上颌窦鳞状细胞癌手术联合放疗3种综合治疗方案的疗效分析  

Analysis of the outcomes of squamous cell carcinoma of maxillary sinus with 3 different comprehensive treatments

作　　者：彭晖 叶茂昌 王来平 李容新 周瑜 王祎 朱伟政 

机构地区：[1]安徽医科大学附属省立医院口腔颌面头颈外科研究室,安徽合肥230001

出　　处：《上海口腔医学》2015年第2期219-223,共5页Shanghai Journal of Stomatology

摘　　要：目的 ：回顾分析采用以手术联合放射治疗的3种综合治疗方案[化疗＋手术＋放疗（CSR）、放疗＋手术（RS）和手术前、后各半程放射治疗（RSR）]治疗中晚期上颌窦鳞癌的中远期疗效。方法：1985—2008年间446例资料完整的上颌窦鳞癌初治病例,非计划性分别应用上述3种治疗方案,其中231例CSR的照射剂量为60-70Gy/30-35次/5-7周;128例RS为40-50Gy/20-25次/4-5周;87例RSR为CSR全量的1/2。手术范围：上颌骨全切除299例,次全切除111例,扩大切除36例（包括眶内容清除13例）;根治性颈淋巴清扫术49例（56侧）,功能性颈淋巴清扫术73例（77侧）,肩胛舌骨肌上淋巴颈清扫术56例。应用SPSS16.0软件包进行统计学分析。结果：446例患者的5年生存率为45.96%（205/446）,因肿瘤死亡220例,84.09%（185/220）为局部复发。CSR 5年生存率为45.88%（106/231）,因肿瘤死亡114例,83.33%（95/114）为局部复发;RS 5年生存率为46.09%（59/128）,局部复发率为85.71%;RSR 5年生存率为45.97%（40/87）,局部复发率为83.72%。其中CSR、RS和RSR的5年生存率无显著差异。结论 ：本组上颌窦鳞癌的非计划性综合治疗（手术加放射治疗）有较高的5年生存率,3种治疗方案的效果无显著差异。对中、晚期上颌窦鳞癌病例进行预防性放疗或颈淋巴清扫术有其合理性和必要性。PURPOSE： To study the medium or long-term survival rates of different methods used in the treatment of advanced squamous cell carcinoma of the maxillary sinus （SCMS）. METHODS： Patients were treated by one of the following methods： 231 patients were treated with induction chemotherapy, followed by radical resection and radiotherapy （CSR）; 128 patients were treated with preoperative irradiation （RS）, and 87 patients underwent adjuvant radiotherapy （RSR）. A total of 446 cases of SCMS from June 1985 to December 2008 were managed with unscheduled application of the above 3 kinds of treatment options. The dose of 231 patients with CSR and 128 patients with RS was 60-70Gy/30- 35times/5-7week and 40-50gy/20-25times/4-5week, respectively. Dose in RSR accounted for half of that in CSR. The number of cases undergoing total resection of maxilla, subtotal resection of maxilla and extended excision of maxilla were 299, 111 and 36, respectively （15 cases had orbital exenteration）. The number of patients with therapeutic radical neck dissection, functional neck dissection and supraomohyoid neck dissection were 49, 73 and 56, respectively. The data was analyzed with SPSS16.0 software package. RESULTS： Five-year survival rate in 446 cases was 45.96% （205/dd6）, and 220 patients died of tumors, among which 84.09% （185/220） of death were due to local recurrences. The 5-year survival rate of CSR, RS, and RSR were 45.88% （106/23）, 46.09% （59/128） and 45.97% （40/87）, respectively; Totally 83.33% of CSR, 85.71% of RS and 83.72% of RSR died of local recurrences. There was no significant difference in the survival rates among CSR, RS and RSR. CONCLUSIONS： Unscheduled comprehensive treatment have a higher 5-year survival rate in this advanced SCMS. Elective neck irradiation and neck dissection are necessary for medium or advanced squamous cell carcinoma of maxillary sinus.

关 键 词：上颌窦肿瘤 放射治疗 综合治疗 

分 类 号：R739.8[医药卫生—肿瘤]