Stern S J, Goepfert H, Clayman G, Byers R, Ang K K, el-Naggar A K, Wolf P
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock.
Arch Otolaryngol Head Neck Surg. 1993 Sep;119(9):964-9. doi: 10.1001/archotol.1993.01880210052008.
Eighty-five patients with squamous cell cancer of the maxillary sinus received all of their treatment at The University of Texas M.D. Anderson Cancer Center between the years 1971 and 1986. Their records were evaluated according to stage, disease at presentation, symptoms and signs at presentation, treatment, and outcome. There were no differences in locoregional control or survival between groups treated with surgery alone vs surgery plus radiotherapy. Careful analysis of the data indicates that there was almost certainly some selection bias for the patients undergoing combination therapy, as most of this group had historically adverse prognostic factors identified. Those patients who underwent radiotherapy alone or chemotherapy presented with either metastatic or locally advanced disease and were treated with palliative intent; therefore, comparison between this group and standard therapy groups was impossible in this retrospective review. Although it is tempting to speculate that combination therapy improved locoregional control and survival in patients with more advanced disease, none of the data presented in this review reach statistical significance. Furthermore, there is no difference in survival in this population compared with a study at this institution 20 years ago. Squamous cell cancer of the maxillary sinus continues to be a challenging neoplasm. Radiotherapy may improve locoregional control and survival in a group of patients with more advanced disease and may have its greatest utility in earlier-stage disease. A multi-institutional prospective trial is needed to find ways to improve outcome in this patient population.
1971年至1986年间,85例上颌窦鳞状细胞癌患者均在德克萨斯大学MD安德森癌症中心接受了全部治疗。根据分期、初诊时的疾病情况、初诊时的症状和体征、治疗方法及治疗结果对他们的病历进行了评估。单纯手术治疗组与手术加放疗组在局部区域控制或生存率方面没有差异。对数据的仔细分析表明,接受联合治疗的患者几乎肯定存在一些选择偏倚,因为该组大多数患者既往已确定有不良预后因素。那些单独接受放疗或化疗的患者表现为转移性或局部晚期疾病,且治疗目的是姑息性的;因此,在这项回顾性研究中,无法将该组与标准治疗组进行比较。尽管推测联合治疗可改善更晚期疾病患者的局部区域控制和生存率很诱人,但本综述中呈现的数据均未达到统计学意义。此外,与该机构20年前的一项研究相比,该人群的生存率没有差异。上颌窦鳞状细胞癌仍然是一种具有挑战性的肿瘤。放疗可能会改善一组更晚期疾病患者的局部区域控制和生存率,并且在早期疾病中可能具有最大的效用。需要进行一项多机构前瞻性试验,以找到改善该患者群体治疗结果的方法。