体外放疗合并腔内固化治疗鼻咽癌的疗效观察

目的探讨体外放射治疗合并微波固化热疗对鼻咽癌的临床治疗价值.方法采用放射治疗合并微波固化热疗对临床32例鼻咽癌患者进行治疗观察,与常规单纯放射治疗进行对比分析.治疗组体外照射36Gy后,采用微波腔内固化一次,瘤体表面温度90±5℃.休息一周继续放疗至总剂量50～70Gy,再给予腔内微波固化1～4次.结果放射合并微波固化热疗对鼻咽癌的疗效比单纯放疗有明显优势.临床疗效显示治疗组完全缓解达75%.结论正确选择适应证并规范操作,放疗合并微波腔内固化治疗鼻咽癌可以获得更好的临床疗效,值得推广.     

中药放疗增敏散对鼻咽癌放疗增敏作用的临床观察

目的：探讨中西医结合治疗鼻咽癌的合理途径。方法：60例Ⅱ，Ⅲ期低分化鳞状细胞癌且有颈淋巴转移灶的鼻咽癌随机分为实验组30例，对照组30例，实验组使用常规放疗加中药放疗增敏散治疗，对照组单用常规放疗，观察两组近期疗效，颈淋巴转移灶缩小及放疗副反应情况。结果：实验组与对照组CR（完全缓解），PR（部分缓解）分别为83．3％、16．7％胶73．3％、26．7％；颈淋巴转移灶缩小50％及完全消退时，实验组与对照组的中位放疗时间分别为14．7天、23．5天和18．7天、28．9天。实验组优于对照组（P＜0．01）。结论：中药放疗增敏散配合鼻咽癌放射治疗能缩短肿瘤的消退时间，提高治疗效果，优于单纯放射治疗疗法。     

鼻咽癌激光手术后放射治疗和单纯放射治疗的疗效比较

为研究鼻咽癌新的治疗手段，采用Ｎｄ：ＹＡＧ激光对６７例鼻咽喉癌者进行激光手术及颈淋巴结清扫术再用直线加速器放射治疗（放疗），并与４２例鼻咽癌单纯放疗者作比较，观察５年存活率，发现Ｎｄ：ＹＡＧ激光手术后放疗组５年生存率达７６．１％，而单纯疗效为４２．９％，认为：Ｎｄ：ＹＡＧ激光手术治疗不失为鼻咽癌治疗的一种新手段。     

血卟啉衍生物配合放射治疗鼻咽癌患者三项免疫功能的检测

观察在放射治疗鼻咽癌时血卟啉衍生物（hematoporphyrinderivative，HPD）对患者免疫功能的影响，选择病理确诊的初诊鼻咽癌78例，分成单纯放疗组和血卟啉衍生物（HPD）＋放疗组，各39例，采用自身配对方法，分别测定各组放疗前、后免疫功能。结果为：①HPD＋放疗组放疗前后免疫功能无明显变化；②单纯放疗组放疗后较放疗前免疫功能明显下降，包括OKT3、OKT4、OKT4／OKT8和淋巴细胞转化率均具有统计学意义（P＜0．01和P＜0．05）。上述结果提示HPD配合放射治疗鼻咽癌对免疫功能具有一定的保护作用。     

金果钦加微波热凝术综合治疗慢性增生性咽炎的临床观察

目的观察中成药金果饮结合微波热凝术综合治疗慢性增生性咽炎的临床疗效。方法将符合诊断的126例慢性增生性咽炎患者按数字表法分为冶疗组和对照组各63例。对照组予以微波热凝术及术后口服常规消炎含片；治疗组在对照组的基础上加以中成药金果饮口服液治疗。在治疗结束半年后随访比较总体疗效。结果综合治疗组总有效率为92．1％；微波治疗组总有效率为87．3％。经统计学分析2组间差异有统计学意义（P〈0．05）。结论金果饮加微波热凝术综合治疗慢性增生性咽炎可明显改善患者症状，提高患者生活质量。     

金果饮加微波热凝术综合治疗慢性增生性咽炎的临床观察

目的观察中成药金果饮结合微波热凝术综合治疗慢性增生性咽炎的临床疗效。方法将符合诊断的126例慢性增生性咽炎患者按数字表法分为冶疗组和对照组各63例。对照组予以微波热凝术及术后口服常规消炎含片；治疗组在对照组的基础上加以中成药金果饮口服液治疗。在治疗结束半年后随访比较总体疗效。结果综合治疗组总有效率为92．1％；微波治疗组总有效率为87．3％。经统计学分析2组间差异有统计学意义（P〈0．05）。结论金果饮加微波热凝术综合治疗慢性增生性咽炎可明显改善患者症状，提高患者生活质量。     

用聚合酶链反应检测鼻咽癌脱落细胞中EB病毒DNA

应用聚合酶连反应技术检测３５例鼻咽癌患者（２４例刚进行＾６０Ｃｏ放疗或未治疗，１１例放疗接近结束或刚结束）的鼻咽部脱落细胞中的ＥＢ病毒ＤＮＡ，１２例急、慢性扁桃体炎或咽炎患者为正常对照组，另有４例鼻咽癌的活检组织。结果：２４例鼻咽癌未治疗或刚治疗组中脱落细胞ＥＢ病毒ＤＮＡ阳性２０例（８３．３％），阴性４例（１６．７％）；１１例鼻咽癌放疗将近结束或刚结束组ＥＢ病毒阳性１例（９．１％），阴性１０例（９     

放射疗法联合应用活血与扶正活血中药治疗鼻咽癌的对比研究

目的 观察活血与扶正活血中药联合放射治疗鼻咽癌的远期疗效。方法 98例首程放疗的鼻咽癌患者随机分成三组，I组31例采用单纯放射治疗，Ⅱ组33例联合活血汤治疗，Ⅲ组34例联合扶正活血汤治疗。观察治疗前后患症症状、瘤体变化及细胞免疫功能，随访5年以上。结果 三组近期有效率差异无显著性意义（P＞0．05）。毒副反应I组明显高于Ⅱ、Ⅲ组（P＜0．05）。5年生存率三组依次为35．48％、51．52％、61．70％，I组明显低于后两组（P＜0．01）。远处转移率三组依次为19．35％、27．27％和11．76％，Ⅱ组与I、Ⅲ组比较差异有显著性意义（P＜0．05）。治疗结束2个月后Ⅱ组CD3、CD4及NK细胞活性明显低于I、Ⅲ组（P＜0．05）。结论 扶正活血中药联合放射治疗能明显提高鼻咽癌患者远期生存率，而单纯活血药物有可能增加远处转移。     

微波治疗特发性突聋的疗效评价

采用频率为9370MHz脉冲式微波仪加综合药物疗特发性突聋70例，而对照组41例仅用药物综合治疗，疗程均20天。结果表明：微波组的有效率＝69．23％，对照缚为41．45％，两组间有显著差异（P＜0．01）：对发病后2周以上、2个月以内的患者，微波组的有效率为47．82％对照组为9．09％，两组也有显著差异（P＜0．05）。由此认为：微波对突聋确有明显的治疗作用。本文还探讨了微波的作用机理。     

鼻咽癌患者放疗后引起感音神经性聋的临床观察

目的探讨鼻咽癌患者放疗后不同时期感音神经性聋的程度及发生率。方法选择无分泌性中耳炎的鼻咽癌患者28例，利用纯音测听和听性脑干反应（ABR），结合声导抗和耳声发射测试患者放疗前和放疗后1个月、1年、2年和5年的纯音听阈及波Ⅰ、Ⅲ、Ⅴ潜伏期、Ⅰ～Ⅴ波间期、鼓室压和镫骨肌声反射，以及部分受放射耳的诱发性耳声发射。结果语频（0．5～4．0kHz）和高频（8kHz）平均骨导听阈情况：①放疗后1个月较治疗前分别提高7．1dB和25．7dB，与放疗前比较差异有统计学意义（P〈0．001）；②放疗后1年分别提高17．6dB和28．1dB，与放疗前比较差异有统计学意义（P〈0．001），与放疗后1个月比较差异也有统计学意义（P值均〈0．001或P〈0．05）；③放疗后2年分别提高21dB和27．4dB，与放疗后1年比较差异仅语频有统计学意义（P〈0．05）；④放疗后5年分别提高26．7dB和35．8dB，与放疗前、放疗后1个月、1年和2年比较差异均有统计学意义（P值均〈0．001）。其中语频和高频听力损害大于15dB的发生率分别为37．5％～94．7％和85．4％～97．4％；听力损害大于30dB的发生率分别为14．6％～63．2％和37．5％～73．7％。平均ABR波Ⅰ、Ⅲ和Ⅴ潜伏期及Ⅰ～Ⅴ波间期的情况：放疗后1个月与放疗前比较无明显延长（P〉0．05）；放疗后1年和2年，均较放疗前和放疗后1个月明显延长，差异有统计学意义（P〈0．05），1年和2年组比较差异无统计学意义（P〉0．05）；放疗后5年较放疗前显著延长（P〈0．001），与放疗后1年和2年比较，波Ⅰ、Ⅲ和Ⅴ潜伏期明显延长（P〈0．05），而Ⅰ～Ⅴ波间期无明显延长（P〉0．05）。放疗1年后10耳中有7耳，放疗5年后7耳中有4耳诱发性耳声发射正常，但ABR均明显异常。结论放射所致的感音神经性聋可发生在部分患者放疗后的早期，特别是高频；随放疗后时间延长，听力损害的发生率增加，程度加重；损害可发生在耳蜗或（和）蜗后听觉通路，表明听觉系统不同部位和不同个体对放射损伤的敏感性可能存在差异。     

Effect of microwave and ionizing radiation in patients with recurrent laryngeal carcinoma

This study describes the treatment and survival of 54 patients with gross recurrent laryngeal carcinoma after radiotherapy. Twenty-six patients were treated with local ultra-high frequency hyperthermia in combination with radiotherapy and chemotherapy (HRCH). Twenty-eight control patients were treated with radiotherapy and chemotherapy (RCh). Eight patients (33 per cent) in HRCh showed a three year survival but no patient in the RCh group. At two years 18 patients (75 per cent) in HRCh and two (7 per cent) in RCh survived.     

Induction chemotherapy and laryngeal preservation in pharyngolaryngeal carcinomas. Study of a 124 serie's patients and patient's follow up with laryngeal preservation

OBJECTIVE: To try and determine the value of chemotherapy and its subsequent effect on laryngeal preservation in patients presenting with laryngeal and pharyngeal carcinomas. One group was initially treated with surgery and radiotherapy. The second group was treated with chemotherapy and subsequent salvage surgery and/or radiotherapy. Their survival rates and laryngeal preservation rates were compared. PATIENTS AND METHODS: From 251 patients the authors have retrospectively studied 124 patients with induction chemotherapy. The survival rate has been compared with a control group of 127 patients who was treated by initial surgery and radiotherapy. RESULTS: The survival rate at 5 years for the patients initially treated by surgery and radiotherapy was 64.1%. The survival for patients with a total clinical response following chemotherapy was 49.8% at 5 years. Survival with no total clinical response following chemotherapy treated by secondary radiotherapy was 25.7% at 3 years. The initial rate of laryngeal preservation is 32.2% but this rate fell to 22% after local recurrencies. CONCLUSION: The group with total clinical response after induction chemotherapy with laryngeal preservation have a non significantly difference in their survival compared with the group initially treated by surgery and radiotherapy. In contrary patients with non complete clinical response have a survival of 25.7% at 3 years. The rate of local recurrency of patients with laryngeal preservation is 32.5% and gives a finally rate of laryngeal preservation of 21%. These recurrencies decrease the survival rate.     

Results of treating cervical metastases of an unknown primary tumor. A report of 29 cases

A retrospective study was made of 29 patients with cervical metastasis of an unknown primary tumor. Sixteen patients received local treatment with surgery and radiotherapy (group A) and 13 patients were treated with induction chemotherapy, surgery and radiotherapy (group B). All patients responded. Local recurrence occurred in 21.4% of group A and 20% of group B. The frequency of distant metastases was similar (18.8% vs 15.4%). The mean survival time of 68 months in group A was longer than the 40 months of group B, and the a 2-year survival rate was 81% in group A and 67% in group B. The 5-year survival was better in group B (56% vs 40%). The primary tumor was identified twice as often in the patients who received only local treatment (group A 37.5% and group B 15.4%). Detection of the primary tumor was the only factor that significantly influenced patient survival.     

Radiotherapy versus surgery for early T1-T2 glottic carcinoma

OBJECTIVES: To compare surgery and radiotherapy as treatments for early T1-T2 glottic cancer in terms of local and regional control, complications, cost, and voice outcome. METHODS: Retrospective comparative review of 36 patients with T1 or T2 glottic carcinoma diagnosed between 1992 and 2003 at the McGill University Health Centre. Twelve patients postsurgery (group 1) and 26 patients postradiotherapy (group 2) were compared in terms of local and regional control and complications related to treatment. The costs of surgery and radiotherapy, including all personnel and equipment, were estimated. A cross-sectional study was undertaken of 11 patients with a history of T1 or T2 glottic carcinoma: 5 patients postsurgery, 4 patients postradiotherapy, and 2 patients postradiotherapy and surgery. Vocal fold function and voice quality were assessed by an otolaryngologist using videostroboscopy and a standardized questionnaire (Voice Handicap Index) and by an experienced speech-language pathologist using the Visipitch II computer program (Kay Elemetrics Corp., Lincoln Park, NJ). RESULTS: Retrospective study: The recurrence rate following primary treatment was 37.5% for group 1 and 22% for group 2. Group 1 patients presented with 25% of local complications (vocal fold scars) and no systemic complications. Patients in group 2 presented with local and systemic complications: 35% for local and 27% for systemic. One patient had mild carotid stenosis, and one patient had mild esophageal stenosis. The cost of treatment with radiotherapy was five times higher than the cost of surgery. Cross-sectional study: Vocal fold function assessed by videostroboscopy was superior in group 2. However, patients in group 1 scored higher on the subjective (Voice Handicap Index questionnaire) and objective (Visipitch parameters) voice assessments. CONCLUSION: Surgery and radiotherapy are both very effective in terms of local and regional control for early glottic carcinoma. However, surgery tends to be more cost-effective, with less complications and possibly a better voice outcome.     

57例鼻腔鼻窦T细胞淋巴瘤临床疗效及预后分析

目的探讨鼻腔鼻窦T细胞淋巴瘤临床疗效及预后因素。方法回顾性分析1983年7月~2001年4月我院收治的57例鼻腔鼻窦T细胞淋巴瘤,其中单纯放疗(R组)22例,放疗 化疗(R C组)35例。Kaplan-Meier法计算3,5年生存率和局控率,Logrank进行显著性检验和单因素分析,Cox模型进行多因素分析。结果放疗组(R组)和放疗 化疗组(R C组)3,5年生存率分别为64.7%,55.2%和74.4%,69.8%。两组3,5年生存率比较有统计学意义(P<0.05)。两组3,5年局控率分别为95.4%,87.2%和94.5%,89.7%。两组3,5年局控率比较无统计学意义(P>0.05)。多因素分析显示,B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的独立预后因素;影响鼻腔鼻窦T细胞淋巴瘤局控率的独立预后因素是累及部位、临床分期、治疗方式、放疗剂量。结论放疗 化疗组(R C组)明显提高了鼻腔鼻窦T细胞淋巴瘤3,5年生存率,但不能改善局控率。B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的重要因素,累及部位、临床分期、治疗方式、放疗剂量与鼻腔鼻窦T细胞淋巴瘤局控有关。     

Squamous cell carcinoma of the nasal vestibule

Squamous cell carcinoma of the nasal vestibule is a rare disease. Most advocate radiotherapy as a primary treatment for early tumours, with surgery reserved for salvage. For advanced disease, combined therapy with surgery and postoperative radiotherapy is generally recommended. Fourteen patients with squamous cell carcinoma of the nasal vestibule were reviewed. A classification of early versus late lesions was used. We achieved a 78% local regional control rate (minimum follow-up 3 years) in patients with early disease, with either radiotherapy or surgery as a primary modality of treatment. All patients with late disease recurred, requiring further surgical and/or radiation treatment. Only 20% of these patients were disease free at 2 years. Recurrent disease in either group, whether local or regional, carried a grave prognosis, with a 25% disease-free survival at 3 years.     

Ploidy status and the response of T1 glottic carcinoma to radiotherapy

Flow cytometric DNA ploidy measurements were performed on formalin fixed paraffin embedded tumour specimens from patients with a T₁ glottic laryngeal carcinoma in order to evaluate the role of DNA content in relation to local control. From 1980 to 1987, a consecutive series of 90 patients with a T₁ glottic laryngeal carcinoma were treated by radiotherapy with curative intent. Biopsies from 44 of these patients were readily available for DNA flow cytometry. In this group aneuploidy was associated with a significantly higher risk (P= 0.018) of local recurrence within 2 years after completion of radiotherapy (38% vs. 9% in the diploid group).     

T2 laryngeal carcinoma with impaired mobility: subtypes with therapeutic implications

The aim of this study was to evaluate the outcome in the treatment of T2 laryngeal carcinoma with impaired laryngeal mobility, comparing surgical management to radiotherapy in terms of local control and survival. The files of 66 patients treated between 1988 and 1994 were retrospectively studied for tumor location, treatment and outcome. Forty-two patients were treated surgically and 24 by radiotherapy. Follow-up averaged 8.5 years. Local recurrence occurred in 12.5% of the cases treated by conservation laryngeal surgery and in 21% of the cases by radiotherapy. Ultimate laryngeal preservation was achieved in 90.9% of the cases initially treated by partial laryngectomy and in 87.5% of the cases treated by radiotherapy. Five-year actuarial survival rates were 90% and 28%, respectively. A higher rate of metastases and second primaries occurred in the group treated by radiotherapy. T2 laryngeal carcinoma amenable to partial laryngectomy had a higher local control rate than the cases not amenable to conservation surgery and treated by radiotherapy. Tumors differed in the two treatment groups in location and extensions, despite the fact that all were T2 tumors. We emphasize the limits of retrospective studies. Only prospective randomized studies will determine the true results of surgery versus radiotherapy for a homogeneous subset of T2 laryngeal tumors. Received: 17 May 2001 / Accepted: 21 August 2001     

Olfactory neuroblastoma: long-term clinical outcome at a single institute between 1979 and 2003

CONCLUSIONS: The progression of olfactory neuroblastoma showed a biphasic pattern. As well as Hyams' histopathological grading and neck metastasis at presentation, early phase recurrence should be regarded as an important prognosticator. A high local failure rate suggests that craniofacial resection followed by postoperative radiotherapy should still be the standard treatment for olfactory neuroblastoma. OBJECTIVE: The aim of this study was to evaluate factors associated with survival and local control of olfactory neuroblastoma in the long run and to estimate treatment strategies. PATIENTS AND METHODS: Twelve patients (seven men and five women) who had undergone initial curative treatment for olfactory neuroblastoma were retrospectively analyzed. RESULTS: Cause-specific 10-year survival was 64.8%, while disease-free 10-year survival remained 28.6%. Local failure was found in half of the patients. All of the three patients who did not receive radiotherapy developed local failure. A biphasic pattern of recurrence was observed. The early phase recurrence group showed a significantly poorer survival than the late phase recurrence group. Hyams' histopathological grading and neck metastasis at presentation were also correlated with survival.     

A comparison of surgery and radiotherapy in the management of advanced pyriform fossa carcinoma

This retrospective study analyses the outcome of treatment of 61 patients with advanced carcinoma of the pyriform fossa. Thirty-two patients (group 1) underwent surgery and postoperative radiotherapy and 29 patients (group 2) had induction chemotherapy followed by radiotherapy. The local recurrence-free survival at 5 years from the completion of therapy for group 1 was 54%, compared to 61% for group 2. The 5-year neck recurrence-free survival for groups 1 and 2 were 54% and 59%, respectively. The 5-year overall survival rates for groups 1 and 2 were 19% and 14%, respectively. Non-surgical therapy for advanced stage pyriform fossa cancer provides survival comparable with that achieved with the standard approach of surgery and postoperative radiotherapy. We advocate radical irradiation as the method of choice because it provides nodal coverage to the bilateral jugular chains and retropharyngeal nodes, all known to be at risk for metastases, and is associated with lower morbidity compared to surgery. But, however, despite the therapy, the outcome is poor.