鼻咽癌放疗后骨肉瘤的临床病理特点和预后

Clinicopathological features and prognosis of postirradiation osteosarcoma in nasopharyngeal carcinoma

目的本文探讨鼻咽癌放疗后骨肉瘤的临床病理特征、治疗和预后。方法回顾1964—2003年于中山大学肿瘤防治中心治疗的426例骨肉瘤患者,其中15例诊断为鼻咽癌放疗后骨肉瘤。描述其发生率,发生时间,好发部位,影像学特征,病理亚型以及治疗情况。随访并应用KaplanMeier法统计生存率并分析影响预后的相关因素。结果12例行根治性手术治疗患者中1例局部残留,6例术后局部复发。复发间隔时间5～19个月(平均9个月)。所有患者生存时间介于7～41个月,平均18个月。1年和2年累积生存率分别为60%和24%。影像学上有大量骨形成的女性患者较仅有少量或无骨形成男性患者的生存率明显增高。预后分析显示年龄、放疗剂量、放疗后骨肉瘤发生时间、肿瘤大小和治疗情况可能不是预后的影响因素。结论鼻咽癌放疗后骨肉瘤是高度恶性的肿瘤,预后差。手术联合术前术后化疗有可能改善预后。

Objective Post irradiation osteosarcoma （PIOS） in patients with nasopharyngeal carcinoma （NPC） is rare and a potential late complication of radiation. We investigate its clinicopathological features and prognosis. Methods 426 cases of bone sarcomas in Cancer Center of Sun Yat-sen University, China between 1964 and 2003 were reviewed retrospectively. Fifteen patients were determined to have PIOS after radiation of NPC. Its prevelance rate, onset time, site, image features, and treatment were described. Kaplan-Meier analysis was used to determine the relative prognostic factors. Results In 12 patients undertaken radical surgery, one patient had residual tumor and six patients presented tumor recurrence five to 19 months （ mean of nine months） after surgery. All patients survived seven to 41 months with a mean of 18 months. The one-year and two-year survival rates were 60% and 24% respectively. Female patients with large area of tumor bone formation in images had better survival than male patients without or few tumor bone formation. Age, radiation dosage, onset time of PIOS, tumor size, and treatment were probably not significant factors to prognosis. Conclusions PIOS in patients with NPC is a high malignant disease and often has poor prognosis. Surgery with pre-and post-operative chemotherapy might be a way to improve its survival.