上颌窦鳞状细胞癌不同治疗方式的临床疗效及预后分析

目的:探讨49例上颌窦鳞状细胞癌患者的临床疗效并分析生存率.方法:回顾性分析2000年1月至2012年1月收治的49例上颌窦鳞状细胞癌患者临床资料,分别比较单纯手术+术后放疗组患者和诱导化疗+手术+术后放疗组的5年生存率.这些病例(5年内死亡病例随访至死亡日)均随访5年以上,无1例失访.结果:49例病例资料中,随访率为100.0％.5年中29例患者死亡,总生存率为40.8％(20/49),单纯手术+术后放疗者23例,死亡患者15例,生存率为34.8％(8/23);诱导化疗+手术+术后放疗者26例,死亡患者14例,生存率为46.2％ (12/26),两组生存率比较,差异有统计学意义(P＜0.05).结论:上颌窦鳞状细胞癌主要的死亡原因与临床分期及术后复发转移密切相关,以手术为主的综合治疗有益于上颌窦鳞状细胞癌疗效的提高,控制局部瘤体病变及预防术后复发是影响上颌窦鳞状细胞癌疗效的关键.     

Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of maxillary sinus

A series of 50 patients with cancer of the maxillary sinus treated by either preoperative or postoperative radiation from February, 1958 to June, 1974 is presented. In the postoperative group the patients were either free from recurrence, of if there was recurrence, the tumor was less than 0.5 cm in diameter. In the preoperative group, 23 of 36 patients survived for more than five years (64 % ). In the postoperative group, 4 of 14 patients survived for more than five years (26%). There is an obvious superiority in the preoperative radiation group. The surgical complication rate in the preoperative group was 29% as compared to 14% in the postoperative group. Although the incidence of complications in the preoperative group is higher, we believe it is worth attempting in clinical practice because of the more favorable survival rates.     

Clinical patterns and treatment outcome of elderly patients in clinical stage IB/II non-small cell lung cancer

BACKGROUND AND OBJECTIVES: Surgery is a standard treatment in patients with clinical stage IB/II non-small cell lung cancer (NSCLC). We often have difficulty in treating of elderly patients due to their insufficient physiological function. To better manage such elderly patients, the clinical characteristics and prognosis of patients with these stages, who were 75 years of age or older, were reviewed. METHODS: From 1972 to 1999, 112 elderly patients with these stages were treated in our department. These patients comprised 88 men and 24 women. The histological types were 50 adenocarcinomas, 51 squamous cell carcinomas, 8 large cell carcinomas, and 3 adenosquamous carcinomas. RESULTS: Seventy-four patients (66%) underwent a surgical resection, including 60 surgery alone, 14 combined modality therapy. Radiotherapy, with or without chemotherapy, was given to 30 patients (27%), and chemotherapy alone to 5 (4.5%). In addition, 3 (2.7%) were given no therapy. The survivals of the surgery group at 2 and 5 years are 53% and 21% and those of the radiotherapy group are 35% and 3%, respectively. A multivariate analysis in radiotherapy group shows the predominant prognostic factor to be adenocarcinoma. The 2-year survival of the radiotherapy group in patients with adenocarcinoma is 58%, while that of patients with squamous cell carcinoma is 22%. CONCLUSIONS: These above observations suggest that radiotherapy is an alternative strategy for patients who cannot undergo surgery, especially with adenocarcinoma.     

上颌窦癌60例序贯性综合治疗临床分析

目的观察上颌窦癌序贯性综合治疗效果及长期生存情况.方法对60例上颌窦癌患者进行序贯性综合治疗,其中鳞癌38例,腺癌15例,其它7例;男性39例,女性21例;采用诱导性化疗-上颌窦开窗-放疗-巩固性化疗方案治疗.结果全组患者5年生存率46.7%(28/60),其中16例能正常生活或工作,12例长期休养;死亡病人中16例死于原发灶复发.结论上颌窦癌的序贯性非手术切除综合治疗能最大限度地保留患者的面容和器官功能,减少并发症,提高生存质量,患者较易接受.     

Sarcoma of the maxillary sinus in a patient with malignant melanoma: Report of a case

A patient with a level II malignant melanoma arising in a lentigo maligna later developed a spindle cell sarcoma of the maxillary sinus which proved fatal. Criteria for the reporting of multiple malignancies, incidence, and possible etiologies are discussed.     

上颌窦癌74例的治疗与影响预后的因素

目的：研究上颌窦癌74例的治疗与影响预后的因素。方法：1995年1月--1995年12月本院治疗74例上颌窦癌,男、女之比1.6:1,中位年龄55岁（25-76岁）,病理：鳞癌55例,腺癌8例,未分化癌等11例。T24例、T332例、T438例按AJCC分期,确诊时20例有颈部淋巴结转移,其中15例为同侧上颈部。全组原发灶单纯放疗43例,放疗 手术31例,放疗肿瘤剂量41天50Gy/28次--55天78Gy/39次。用Kaplan-Meier计算生存率、局控率、转移率,用Log-Rank进行结果之间的比较,用Gox比较风险模型行多因素分析。结果：全组五年生存率33.9%,原发灶五年失控率56.2%,颈部淋巴结五年失败率20.0%,五年远处转移率19.7%。单纯放疗组、放疗 手术组五年生存率分别为16.4%、56.1%(P=0.0003）,54例N0病例中7例在治疗中（后）出现颈部淋巴结转移,5例为同侧上颈部。N（ ）组、N（-）组的五年生存率分别为20%和41.9%(P=0.0076）。结论：综合治疗有益于上颌窦癌疗效的提高。上颌窦癌治疗失败的原因主要是原发灶,而颈部淋巴结转移多在同侧上颈部,一旦出现则预后较差。     

全程加速超分割治疗局部晚期上颌窦癌的疗效分析

目的:评价全程加速超分割治疗局部晚期不能手术的上颌窦癌的疗效及预后。方法:1996年3月~2004年3月收住71例局部晚期不能手术的上颌窦癌患者,随机分为两组。(1)全程加速超分割组(CAHF)36例;每周5d,每天2次,每次1.5Gy,间隔时间6h以上,总量DT66~70Gy/44~46 f/32~34d;(2)常规分割照射组(CF)35例,5次/w,1次/d,每次2.0Gy,总量DT66~80Gy/33~35 f/44~46d。结果:常规照射组和全程超分割组1,2,3,4,5年的局控率分别为62.8%,34.3%,22.9%,14.3%,5.7%和88.6%,66.7%,52.8%,36.3%,25%(P<0.05);常规照射和全程加速超分割组1,2,3,4,5年的生存率分别为6 5.7%,4 5.7%,2 8.6%,2 2.8%,1 6%和9 4.4%,7 2.2%,5 8.3%,5 7.2%,3 6.1%(P<0.0 5),加速超分割组较常规分割组高,两组的晚期并发症及死亡原因无明显差异。结论:全程加速超分割放射治疗对不能手术的晚期上颌窦癌患者,能明显提高局控率和生存率,但口腔粘膜反应较常规分割组增高,但可耐受。     

全程加速超分割治疗局部晚期上颌窦癌的疗效分析

目的：评价全程加速超分割治疗局部晚期不能手术的上颌窦癌的疗效及预后。方法：1996年3月-2004年3月收住71例局部晚期不能手术的上颌窦癌患者,随机分为两组。（1）全程加速超分割组（CAHF）36例;每周5d,每天2次,每次1.5Gy,间隔时间6h以上,总量DT66-70Gy/44-46 f/32-34d;（2）常规分割照射组（CF）35例,5次/w,1次/d,每次2.0Gy,总量DT66-80Gy/33-35 f/44-46d。结果：常规照射组和全程超分割组1,2,3,4,5年的局控率分别为62.8%,34.3%,22.9%,14.3%,5.7%和88.6%,66.7%,52.8%,36.3%,25%（P〈0.05）;常规照射和全程加速超分割组1,2,3,4,5年的生存率分别为6 5.7%,4 5.7%,2 8.6%,2 2.8%,1 6%和9 4.4%,7 2.2%,5 8.3%,5 7.2%,3 6.1%（P〈0.0 5）,加速超分割组较常规分割组高,两组的晚期并发症及死亡原因无明显差异。结论：全程加速超分割放射治疗对不能手术的晚期上颌窦癌患者,能明显提高局控率和生存率,但口腔粘膜反应较常规分割组增高,但可耐受。     

Superselective intra-arterial cisplatin infusion and concomitant radiotherapy for maxillary sinus cancer

Background:

The purpose of this study was to evaluate the efficacy of superselective cisplatin infusion with concomitant radiotherapy (RADPLAT) for previously untreated patients with the squamous cell carcinoma of maxillary sinus (SCC-MS).

Methods:

Between 1999 and 2010, 54 patients were given superselective intra-arterial infusions of cisplatin (100–120 mg m⁻² per week) with simultaneous intra-venous infusions of thiosulfate to neutralise cisplatin toxicity and conventional radiotherapy (65–70 Gy).

Results:

One patient (1.9%) was diagnosed with T2, 14 (25.9%) with T3, 27 (50%) with T4a, and 12 (22.2%) with T4b disease. Lymph-node involvement was present in 12 patients (22.2%). During the median follow-up period of 6.4 years, the 5-year local progression-free and overall survival rates were 65.8 and 67.9% for all patients, respectively. No patient died as a result of treatment toxicity or experienced a cerebrovascular accident. Osteonecrosis (n=5), brain necrosis (n=1), and ocular/visual problems (n=14) were observed as late adverse reactions.

Conclusion:

We have shown excellent overall survival and local progression-free rate in SCC-MS patients treated by RADPLAT with acceptable rates of acute and late toxicity. A multi-institutional trial is needed to prove that this strategy is a feasible and effective approach for the treatment of SCC-MS.     

原发于上颌窦非霍奇金淋巴瘤15例临床分析

目的对原发于上颌窦非霍奇金淋巴瘤的临床、病理、治疗及预后结合文献进行分析。方法经手术后病理确诊为原发于上颌窦非霍奇金淋巴瘤15例在本院行放疗和化疗的综合治疗。放疗采用60Co-γ线或6MV~8MV高能X线,原发灶放疗中位剂量为56Gy,颈部放疗剂量为50Gy,颈部预防放疗剂量为44Gy。放射治疗前后行CHOP、COPP、COMP、BACOP等方案化疗2个~6个周期。结果5年生存率为53.4%。死亡8例,均死于远处转移。结论上颌窦非霍奇金淋巴瘤需行放射治疗和全身化疗,有条件时给予鞘内预防化疗。     

Squamous cell carcinoma of the thyroid: outcome of treatment in 16 patients

AIMS AND METHODS: Squamous cell carcinoma of the thyroid is very rare and has a poor prognosis. Treatment and outcome were retrospectively analysed in a consecutive series of 16 patients treated at the Royal Marsden Hospital, with the aim of establishing guidelines for management. RESULTS: Twelve of the 16 patients had locoregional disease only at presentation and four had distant metastases. Eight of the 16 underwent surgery and four were given post-operative radiotherapy. Radiotherapy alone was used in six patients unsuitable for surgery. Median survival was 16 months. There were three long-term survivors; each had localized disease treated with surgery and post-operative radiotherapy. Patients treated with surgery alone all developed local recurrence. Two of six patients treated with radiotherapy alone had a partial response but all subsequently developed progressive local disease. Chemotherapy was used in two patients with no response. CONCLUSIONS: Long-term survival is possible if disease is diagnosed early and is completely resected. Surgery should be followed by radical dose radiotherapy.     

头颈部鳞癌的术后放疗

头颈部鳞癌术后放疗的临床研究表明术后病理检查结果可作为术后放疗的主要依据；术后放疗与手术的时间间隔是否影响肿瘤的局部控制没有明确证据，但根据放射生物学理论，术后放疗仍宜尽早进行，尤其是具有高危因素的患者；术后放化疗的综合治疗推荐采用同步放化疗，可提高局部控制率、总的生存率和无病生存率，尽管同步放化疗明显增加了急性毒副反应，但远期损伤没有增加，包括第二原发肿瘤：调强收疗（IMRT）和靶向治疗如单克隆抗体C225在头颈部肿瘤术后治疗中的地位和作用有待研究。     

The evaluation of radiotherapy after incomplete surgery in patients with carcinoma of the maxillary sinus

The retrospective analysis of 57 patients with cancer of the maxillary antrum irradiated after incomplete surgery was performed. The majority of patients had very advanced disease (54% T4 tumors). In 18 patients partial resection of maxillary antrum was performed: 39 patients underwent total maxillectomy. In 35 patients macroscopic residual tumor (MRT) was present after surgery. All patients were irradiated postoperatively with 60Co teletherapy and received a dose of 60 Gy in 20-30 fractions over 4-6 weeks. Five year symptom-free survival in the whole group was 35%. Significantly better survival was found in patients with T2 tumors in comparison with patients with T3 and T4 tumors, in patients with infrastructural localization in comparison with patients with suprastructural localization and in patients with microscopic residual tumor in comparison with MRT patients. An analysis of pattern of relapses indicates that histology should be regarded as an important factor of management. In keratinizing squamous cell cancer, local control remains the main problem. In patients with nonkeratinizing squamous cell cancer, both local and regional control is important and elective irradiation of neck nodes may be of value. In patients with undifferentiated cancer, distant metastases appear to have the greatest impact on survival.     

124例上颌窦癌预后因素分析

目的探讨上颌窦癌的临床病理特征与预后的关系。方法124例上颌窦癌中放疗40例，手术治疗18例，放疗＋手术治疗66例。生存率计算采用Kaplan-Meier法，生存率差异比较采用Logrank检验，多因素分析采用Cox模型。结果5年总生存率、癌症相关生存率和无进展生存率分别为32.5％、37．4％和27．2％。单因素分析显示，肿瘤位置、病理类型、T分期、淋巴结转移情况、临床分期和治疗方式与癌症相关生存（CSS）和无进展生存（PFS）均有相关性；而年龄仅与CSS相关，而与PFS无关。多因素分析显示，病理类型、T分期、临床分期和治疗方式是影响预后的独立因素。结论T分期和临床分期是影响上颌窦癌预后的重要因素。对113～T4期即使淋巴结阴性上颌窦鳞癌，予以颈部预防性照射也是必要的。上颌窦癌的最佳治疗模式仍有待进一步研究。     

Postoperative radiotherapy for maxillary sinus cancer: long-term outcomes and toxicities of treatment

PURPOSE: To determine the effects of three changes in radiotherapy technique on the outcomes for patients irradiated postoperatively for maxillary sinus cancer. METHODS AND MATERIALS: The data of 146 patients treated between 1969 and 2002 were reviewed. The patients were separated into two groups according to the date of treatment. Group 1 included 90 patients treated before 1991 and Group 2 included 56 patients treated after 1991, when the three changes were implemented. The outcomes were compared between the two groups. RESULTS: No differences were found in the 5-year overall survival, recurrence-free survival, local control, nodal control, or distant metastasis rates between the two groups (51% vs. 62%, 51% vs. 57%, 76% vs. 70%, 82% vs. 83%, and 28% vs. 17% for Groups 1 and 2, respectively). The three changes were to increase the portals to cover the base of the skull in patients with perineural invasion, reducing their risk of local recurrence; the addition of elective neck irradiation in patients with squamous or undifferentiated histologic features, improving the nodal control, distant metastasis, and recurrence-free survival rates (64% vs. 93%, 20% vs. 3%, and 45% vs. 67%, respectively; p < 0.05 for all comparisons); and improving the dose distributions within the target volume, reducing the late Grade 3-4 complication rates (34% in Group 1 vs. 8% in Group 2, p = 0.014). Multivariate analysis revealed advancing age, the need for enucleation, and positive margins as independent predictors of worse overall survival. The need for enucleation also predicted for worse local control. CONCLUSION: The three changes in radiotherapy technique improved the outcomes for select patients as predicted. Despite these changes, little demonstrable overall improvement occurred in local control or survival for these patients and additional work must be done.     

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。     

20例晚期上颌窦癌同期加量放疗的临床研究

目的：分析晚期上颌窦癌同期加量照射与综合治疗的结果。方法：1995年以来本院行同期加量照射的20例晚期上颌窦癌病人，T3 4例，T4 16例，剂量DT60-85Gy／5—6周，其中4例行挽救手术。结果：三年生存率37．7％，五年生存率22．7％，全组二年局控率37．4％，五年局控率20．8％。75％疗终残留，其中80％为后上壁残留。结论：晚期上颌窦癌行同期加量照射能提高放疗疗效，但仍不及术前照射加手术的综合治疗；单纯放疗应采用缩野追量，使剂量达DT85Gy左右。     

上颌窦占位病变的CT诊断

目的　评价上颌窦占位病变的 Ｃ Ｔ 表现,探讨其 Ｃ Ｔ 诊断与鉴别诊断的价值。方法　收集手术病理诊断的上颌窦占位病变１０２ 例。术前经 Ｃ Ｔ 平扫加增强,全部病例行轴位扫描,部分病例加用冠状位扫描。结果　上颌窦囊肿３４ 例,息肉增生 ２９ 例,恶性肿瘤 ２０ 例（鳞癌 １５ 例、囊腺癌４ 例、恶性淋巴瘤 １ 例）,乳头状瘤 １２ 例,骨化性纤维瘤３ 例,骨瘤和曲菌感染各２ 例。与病理对照, Ｃ Ｔ 诊断正确率为８５．３％ （８７／１０２）,误诊率为１４．７％ （１５／１０２）。结论　上颌窦占位病变由多种疾病引起,对大多数有典型 Ｃ Ｔ 表现者能够作出定位、定性诊断,对部分不同病变而 Ｃ Ｔ表现相似者定性困难,除轴位扫描外,应加用冠状位扫描,穿刺活检也是必不可少的。     

Antrolith in the maxillary sinus: an unusual complication of endoscopic sinus surgery

Antrolith of the paranasal sinuses are rare entity which are usually asymptomatic, caused by calcification of a nidus and are detected incidentally on radiological examinations. We report a case which presented to us with features of pansinusitis six months after endoscopic sinus surgery. Radiological examination revealed a discrete bony density in the maxillary sinus blocking the ostiomeatal complex. The bony mass was removed endoscopically from the maxillary sinus with drainage of discharge and debris from the sinuses. Histopathological examination revealed an antrolith with bony nidus and calcium deposited around it. We present the imaging and review the present world literature on this rare complication of endoscopic sinus surgery.     

Outcomes after radiotherapy for squamous cell carcinoma of the eyelid

BACKGROUND: Squamous cell carcinoma (SCC) of the eyelid is a rare malignancy with metastatic potential. In the current study, the outcomes of patients with SCC of the eyelid were evaluated after definitive and postoperative radiation therapy. METHODS: The medical records of all patients treated with radiotherapy for SCC of the eyelid at 1 institution between 1950 and 2005 were reviewed. Patient records were analyzed for clinical characteristics, pathologic features, radiation techniques, and outcomes. Survival rates were calculated using the Kaplan-Meier method; factors affecting survival were assessed using the log-rank test. RESULTS: During the study period, 39 patients with 42 eyelid SCCs were treated with radiotherapy. Thirty-two tumors were treated with primary radiotherapy and 10 were treated with postoperative radiotherapy after wide local excision. Surviving patients were followed for a median of 76 months. The 5-year disease-specific and overall survival rates for all patients were 86% and 71%, respectively. At 5 years, local, regional, and distant disease control rates for all tumors were 88%, 95%, and 97%, respectively. There were no significant differences in the 5-year local, regional, and distant control rates between tumors treated with definitive and those treated with postoperative radiotherapy. There were no grade 3 or 4 complications. CONCLUSIONS: Primary radiotherapy for SCC of the eyelid provides excellent locoregional control with reasonable complication rates and should be considered an alternative to surgery in selected patients.