鼻腔鼻窦黏膜恶性黑色素瘤的治疗选择与生存情况

Management options and survival in malignant melanoma of the sinonasal mucosa.

作者信息

Lund V J, Howard D J, Harding L, Wei W I

机构信息

Institute of Laryngology and Otology, London, England, UK.

出版信息

Laryngoscope. 1999 Feb;109(2 Pt 1):208-11. doi: 10.1097/00005537-199902000-00007.

DOI:10.1097/00005537-199902000-00007

PMID:10890767

Abstract

OBJECTIVES/METHODS: To determine whether surgery combined with radiotherapy confers any survival benefit on radical local excision alone in the management of mucosal malignant melanoma of the nose and sinuses.

STUDY DESIGN

Retrospective review.

METHODS

From a cohort of 72 patients treated between 1963 and 1996 within a single unit, complete data were available for 58 individuals who were examined to determine whether there was any significant statistical difference in local control and/or survival between those receiving surgery and those receiving combined surgery and radiotherapy.

RESULTS

There were 30 men and 28 women. Their ages ranged from 39 to 90 years (mean, 64 y). Twenty-nine patients underwent surgery alone; 23 patients underwent surgery and radiotherapy; 6 patients received surgery and chemotherapy; and 3 patients received surgery, chemotherapy, and radiotherapy. Primary surgery included lateral rhinotomy (42 cases), maxillectomy (8 cases [orbital clearance in 3 cases]), craniofacial resection (3 cases), total rhinectomy (3 cases), and endoscopic clearance (2 cases). Survival ranged from 1 to 228 months with rapid patient loss due to local (and/or systemic) disease during the first 36 months, irrespective of the treatment modality. Overall 5-year actuarial survival was 28%, and overall 10-year actuarial survival 20%, with a median survival of 21 months. There was no statistical difference in local control or survival between patients receiving surgery alone and those receiving surgery and radiotherapy, irrespective of whether this treatment was given in the early part of the series (i.e., before 1983) or thereafter. The addition of chemotherapy had no impact on survival, nor did the site of the tumor, the surgical procedure, the presence of lymph node metastases or the age of the patient.

CONCLUSION

In this large cohort of sinonasal melanoma, overall survival was poor and did not appear to be improved by the addition of radiotherapy.

摘要

目的/方法：确定在鼻腔和鼻窦黏膜恶性黑色素瘤的治疗中，手术联合放疗相对于单纯根治性局部切除是否能带来生存获益。

研究设计

回顾性研究。

方法

在1963年至1996年间于单个医疗单位接受治疗的72例患者队列中，58例患者有完整数据，对这些患者进行检查，以确定接受手术的患者与接受手术联合放疗的患者在局部控制和/或生存方面是否存在显著统计学差异。

结果

男性30例，女性28例。年龄范围为39至90岁（平均64岁）。29例患者仅接受手术；23例患者接受手术和放疗；6例患者接受手术和化疗；3例患者接受手术、化疗和放疗。初次手术包括鼻侧切开术（42例）、上颌骨切除术（8例[3例有眶内容物清除]）、颅面切除术（3例）、全鼻切除术（3例）和内镜清除术（2例）。生存期为1至228个月，在最初36个月内，由于局部（和/或全身）疾病导致患者快速流失，与治疗方式无关。总体5年精算生存率为28%，总体10年精算生存率为20%，中位生存期为21个月。仅接受手术的患者与接受手术和放疗的患者在局部控制或生存方面无统计学差异，无论这种治疗是在该系列早期（即1983年之前）还是之后进行。化疗的加入对生存无影响，肿瘤部位、手术方式、淋巴结转移情况或患者年龄也无影响。