Parsons J T, Mendenhall W M, Mancuso A A, Cassisi N J, Million R R
University of Florida College of Medicine, Division of Radiation Therapy, Gainesville 32610.
Int J Radiat Oncol Biol Phys. 1988 Jan;14(1):11-22. doi: 10.1016/0360-3016(88)90044-2.
Between October 1964 and December 1983, 48 patients with malignant tumors of the nasal cavity (31), ethmoid sinus (13), or sphenoid sinus (4) were treated with curative intent by radiation therapy. There were 21 squamous cell carcinomas, 14 minor salivary gland tumors (adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma), 3 malignant melanomas, 2 soft tissue sarcomas, and 8 esthesioneuroblastomas. Forty-two patients were treated with irradiation alone and six with planned combined irradiation and surgery. The 10-year actuarial local control rate for Stage I (limited to site of origin; 7 patients) was 100%; for Stage II (extension to adjacent sites, e.g., adjacent sinuses, orbit, pterygomaxillary fossa, nasopharynx; 19 patients) was 53%; and for Stage III (destruction of skull base or pterygoid plates, or intracranial extension; 22 patients) was 30%. Of 24 failures at the primary site, 10 occurred greater than 24 months after completion of irradiation. With the exception of adenoid cystic carcinoma (17% local control at 15 years), the ultimate local control rates for all histologies were in the range of 40% to 60%. Of 7 patients with documented intracranial extension, 3 (43%) remained free from local recurrence 3.5, 4, and 9 years after treatment. The 5-, 10-, 15-, and 20-year uncorrected actuarial survival rates for all 48 patients were 52%, 30%, 22%, and 22%, respectively. Continuous disease-free survival according to stage at 10 years was 86% for Stage I, 42% for Stage II, and 22% for Stage III. The single failure in a patient with Stage I disease was a lymph node metastasis that was successfully managed by radical neck dissection. The orbit was grossly invaded by tumor prior to treatment in 22 patients (46%). Sixteen (33%) of 48 patients developed unilateral blindness secondary to radiation retinopathy or optic neuropathy; in the majority of these patients the complication was anticipated because the ipsilateral eye was irradiated to a high dose. Four patients (8%) unexpectedly developed bilateral blindness 17, 35, 46, and 90 months following treatment owing to optic nerve injury. A discussion of possible means of avoiding this latter, unacceptable complication is included.
1964年10月至1983年12月期间，48例鼻腔（31例）、筛窦（13例）或蝶窦（4例）恶性肿瘤患者接受了根治性放射治疗。其中有21例鳞状细胞癌、14例小唾液腺肿瘤（腺癌、腺样囊性癌和黏液表皮样癌）、3例恶性黑色素瘤、2例软组织肉瘤和8例嗅神经母细胞瘤。42例患者仅接受了放射治疗，6例接受了计划中的放疗联合手术。I期（局限于原发部位；7例患者）的10年精算局部控制率为100%；II期（扩展至相邻部位，如相邻鼻窦、眼眶、翼腭窝、鼻咽；19例患者）为53%；III期（颅底或翼板破坏或颅内扩展；22例患者）为30%。在24例原发部位复发的患者中，10例发生在放疗结束后24个月以上。除腺样囊性癌（15年局部控制率为17%）外，所有组织学类型的最终局部控制率在40%至60%之间。在7例有颅内扩展记录的患者中，3例（43%）在治疗后3.5年、4年和9年无局部复发。48例患者的5年、10年、15年和20年未校正精算生存率分别为52%、30%、22%和22%。10年时根据分期的持续无病生存率I期为86%，II期为42%，III期为22%。1例I期疾病患者的唯一复发是淋巴结转移，通过根治性颈清扫成功处理。22例患者（46%）在治疗前眼眶被肿瘤广泛侵犯。48例患者中有16例（33%）因放射性视网膜病变或视神经病变继发单侧失明；在这些患者中的大多数，由于同侧眼睛接受了高剂量照射，并发症是可预见的。4例患者（8%）在治疗后17、35、46和90个月因视神经损伤意外发生双侧失明。文中还讨论了避免后一种不可接受并发症的可能方法。
