Moore Michael G, Lin Derrick T, Deschler Daniel G, Wang Jing J, Chan Annie W
Skull Base. 2011 Mar;21(2):87-92. doi: 10.1055/s-0030-1266762.
We sought to determine the risk of tumor incisional recurrence in patients receiving surgery and postoperative radiation therapy for locally advanced sinonasal malignancies. Medical records for 70 patients newly diagnosed with nonmetastatic American Joint Committee on Cancer stage II to stage IV sinonasal malignancies between 1991 and 2003 were retrospectively reviewed. Patient demographics and tumor variables were recorded. All patients underwent upfront surgical resection with postoperative three-dimensional conformal proton beam radiotherapy. Recurrence and survival-related outcomes were recorded. Two patients with squamous cell carcinoma had pathologically confirmed tumor recurrence at the incision site. The actuarial risk of incisional recurrence for the entire group at 1 year was 3%. One of the two patients had a maxillary sinus tumor and developed isolated skin recurrence along the transfacial incision. The other patient with an ethmoid sinus tumor developed isolated dural recurrence along the craniotomy incision. Both patients underwent multiple courses of salvage surgery and radiation therapy. One was successfully salvaged locally but developed distant metastases and the other died of local recurrence. Tumor seeding following transfacial and craniotomy surgery can occur, especially for squamous cell carcinoma. Sound oncological surgical technique, even when utilizing these difficult surgical approaches, is important to minimize incisional recurrence.
我们试图确定接受手术及术后放疗的局部晚期鼻窦恶性肿瘤患者的肿瘤切口复发风险。对1991年至2003年间新诊断为美国癌症联合委员会II期至IV期非转移性鼻窦恶性肿瘤的70例患者的病历进行了回顾性研究。记录了患者的人口统计学资料和肿瘤变量。所有患者均接受了 upfront 手术切除及术后三维适形质子束放疗。记录了复发及生存相关结果。两名鳞状细胞癌患者在切口部位经病理证实肿瘤复发。整个组1年时切口复发的精算风险为3%。两名患者中的一名患有上颌窦肿瘤，沿经面部切口出现孤立的皮肤复发。另一名患有筛窦肿瘤的患者沿开颅切口出现孤立的硬脑膜复发。两名患者均接受了多疗程的挽救性手术和放疗。一名患者在局部成功挽救但出现远处转移，另一名患者死于局部复发。经面部和开颅手术后可能发生肿瘤种植，尤其是鳞状细胞癌。即使采用这些困难的手术方法，合理的肿瘤外科技术对于将切口复发降至最低也很重要。
