头颈部肿瘤放射治疗后发生第二恶性肿瘤(附18例报道)

Radiation induced second malignant tumors of head and neck following radiotherapy(Report of 18 cases)

目的 :探讨头颈部肿瘤放射治疗后诱发第二恶性肿瘤的诊断、机理及治疗方法。方法 :回顾性分析了我科 18例头颈部肿瘤放射治疗后诱发第二恶性肿瘤的临床资料。结果 :18例中 4例分别于第二次治疗过程中及治疗后 9个月、1年及 3年死于肿瘤 ,1例正在行第二次治疗 ,其余 13例至今健在 ,均无肿瘤复发及转移 ,最长 1例第二次治疗后已存活 7年零 8个月。结论 :放射诱发肿瘤是放射治疗最严重的并发症 ,提高这类患者疗效的关键是早期诊断、积极治疗。首选手术治疗 ,对不宜手术的头颈部诱发肿瘤还可采用再次放疗。

Objective:To investigate the clinical diagnosis,mechanism and treatment for second malignant tumors (SMTs) of head and neck induced by radiotherapy.Methods:18 cases of SMTs of head and neck following radiotherapy were studied retrospectively.Results:1 patient was dead during the second treatment,3 patients died at 9 months,1 year and 3 years after the second treatment,respectively.All of the 4 patients died of SMTs.Of the remaining 14 patients,1 is being treated at present,the rest 13 patients surviving free of disease up to now.1 patient has survived for more than 7 years since the second treatment.Conclusion:SMTs induced by radiation is the most serious complication of radiotherapy.The key to the successful management of this difficult disease is early detection and expedient treatment.The surgical operation is the first choice for these patients.The radiotherapy may be performed again for SMTs of head and neck when the patients are not suitable for operation.