7例鼻腔鼻窦神经内分泌癌的治疗和预后

目的 探讨鼻腔鼻窦神经内分泌癌（SNEC）的治疗方式及预后。方法 对2012年5月至2014年7月收治的7例SNEC患者的临床资料进行回顾性分析。7例患者均为男性,年龄范围39～61岁,就诊主要症状为鼻塞、头痛及面部肿胀疼痛等。临床分期：ⅣA期3例,ⅣB期3例,1例不详。1例行新辅助化疗+手术,1例行术前化放疗+手术,5例行根治性放疗+化疗。结果 7例患者放疗结束时疗效评价均为PR,2例在随访期间获CR。7例患者的随访时间为10～56个月,1例因远处转移死亡,6例随访期间均存活。主要不良反应为口腔黏膜炎、骨髓抑制和转氨酶升高。结论 SNEC临床少见,临床表现不典型,恶性程度高,采取以放疗为主的综合治疗是改善局部晚期患者预后的重要途径。     

鼻腔鼻窦未分化癌2例报告

Ｆｒｉｅｒｓｏｎ等[1] 在 1986年首次报道 8例临床病理具有特征性的鼻腔鼻窦恶性肿瘤 ,称之为鼻腔鼻窦未分化癌。该病恶性程度高 ,预后差。为了提高对该肿瘤的临床诊治水平 ,现报告我院收治的 2例鼻腔鼻窦未分化癌如下。1　病例报告例 1.男性 ,48岁。因鼻塞、面部疼痛、涕血 2个月 ,于 1994年 2月 12日入院。曾诊断为“鼻窦炎” ,经抗感染治疗无效。体检 :右眼眶周围红肿 ,鼻腔外侧壁可见块状暗红色肿物 ,表面有糜烂 ,颈部及颌下淋巴结无肿大。ＣＴ检查提示右鼻腔有一3ｃｍ× 4ｃｍ大小的不规则肿物 ,侵犯右眼眶及筛窦。光镜下发现中等大小…     

鼻腔鼻窦粘液表皮样癌1例

粘液表皮样癌是起源于涎腺的恶性肿瘤。在组织病理学中属于腺癌的一种类型。发生于鼻腔鼻窦者非常罕见。笔者于１９９７年１１月收治１例，报告如下。患者，男，５０岁。因左鼻阻塞伴涕中带血１个月余，于１９９７年１１月１７日入院。检查：全身情况未见异常。左鼻腔及鼻咽部充满灰白色肿物。CT扫描示左鼻腔、鼻咽、筛窦、上颌窦和蝶窦内有肿块影。上颌窦内侧壁骨质破坏。取鼻咽部肿瘤组织活检，病理诊断为慢性炎症伴淋巴组织增生。于１９９７年１１月２４日全麻下行面中部翻揭径路左鼻腔、鼻咽和筛窦、上颌窦及蝶窦内肿瘤切除术。术中见…     

鼻腔及鼻窦肿瘤治疗中一些特殊情况的处理

近年来在鼻腔和鼻窦肿瘤的诊治中有三项引人瞩目的进展,即CT的应用对于确定肿瘤的部位及其扩展的范围明显地较过去更加准确。其次是超高压放射源的应用,使一些早期癌瘤单纯通过放射治疗即可达到治愈的目的,而且在放射和手术的综合治疗中起到举足轻重的作用。第三是颅面联合路切除侵及颅底的鼻腔和鼻窦肿瘤的方法逐渐被广泛地应用,使一些过去认为无法切除的肿瘤得以彻底切除,同时这一术式在提高患者的治愈率方面起到明显的良好作用。在上述技术的影响下,几年来我们在处理鼻腔和鼻窦肿瘤临床工作中取得点滴经验,报道如下。     

38例鼻腔鼻窦肉瘤治疗回顾

对我院收治的38例鼻腔、鼻窦肉瘤作出回顾性分析,且对其据HE染色的病理切片做出肿瘤的分类和检测,及据1997年UICCGTNM软组织肉瘤进行病理分级.治疗方法为选用6MV的X线+电子束两种混合射线DT65～80Gy放射,术前50～60Gy+鼻腔、鼻窦广泛切除术,鼻腔、鼻窦广泛切除+50～70Gy放疗术3种方法.其结果显示单纯放疗3年生存率为33.3%,5年生存率为0;放疗+手术3年生存率为40%,5年生存率为33.3%;手术+放疗3年生存率为82.6%,5年生存率为58%,由此见手术+放疗对提高病人5年生存率具有积极作用,且软组织肉瘤以高剂量为宜,易采用多次.肿瘤防治杂志,2001,8(特)247-248     

鼻腔与鼻窦腺样囊性癌27例分析

鼻腔与鼻窦腺样囊性癌较罕见,我科自1957～1989年底共收治27例,占同期该部位恶性肿瘤的0.7％,现回顾性分析如下。临床资料本组男性15例,女性12例,年龄24～63岁,40岁以上19例(70％)。主要症状依次为鼻塞、鼻衄、面颊凸起、眼球突出、腭凸起,鼻侧凸起、面痛、面麻木、头痛额胀、嗅觉丧失及张口困难。症状历时28天～8年不等,1年内就诊18例,平均1.8年。鼻腔肿块呈分叶状,色苍白或淡红,有些表面布有小血管,触之易出血,质坚实或软。确诊前曾误为鼻息肉3例,上颌窦炎2例,筛额窦囊肿、上颌骨囊肿、泪囊肿瘤及血管瘤各1例。均经鼻窦X线摄片(其中4例辅以断层片,1例造影),肿瘤主要部位计鼻腔10例,上颌窦13例及筛窦4例(其中1例还累及额窦、鼻中隔及前颅底)。 27例中除拒治及未治(颅内转移仅作活检)各1     

鼻腔,副鼻窦病变的CT诊断分析

本文作者分析６２例鼻腔、副鼻窦疾病的ＣＴ表现，其中非肿瘤性病变１６例、良性肿瘤１０例、恶性肿瘤３６例。讨论了各类病变的ＣＴ表现和病理的关系。认为骨壁、窦腔改变的ＣＴ征象、考参软组织表现对炎性病变、囊肿、良性肿瘤、恶性肿瘤的鉴别诊断具有较大意义。ＣＴ扫描可清晰显示病变的部位与范围，对提高术前诊断、治疗方法的制定及追踪术后有无残留或复发帮助较大。     

Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses

PURPOSE: To report the clinical outcome of patients treated with intensity-modulated radiation therapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. METHODS AND MATERIALS: Between 1998 and 2004, 36 patients with malignancies of the sinonasal region were treated with IMRT. Thirty-two patients (89%) were treated in the postoperative setting after gross total resection. Treatment plans were designed to provide a dose of 70 Gy to 95% or more of the gross tumor volume (GTV) and 60 Gy to 95% or more of the clinical tumor volume (CTV) while sparing neighboring critical structures including the optic chiasm, optic nerves, eyes, and brainstem. The primary sites were: 13 ethmoid sinus, 10 maxillary sinus, 7 nasal cavity, and 6 other. Histology was: 12 squamous cell, 7 esthesioneuroblastoma, 5 adenoid cystic, 5 undifferentiated, 5 adenocarcinoma, and 2 other. Median follow-up was 51 months among surviving patients (range, 9-82 months). RESULTS: The 2-year and 5-year estimates of local control were 62% and 58%, respectively. One patient developed isolated distant metastasis, and none developed isolated regional failure. The 5-year rates of disease-free and overall survival were 55% and 45%, respectively. The incidence of ocular toxicity was minimal with no patients reporting decreased vision. Late complications included xerophthalmia (1 patient), lacrimal stenosis (1 patient), and cataract (1 patient). CONCLUSION: Although IMRT for malignancies of the sinonasal region does not appear to lead to significant improvements in disease control, the low incidence of complications is encouraging.     

女性鼻腔鼻窦畸胎癌肉瘤一例

患者女,71岁.因右侧渐进件鼻塞,伴少量脓涕及血性分泌物20余天,于2009年8月24日入院.患者查体未见明显异常.专科检查见双侧下鼻甲不大,鼻中隔居中,右侧鼻腔可见灰白色息肉样新生物,表面有少量血迹,略不平,左侧鼻腔未见明显异常,鼻窦区无压痛.CT显示右侧鼻腔及筛窦密度增高影,无骨质破坏.     

Dose distribution resulting from changes in aeration of nasal cavity or paranasal sinus cancer in the proton therapy

Background and purposeAeration in the nasal cavity and paranasal sinus (NCPS) was investigated during the course of proton therapy (PT), and the influence of aeration on the dose distribution was determined.Material and methodsTwenty patients with NCPS cancer (10 nasal cavity, 10 paranasal sinus) were analyzed. All the patients received a total proton beam irradiation dose of 38–78.4 Gray equivalents (GyE). Two to five CT examinations were performed during the course of treatment. The aeration ratio inside the cavity/sinus was calculated for each CT observation. Moreover, a simulation study supposing that the first treatment plan had been continued until the end of treatment was performed using the subsequent CT findings.ResultsThe aeration ratio was increased in 18 patients. The largest increase was from 15% to 82%. Three patients had a simulated maximum cumulative dose in the brainstem of beyond 60 GyE, while 10 patients had a simulated maximum cumulative dose in the optic chiasm of beyond 50 GyE. The shortest simulated time period to reach the dose limitation was 21 days.ConclusionsAeration in the NCPS is altered during the course of PT treatment and can greatly alter the dose distribution in the brainstem and optic chiasm.     

鼻腔和鼻窦内翻性乳头状瘤74例分析

１９８０～１９９１年收治鼻腔、鼻窦内翻性乳头状瘤（下称ＩＰ）７４例，全部为单侧发病，平均年龄４５．９岁。采用鼻内或鼻内＋Ｃａｌｄｗｅｌｌ－Ｌｕｃ手术或鼻侧切开术＋液氮冷冻治疗，总复发率３５．２％，其中恶变率为２１．６％（１６／７４），作者认为本病术前应作详细的影像学检查，尔后选择治疗。如病变局限，应在鼻内窥镜下作鼻内保守性手术，病变广泛或复发的病历应作鼻侧切开，内侧上颌骨摘除，术中采用液氮冷冻治疗，术后密切随访。     

副鼻窦恶性肿瘤术后放化疗的临床观察

目的探讨鼻腔副鼻窦恶性肿瘤术后放化疗的临床效果。方法选取105例鼻腔副鼻窦恶性肿瘤术后放化疗患者,采用Kaplan-Meler法计算患者的生存率,采用Log-rank法进行生存率差异性检验。结果 105例患者放疗结束后,CR 42例,PR 14例,有效率为53.33%(56/105);化疗结束后,CR 55例,PR 23例,有效率74.29%(78/105)。放化疗近期疗效明显优于放疗,差异具有统计学意义(P<0.05)。患者1年生存率明显高于3、5、10年生存率(P<0.05),其中3、5、10年生存率腺癌亦显著高于鳞癌(P<0.05)。单因素分析发现临床分期、病理类型和手术方法是放化疗疗效的影响因素,其中Ⅱ期中位生存时间明显高于Ⅲ~Ⅳ期、腺癌高于鳞癌、微创切除高于广泛性切除,比较差异均有统计学意义(P<0.05);经Cox模型多因素分析发现临床分期、病理类型和手术方法是影响放化疗疗效和预后的独立影响因素。全部患者未出现严重近期并发症,随访发现听视力障碍11例。结论术后放化疗是改善鼻腔副鼻窦恶性肿瘤临床效果的重要环节,临床分期、病理类型是影响术后放化疗疗效的主要影响因素。     

鼻腔副鼻窦内翻性乳头状瘤——附53例报告

目的 重视鼻腔鼻窦内翻性乳头状瘤临床特征，并介绍手术方法，以减少复发。方法 介绍作者采用的鼻腔外侧壁大块节除手术方法（大块组）３７例，与同期１６例行鼻侧切开肿瘤切除术（鼻侧组）对照比较。结果 大块组的复发率明显低于鼻侧组：２／３７：７／１６有明显差异。结论 鼻腔副鼻窦内翻生乳头状瘤患病率居局部良性肿瘤的首位，手术后复发率亦较高，且有恶变倾向，故应采取较广泛的切除手术益畏以放射治疗。     

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.     

肿瘤基因治疗的研究进展

目的:综述分析国内外肿瘤基因治疗研究现状的文献,为基础与临床研究提供研究方向、思路和资料。方法:应用MEDLINE、CA、CBMdisc、CMCC、CJFD和CSTPCD等数据检索系统及数据库,以"肿瘤基因治疗"等为关键词,检索1998-01～2007-06与肿瘤基因治疗相关的文献。纳入标准:1)肿瘤基因治疗的动物及临床试验研究,包括方法、效果及进展;2)肿瘤基因治疗与其他生物疗法疗效、不良反应及优缺点的比较。根据纳入标准,粗选143篇文献,最后17篇文献纳入综述分析。结果:基因治疗作为肿瘤治疗的新手段是随着DNA重组技术的成熟而发展起来的,是以改变遗传物质为基础的生物医疗技术,它通过将正常基因或有治疗作用的基因导入靶细胞来纠正突变或有缺陷的基因,以达治疗目的。基因沉默疗法、自杀基因疗法、免疫基因疗法、基因替代疗法、反义基因疗法、多药耐药相关基因治疗、抗肿瘤新生血管治疗和抗端粒酶治疗等均取得显著进展。结论:不同的肿瘤基因治疗方法各有利弊,随着治疗方法与病毒载体的不断改造和完善,基因的转移率、靶向性与安全性不断提高。