE期22例,ⅣE期5例。124例ⅠE／ⅡE期患者单纯放疗22例,单纯化疗7例,45例放疗后化疗,50例化疗后放疗。5例ⅣE期以化疗为主。结果：全组5年总生存率（overall survival,OS）和无病生存率（disease-freely survival,DFS）分别是68．0％和55．8％。ⅠE期和ⅡE期患者的5年OS分别是71．7％和70．6％（P=0．77）,DFS分别是60．9％和47．0％（P=0．09）。首程治疗后完全缓解（complete response,CR）的患者5年OS为83．1％,而未达CR患者的5年OS为18．0％（P〈0．01）,相应5年DFS分别为68．0％和15．5％（P〈0．01）。国际预后指数（international prognostic index,IPl）评分为0,1和≥2的5年OS分别为81．1％、60．1％和14．3％（P〈0．01）,DFS分别为68．8％、44．6％和22．5％（P〈0．01）。38例患者治疗中进展或疗后复发,远处结外器官复发占78．9％,是治疗失败主要原因。单因素分析显示,首程治疗后的CR率、一般状态评分（performance status,PS）、IPI和修订后IPI与预后相关。多因素分析显示仅治疗后的CR率是独立预后因素。结论：治疗后的CR率是影响原发鼻腔NHL的重要预后因素,原因以远处病灶治疗失败为主。     

147例鼻咽癌调强放疗结果分析

目的 总结我院鼻咽癌调强放疗的经验和结果.方法 5年内采用调强放疗初程鼻咽癌患者147例.T1-2期38例鼻咽原发病变靶区(GTVnx)和阳性淋巴结(GTVnd)的处方剂量为70.0～72.6 Gy,高危区(CTV1)处方剂量为60Gy,低危区(CTV2)处方剂量为50Gy.T3-4期109例GTVnx74`78Gy,其他靶区处方剂量同T1-2期.局部控制率、生存率用Kaplan-Meier方法计算.结果 中位随访时间15个月,全组3年局部控制率、总生存率、无瘤生存率和无远转生存率分别为93.2%、93.5%、72.6%～1174.4%,T1-2、T3-4期局部控制率分别为100%和86.9%(P=0.007),总生存率为95.5%和91.3%(P=0.030).N0-1和N2-3期的总生存率、无瘤生存率、无远转生存率分别为99%和68.5%(P=0.030)、79%和64.O%(P=0.004)、81%和65.2%(P=0.000).急性腮腺功能损伤1+2级为96.6%,3级为1.4%,2级发生于放疗后3、6个月和1、2年的分别为43.0%、12.O%和4.9%、3.2%.结论 鼻咽癌凋强放疗方案取得了很好的疗效同时保护了腮腺功能.     

Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy

PURPOSE: To evaluate the long-term clinical outcome and toxicity of conventional and three-dimensional conformal radiotherapy for malignancies of the nasal cavity and paranasal sinuses. METHODS AND MATERIALS: Between January 1976 and February 2003, 127 patients with histologically proven cancer of the paranasal sinuses (n = 119) or nasal cavity (n = 8) were treated with preoperative (n = 61), postoperative (n = 51), or primary (n = 15) radiotherapy, using conventional (n = 74) or three-dimensional conformal (n = 53) techniques. No elective neck irradiation of the cervical lymph nodes was performed in N0 patients. RESULTS: Median follow-up was 5.6 years (range, 3-307 months) for all patients, and 7.3 years (range, 47-307 months) for patients still alive at the close-out date. The actuarial 5-year local control, overall survival, and disease-free survival rates were 53%, 54%, and 37%, respectively. Only 6 (5%) of all 127 patients and 4 (3%) of 122 originally N0 patients developed a regional failure in the neck. Distant metastasis occurred in 20% of patients. Both primary tumor extent and lymph node involvement were the most important prognostic factors, together with squamous cell carcinoma histology. CONCLUSION: Local failure remains the dominant cause of poor outcome for patients with sinonasal cancer, despite aggressive local treatment with combined surgery and radiotherapy in operable patients. Distant metastasis and certainly regional relapse were much less common sites of failure. Overall survival remains poor, suggesting the need for more efficacious local and possibly systemic therapy.     

Post-operative intensity-modulated radiotherapy for malignancies of the nasal cavity and paranasal sinuses.

PURPOSE: To evaluate the clinical outcome and toxicity of post-operative intensity-modulated radiotherapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. METHODS AND MATERIALS: Twenty-five patients with histological proven cancer of the paranasal sinuses (n=21) or nasal cavity (n=4) were post-operatively treated with IMRT at the Leuven department to a total dose of 60 Gy (n=15) or 66 Gy (n=10). Both acute and chronic toxicity were prospectively scored in all patients. RESULTS: Median follow-up was 27 months (range: 12-47 months) among surviving patients. The actuarial 2-year local control (LC), overall survival (OS) and disease-free survival (DFS) rates were 81%, 88% and 77%, respectively. One patient developed isolated distant metastasis, while none of the patients developed regional failure. No grade 3 or 4 toxicity was reported, either acute or chronic. No radiation-induced blindness or brain necrosis was reported to date, although longer follow-up has to be awaited for definitive results. CONCLUSION: Post-operative IMRT for sinonasal cancer resulted in similar local control and survival rates as conventional or 3D-conformal radiotherapy techniques, and was associated with little acute toxicity. Longer follow-up is necessary to confirm the lack of late complications.     

Cancer of the Nasal Cavity and Paranasal Sinuses: A Clinico-pathological Study of 277 Patients

In the period 1963-1991, a total of 277 consecutive patients with malignant tumours of the nasal cavity and paranasal sinuses were treated at Aarhus University Hospital. The major histological types included squamous cell carcinoma (46%), lymphoma (14%), adenocarcinoma (13%), and malignant melanoma (9%). Kaplan-Meier estimates of 5-year corrected survival (death from cancer) showed the best prognosis for adenoid cystic carcinoma (87%), adenocarcinoma (65%) and lymphoma (56%), and the poorest prognosis for undifferentiated carcinoma (17%) and malignant melanoma (24%). The 5-year corrected survival for squamous cell carcinoma was 35%. Of the 180 patients with treatment failure, the vast majority occurred locally (n = 166); a minor proportion was regional (n = 23) or distant (n = 30). For the 195 patients with carcinoma, the following parameters were of statistical prognostic significance (5-year corrected survival): histological differentiation (moderate-well 65% vs. poor 22%), primary T-site (nasal cavity 56% vs. maxillary antrum 39% vs. other sinuses 24%), tumour stage (T2 68% vs. T3 37% vs. T4 29%), nodal stage (NO 48% vs. Nl-3 21%), treatment (radiotherapy + surgery 56% vs. radiation alone 35%).     

嗜神经侵袭阳性鼻腔副鼻窦腺样囊性癌的治疗及预后分析

目的分析嗜神经侵袭(PNI)阳性鼻腔副鼻窦腺样囊性癌(ACC)的疗效, 探讨PNI在鼻腔副鼻窦ACC中的预后价值。方法回顾性分析2000年1月至2016年12月中国医学科学院肿瘤医院收治的105例鼻腔副鼻窦ACC患者的临床资料。按照美国癌症联合委员会和国际抗癌联盟第8版分期系统重新分期。随访获取患者治疗失败和生存资料, 预后影响因素的单因素分析采用Log rank检验, 多因素分析采用Cox回归比例风险模型。结果上颌窦(59例)为最常见的肿瘤原发部位, 其次为鼻腔(38例)。Ⅲ～Ⅳ期患者93例。治疗方式包括单纯手术14例, 单纯放疗13例, 术前放疗+手术10例, 手术+术后放疗68例。中位随访91.8个月, 5年局部控制率、无远处转移生存率、无进展生存率和总生存率分别为72.6%、73.0%、52.9%和78.0%。33例(31.4%)患者PNI阳性, 其5年无远处转移生存率、无进展生存率和总生存率分别为53.7%、29.4%和56.5%, 均低于PNI阴性组(分别为80.8%、63.0%和86.8%, 均P<0.05), 而两组的局部控制率差异无统计学意义(64.5%和76....     

44例原发性鼻粘膜恶性黑色素瘤的临床特征及预后分析

背景与目的:原发性鼻粘膜恶性黑色素瘤是一种罕见肿瘤,其临床资料主要来源于西方人群。本文总结原发性鼻粘膜恶性黑色素瘤患者的临床资料,分析其临床特征和影响预后的因素。方法:回顾性分析1971年1月至2005年7月中山大学肿瘤防治中心收治的原发性鼻粘膜恶性黑色素瘤66例,其中有完整随访资料的44例。复习病历登记的临床表现和治疗方法,信件或电话随访记录肿瘤复发和患者生存情况。用Kaplan-Meier方法计算生存率,用Cox比例风险模型进行多因素分析。结果:44例有完整随访资料的患者中,37例原发于鼻腔粘膜,5例原发于副鼻窦粘膜,2例原发于鼻咽粘膜。初治时12例患者出现颈淋巴结转移。31例接受以手术为主的治疗,其中8例接受辅助性放疗,13例接受辅助性化疗,6例接受辅助性非特异性免疫治疗。中位随访时间29个月,局部复发率为54.5%(24例),10例(22.7%)患者发生颈淋巴结转移复发,11例(25%)发生远处转移。中位生存时间为24个月,5年生存率为25%。预后分析显示,临床分期影响患者5年生存率,而性别、年龄、原发肿瘤部位、原发肿瘤大小、是否接受辅助治疗与5年生存率无关。结论:原发性鼻粘膜恶性黑色素瘤局部复发率和远处转移率高,且易出现颈淋巴结转移。临床分期影响患者5年生存率。     

基于MRI和IMRT的鼻咽癌鼻窦侵犯的预后研究

目的探讨基于MRI和IMRT的鼻咽癌鼻窦侵犯在鼻咽癌分期中的意义。方法 回顾分析2005—2010年基于MRI诊断的接受IMRT的1197例初诊鼻咽癌患者资料。根据AJCC第7版分期重新分期。鼻窦侵犯分为伴有鼻窦侵犯T₃、T₄期。Kaplan-Meier法计算LRFS、DMFS、OS率并Logrank法检验。Cox模型多因素预后分析及T分期各亚组局部复发风险比。结果 鼻窦侵犯率为14.2%。鼻窦侵犯不是影响鼻咽癌OS、LRFS、DMFS的因素(P=0.677、0.485、0.211)。T₂期、伴鼻窦侵犯T₃期及不伴鼻窦侵犯T₃期局部复发风险比接近(HR=1.927、2.030、2.283)。LRFS、OS曲线在T₂期、伴鼻窦侵犯T₃期及不伴鼻窦侵犯T₃期接近(P>0.05),与伴鼻窦侵犯T₄期及不伴鼻窦侵犯T₄期明显分开(P<0.05)。结论 鼻窦侵犯不是IMRT鼻咽癌OS、LRFS和DMFS的预后因素,但伴鼻窦侵犯的T₃期OS、LRFS与T₂、T₃期相似,预后较T₄期好。     

Carcinomas of the Paranasal Sinuses and Nasal Cavity Treated With Radiotherapy at a Single Institution Over Five Decades: Are We Making Improvement?

PURPOSE: To compare clinical outcomes of patients with carcinomas of the paranasal sinuses and nasal cavity according to decade of radiation treatment. METHODS AND MATERIALS: Between 1960 and 2005, 127 patients with sinonasal carcinoma underwent radiotherapy with planning and delivery techniques available at the time of treatment. Fifty-nine patients were treated by conventional radiotherapy; 45 patients by three-dimensional conformal radiotherapy; and 23 patients by intensity-modulated radiotherapy. Eighty-two patients (65%) were treated with radiotherapy after gross total tumor resection. Nineteen patients (15%) received chemotherapy. The most common histology was squamous cell carcinoma (83 patients). RESULTS: The 5-year estimates of overall survival, local control, and disease-free survival for the entire patient population were 52%, 62%, and 54%, respectively. There were no significant differences in any of these endpoints with respect to decade of treatment or radiotherapy technique (p > 0.05, for all). The 5-year overall survival rate for patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s was 46%, 56%, 51%, 53%, and 49%, respectively (p = 0.23). The observed incidence of severe (Grade 3 or 4) late toxicity was 53%, 45%, 39%, 28%, and 16% among patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s, respectively (p = 0.01). CONCLUSION: Although we did not detect improvements in disease control or overall survival for patients treated over time, the incidence of complications has significantly declined, thereby resulting in an improved therapeutic ratio for patients with carcinomas of the paranasal sinuses and nasal cavity.