现代放疗技术下鼻腔鼻窦恶性肿瘤转归分析

Synthetic treatment of malignant tumor of nasal cavity and sinus based-on modern technique radiotherapy

目的:评价基于现代放疗技术条件下鼻腔鼻窦恶性肿瘤的生物学行为差异及其治疗和疗效。方法:回顾性分析2004-2007年间治疗的200例鼻腔鼻窦恶性肿瘤患者病例资料。全部病例采用CT模拟定位及三维适形放疗技术。结果:在鼻腔鼻窦各种恶性肿瘤中,以发病部位计,发生率鼻腔>上颌窦>筛窦>蝶窦。从病理学角度分析,以鳞状细胞癌发病率最高,约占全部病例的54.5%,鼻窦鳞状细胞癌(主要是上颌窦鳞状细胞癌)多于鼻腔鳞状细胞癌;其他病理类型的发病率依次为腺癌>嗅(母细胞)神经上皮瘤>恶性黑色素瘤>胚胎型横纹肌肉瘤。颈淋巴结转移发生率胚胎型横纹肌肉瘤>嗅(母细胞)神经上皮瘤>恶性黑色素瘤>鳞状细胞癌>腺癌;从全身转移角度比较,发生率胚胎型横纹肌肉瘤>恶性黑色素瘤>腺癌>鼻腔鼻窦鳞状细胞癌和嗅(母细胞)神经上皮瘤。3年生存率:嗅上皮(嗅母细胞)瘤>腺癌>鼻腔鼻窦鳞状细胞癌>胚胎性横纹肌肉瘤>恶性黑色素瘤。无病例发生放疗相关的严重后遗症。结论:预后与病理类型、性别及疾病分期相关;综合治疗是鼻腔鼻窦恶性肿瘤应首选的治疗方法;以CT模拟定位为基础的三维适形放疗技术提高了鼻腔鼻窦恶性肿瘤的治疗效果,并能很好地保护正常组织。

Objective：To evaluate the therapeutic effect of malignant tumor of nasal cavity and sinus that based on modern radiotherapy.Method：Two hundred cases of malignant tumor of nasal cavity and sinus were retrospectively analyzed from 2004 to 2007.All the cases were location by CT simulator system and were treated with three dimensional conformal radiotherapy.Result：Among malignant tumor of nasal cavity and sinus,the incidence for locations was nasal cavity maxillary sinus ethmoid sinus sphenoid sinus;the incidence for the type of pathology was squamous cell carcinoma adenocarcinoma olfactory neuroblastoma and olfactory esthesioneoroepithelioma malignant melanoma rhabdomyosarcoma;the incidence for general metastasis was rhabdomyosarcoma malignant melanoma adenocarcinoma,inverted papilloma and malignant changes squamous cell carcinoma,olfactory neuroblastoma and olfactory esthesioneoroepithelioma.No severe radiation-related complication were found.Conclusion：Clinical stage,pathological type were the important factors effecting the prognosis of patients with malignant tumor of nasal cavity and sinus.Three dimensional conformal radiotherapy based on CT simulator system could improve therapeutic effect and protect the normal tissue very well.