放射诱发的第二原发性恶性肿瘤的临床治疗

目的 探索放射诱发的第二原发性恶性肿瘤的临床诊断和治疗。方法 回顾分析108例鼻咽癌患者因放射诱发的第二原发性恶性肿瘤的临床资料。结果 小组108例患者中,鳞状上皮癌43例,占39．8％;肉瘤类26例,占24．1％;恶性纤维组织细胞瘤14例,占13．0%;腺样囊性癌12例,占11．1％;甲状腺乳头状腺癌8例,占7．4％;恶性黑色素瘤5例,占4．6％。手术治疗50例,放射治疗32例,全身化疗18例,诱导化疗并手术治疗8例。手术组3,5年无瘤生存率分别为64．0％和36．0％,放疗组3,5年无瘤生存率分别为34．4％和18．8％。结论 放射诱发的第二原发性恶性肿瘤如具备手术适应证,应首选外科治疗。与治疗第一原发癌一样,积极治疗第二原发性恶性肿瘤同样可以获得较好的治疗效果。

Treatment of second primary malignant tumor induced by radiotherapy

Objective To study the diagnosis and treatment of a second primary malignant tumor induced by previous radiotherapy. Methods From March 1970 to March 1997, 108 nasopharyngeal cancer (NPC) patients who developed a second primary malignant tumor induced by radiotherapy were treated. There were squamous carcinoma 43 (39.8%), sarcoma 26 (24.1%), malignant fibrous histiocytoma 14 (13.0%), adenoid cystic carcinoma 12 (11.1%), thyroid papillary adenocarcinoma 8 (7.4%) and malignant melanoma 5(4.6%). Fifty patients underwent operation, 32 received radiotherapy, 18 received chemotherapy and 8 received operation combined with chemotherapy. Results The 3 and 5 year tumor free survival rates were 64.0% and 36.0 % in the operation group. They were 34.4% and 18.8% in the radiotherapy group. Conclusion Surgery, if not contra indicated, is the first choice for the second primary malignant tumor induced by radiotherapy. Aggressive treatment for these patients is, hence, indicated clinically. [