蝶窦原发恶性肿瘤16例治疗分析

Treatment of primary sphenoid sinus malignancies：an analysis of 16 patients

目的：分析原发蝶窦恶性肿瘤治疗结果。方法回顾分析2000—2013年我院收治的原发蝶窦恶性肿瘤16例。初诊无颈部淋巴结发生转移。ⅣA期1例，ⅣB期15例。治疗方法包括手术＋放疗11例、单纯手术1例、单纯放疗3例、单纯化疗1例。手术全部为减瘤手术。放疗中位剂量69．96 Gy （56．00～80．56 Gy）。结果全组3年LC、DMFS、DFS、DSS分别为67％、69％、44％、58％，减瘤术＋放疗组分别为67％、55％、30％、41％。全部保留眶内容物及颅底。全组LR率25％，远处转移率37％，淋巴结复发率6％。预后分析未见与LC率及DSS相关因素。结论蝶窦肿瘤经减瘤手术＋术后放疗在保留眼眶及颅底前提下能取得良好疗效。蝶窦肿瘤治疗后淋巴结复发率低，临床不建议常规颈部淋巴结预防照射。

Objective To analyze the treatment outcomes of patients with primary sphenoid sinus malignancies. Methods Sixteen patients with primary sphenoid sinus malignancies admitted to our hospital from 2000 to 2013 were analyzed retrospectively. No patients were newly diagnosed with cervical lymph node metastasis. One patient had stageⅣA disease, while fifteen had stageⅣB disease. Eleven patients received surgery followed by radiotherapy, one surgery alone, three radiotherapy alone, and one chemotherapy alone. All surgeries were cytoreductive . The median dose of radiotherapy was 69. 96 Gy （ 56.00？80. 56 Gy ） . Results The 3？year local control （ LC） , distant metastasis？free survival （ DMFS） , disease？free survival （ DFS） , and disease？specific survival （ DSS） rates were 67%, 69%, 44%, and 58%, respectively, in all patients, and 67%, 55%, 30%, and 41%, respectively, in patients treated with cytoreductive surgery followed by radiotherapy. All orbital contents and skull base were preserved. In all patients, the local recurrence, distant metastasis, and lymph node recurrence rates were 25%, 37%, and 6%, respectively. There were no independent predictors for the LC and DSS rates based on the prognostic analysis. Conclusions With the orbital contents and skull base preserved, the cytoreductive surgery followed by radiotherapy yields satisfactory outcomes and a low lymph node recurrence rate in the treatment of sphenoid sinus malignancies. The prophylactic irradiation of cervical lymph nodes is not recommended in clinical practice.