Krengli M, Gabriele P, Turri L, Ruo Redda M G, Pisani P, Negri G
Divisione di Radioterapia, Facoltà di Medicina e Chirurgia di Novara.
Radiol Med. 1994 Sep;88(3):291-4.
Seventy-three cases of paranasal sinus tumors observed between 1980 and 1991 were retrospectively analyzed. Our series consisted of 50 men and 23 women aged 43 to 83 years. Histology demonstrated 33 squamous cell carcinomas, 20 adenocarcinomas, 10 undifferentiated carcinomas, 3 mucoepidermoid carcinomas, 3 adenoid-cystic carcinomas, 2 osteosarcomas, 1 fibrosarcoma and 1 melanoma. All patients were untreated. The lesions from maxillary sinus consisted of 3 T2, 13 T3 and 39 T4 tumors; 50 cases were N0 and 5 N+. "Central" neoplasms consisted of 6 stage I, 7 stage II and 5 stage III lesions. All patients underwent irradiation (with 60Co) with two angled fields or three fields -2 opposing lateral and 1 anterior. Critical structures were shielded when possible and wedges were used to optimize dose distribution. Locoregional lymph nodes were treated in N+ cases only. Dose distribution was studied on CT images. All patients received a total dose of 54-72 Gy (mean: 61.4, median: 62 Gy) with 1.8-2 Gy/day fractions for 5 days/week. After irradiation 27/73 (30.8%) complete responses were observed. Local control at 6 months was obtained in 17/73 cases (23.3%) and it was correlated with the total dose. Actuarial survival rates at 3 and 5 years were 27.9% and 21.8%, respectively. At the multivariate analysis, the only significant variable was the stage; no correlations were found with sex, histology and site. During follow-up, lymph node metastases were observed in 4/66 initially N0 cases. Distant metastases were found in 10/73 patients (13.7%) and secondary lesions in 8/73 (11%). Severe complications were observed in 7/73 cases (9.6%).
对1980年至1991年间观察到的73例鼻窦肿瘤进行回顾性分析。我们的病例系列包括50名男性和23名女性，年龄在43至83岁之间。组织学检查显示33例鳞状细胞癌、20例腺癌、10例未分化癌、3例黏液表皮样癌、3例腺样囊性癌、2例骨肉瘤、1例纤维肉瘤和1例黑色素瘤。所有患者均未接受过治疗。上颌窦病变包括3例T2、13例T3和39例T4肿瘤；50例为N0，5例为N+。“中心”肿瘤包括6例I期、7例II期和5例III期病变。所有患者均接受了（使用60Co）两个成角野或三个野（两个相对的侧野和一个前野）的照射。尽可能对关键结构进行屏蔽，并使用楔形板优化剂量分布。仅对N+病例的局部区域淋巴结进行治疗。在CT图像上研究剂量分布。所有患者接受的总剂量为54-72 Gy（平均：61.4，中位数：62 Gy），每周5天，每天分次给予1.8-2 Gy。照射后观察到27/73（30.8%）完全缓解。17/73例（23.3%）在6个月时获得局部控制，且与总剂量相关。3年和5年精算生存率分别为27.9%和21.8%。多因素分析显示，唯一显著的变量是分期；未发现与性别、组织学和部位相关。随访期间，4/66例最初为N0的病例出现了淋巴结转移。10/73例患者（13.7%）发现远处转移，8/73例（11%）出现继发性病变。7/73例（9.6%）观察到严重并发症。
