Carrau R L, Segas J, Nuss D W, Snyderman C H, Janecka I P, Myers E N, D'Amico F, Johnson J T
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Laryngoscope. 1999 Feb;109(2 Pt 1):230-5. doi: 10.1097/00005537-199902000-00012.
OBJECTIVE/HYPOTHESIS: The treatment of squamous cell carcinoma (SCC) of the sinonasal tract has evolved from routine exenteration of the orbital contents to sparing of the orbit when the SCC does not transgress the periorbita. Nonetheless, the influence of this change in treatment over the rate of local recurrence or survival has not been clearly elucidated. The objective was to ascertain whether orbital sparing surgery for the treatment of SCC of the paranasal sinuses influences the rate of local recurrence or survival.
This is a retrospective study of patients presenting with SCC arising in the sinonasal tract, treated primarily at the University of Pittsburgh Medical Center from 1977 to 1990, including meta-analysis of the English literature regarding SCC of the sinonasal tract.
Review of medical records regarding demographics, histology, extension of tumor, pathologic results, type of surgery, adjunctive therapy, and outcome. Articles for meta-analysis were identified by Medline search and cross-referencing.
Fifty-eight patients with orbital invasion, including bone and/or soft tissue invasion, were included in the study. Patients presenting with invasion of the bony orbit without soft tissue invasion were treated with maxillectomy and/or ethmoidectomy, sparing the orbital contents. Patients presenting with invasion of the orbital bones and soft tissues were treated with ethmoidectomy or maxillectomy, including orbital exenteration. At 3 years' follow-up, 52% of the patients whose orbit was exenterated were alive and without evidence of disease, compared with 59% of the patients whose orbit was spared. This difference was not statistically significant. Similarly, the rate of local recurrence was not statistically significant (P > .05). A meta-analysis of the literature revealed similar results.
Our data suggest that sparing of the soft tissues of the orbit when the periorbita has not been transgressed by SCC does not downgrade the rate of cure or local control.
目的/假设：鼻窦鳞状细胞癌（SCC）的治疗已从常规的眶内容物剜除术发展为当SCC未侵犯眶周组织时保留眼眶。然而，这种治疗方式的改变对局部复发率或生存率的影响尚未明确阐明。目的是确定鼻窦SCC的眼眶保留手术是否会影响局部复发率或生存率。
这是一项对1977年至1990年主要在匹兹堡大学医学中心接受治疗的鼻窦SCC患者的回顾性研究，包括对有关鼻窦SCC的英文文献的荟萃分析。
回顾关于人口统计学、组织学、肿瘤扩展、病理结果、手术类型、辅助治疗和结果的医疗记录。通过Medline搜索和交叉引用确定用于荟萃分析的文章。
58例伴有眼眶侵犯（包括骨和/或软组织侵犯）的患者纳入研究。眼眶骨侵犯但无软组织侵犯的患者接受上颌骨切除术和/或筛窦切除术，保留眶内容物。眼眶骨和软组织均受侵犯的患者接受筛窦切除术或上颌骨切除术，包括眼眶剜除术。随访3年时，接受眼眶剜除术的患者中有52%存活且无疾病证据，而眼眶保留的患者为59%。这种差异无统计学意义。同样，局部复发率也无统计学意义（P>.05）。文献荟萃分析显示了类似结果。
我们的数据表明，当SCC未侵犯眶周组织时保留眼眶软组织不会降低治愈率或局部控制率。
