累及眼眶的鼻腔鼻窦鳞癌(SNSCC)综合治疗的预后分析

Prognostic analysis of comprehensive treatment of orbit involved sinonasal squamous cell carcinoma (SNSCC)

目的分析累及眼眶的鼻腔鼻窦鳞癌(sinonasal squamous cell carcinoma,SNSCC)患者综合治疗情况及其预后。方法对2007年1月至2017年5月在复旦大学附属眼耳鼻喉科医院确诊并行放疗、手术、化疗或联合治疗的累及眼眶的40例SNSCC患者进行回顾性分析。结果全部病例中,男性24例,女性16例,中位年龄57岁,5年生存率为62.5%。仅2例行剜除眼球手术,16例行上颌骨截除、鼻外侧切等开放性手术,15例行鼻内镜手术,9例未接受手术。开放手术患者相对鼻内镜手术和未手术患者生存状况更好。所有患者均进行放疗,术前放疗19例,术后放疗12例,单纯放疗9例。术后放疗有改善生存的趋势,但差异无统计学意义。23例行调强放疗,17例行三维适形常规放疗,调强放疗剂量高于常规放疗,但未改善远期生存。姑息放化疗对累及眼眶的SNSCC患者仍有重要意义。结论对于累及眼眶的晚期SNSCC患者,保存眼球的综合治疗模式可以取得很好的总体生存率。

Objective To analyze the effectiveness and prognosis of the comprehensive treatment on patients with orbital involved sinonasal squamous cell carcinoma(SNSCC).Methods In Eye&ENT Hospital,Fudan University,40 cases of SNSCC diagnosed and treated,including radiotherapy,surgery,chemotherapy or combined treatment during Jan.,2007 and May,2017,were retrospectively analyzed.Results The median age of 24 males and 16 females was 57 years old,and the 5-year overall survival(OS)was 62.5%.Only 2 cases underwent orbital exenteration.Of all patients,16 cases underwent open surgery,including maxillary osteotomy,lateral nasal incision and so on,15 cases underwent endoscopic surgery,while 9 cases didn't receive surgery.Compared with endoscopic surgery and radiotherapy alone,open surgery can obtain survival benefit.All patients received radiotherapy,including 19 cases of preoperative radiotherapy,12 cases of postoperative radiotherapy and 9 cases of radiotherapy alone.Postoperative radiotherapy had the trend of survival improvement,although without statistical significance.Intensity modulated radiotherapy(IMRT)were performed in 23 cases,and 3-dimensional conformal radiotherapy(3DCRT)were performed in 17 cases.The radiation dose of IMRT was significantly increased compared with conventional radiotherapy,while the 5-year OS was not improved.Palliative radiochemotherapy is still of great significance in SNSCC with the orbit involved.Conclusions For the patients with advanced nasal sinus squamous cell carcinoma involving the orbit,the satisfactory OS of the preservation of the eyeball can be achieved through comprehensive treatment.