鼻咽部腺样囊性癌的治疗体会

目的总结鼻咽腺样囊性癌的临床特征、治疗方法及预后，探讨更有效的治疗方式。方法回顾性分析中国医学科学院肿瘤医院头颈外科1968年1月—2000年5月问21例原发于鼻咽的腺样囊性癌患者的临床资料，分析单纯放疗与放疗结合手术两种治疗方式的5、10年的无瘤生存率以及肿瘤复发情况。结果21例鼻咽腺样囊性癌患者就诊时的主要症状有回吸性涕中带血、头痛、鼻塞、耳聋耳闷、复视伴视力减退及面部麻木等。其中T1、他期患者占28．6％（6／21），T3、T4期患者占71．4％（15／21）。颈部淋巴转移率为14．3％（3／21）。13例行单纯放疗，8例放疗结合手术治疗。2l例鼻咽腺样囊性癌患者失访1例，5年无瘤生存率为42．9％（9／21）。单纯放疗的5年无瘤生存率为38．5％（5／13），放疗结合手术的5年无瘤生存率为50．0％（4／8），二者差异无统计学意义（P=0．472）。随访10年的无瘤生存率为16．7％（3／18）。单纯放疗的10年无瘤生存率为0／12，放疗结合手术的10年无瘤生存率为50．0％（3／6），二者差异有统计学意义（P=0．025）。治疗后的局部复发率为50．0％（10／20）。单纯放疗的局部复发率为66．7％（8／12），放疗结合手术的局部复发率为25．0％（2／8），二者差异无统计学意义（P=0．085）。远处转移率为30．0％（6／20）。单纯放疗的远处转移率为25．0％（3／12），放疗结合手术的远处转移率为37．5％（3／8），二者差异无统计学意义（P=0．455）。结论鼻咽腺样囊性癌治疗后局部复发率高，晚期易出现远处转移。与单纯放疗相比，放疗结合手术可以提高鼻咽腺样囊性癌的10年无瘤生存率。

Therapeutic modalities of nasopharyngeal adenoid cystic carcinoma

Objective To grasp clinical characteristics, therapeutic methods and prognosis of the patients with nasopharyngeal adenoid cystic carcinoma, and explore the optimal therapeutic modalities. Methods Twenty one cases with nasopharyngeal adenoid cystic carcinoma were retrospectively reviewed. The treatment results were compared between radiotherapy alone and combined therapy. Results The cases with nasopharyngeal adenoid cystic carcinoma in T1,T2 phases was 28.6%,the cases in T3,T4 phases was 71.4%.The lymphatic node metastasis rate was 14.3%. The present symptoms were nasal discharge with blood, headache, nasal obstruction, deafness, double vision, facial insensibility,etc. One of 21 cases was lost follow up. Five years free-disease survival rates of the patients with nasopharyngeal adenoid cystic carcinoma was 42.9%(9/21). Five years free-disease survival rate of the patients with radiotherapy alone(RA) and the patients with radiotherapy combining surgery(R+S) were respectively 38.5%(5/12) and 50.0%(4/8),P=0.472. Ten years free-disease survival rates of the patients was 16.7%(3/18). Ten years free-disease survival rates of the patients with RA and the patients with R+S were respectively 0/12 and 3/6,P=0.025. The local recurrent rate was 50.0%(10/20). The local recurrent rates of the patients with RA and the patients with R+S were respectively 66.7%(8/12) and 25.0%(2/8),P=0.085. The distant metastasis rate was 30.0%(6/20). The distant metastasis rates of the patients with RA and the patients with R+S were respectively 25.0%(3/12) and 37.5%(3/8),P=0.455. Conclusions The course of nasopharyngeal adenoid cystic carcinoma is long, and it is prone to the local recurrence and the distant metastasis in advanced stage. Comparing with the radiotherapy alone, the radiotherapy combining surgery has better 10 years free-disease survival rate.