Hug E B, Wang C C, Montgomery W W, Goodman M L
Department of Radiation Oncology, Massachusetts General Hospital, Boston 02114.
Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):67-72. doi: 10.1016/0360-3016(93)90174-t.
Locally advanced inverted papilloma and inverted papilloma associated with squamous cell carcinoma are at high risk of local failure due to limitations of surgical resection resulting in repeat surgical procedures. The role of adjuvant radiation therapy is poorly defined. This study reviews a single institution experience of radiation therapy in the management of this disease.
Between 1977 and 1990 25 patients were treated at the Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary with radiation therapy for inverted papilloma (seven patients) and inverted papilloma associated with squamous cell carcinoma (18 patients) of the nasal cavity and paranasal sinuses. All patients presented with locally advanced invasive tumors; 5 of 7 with inverted papilloma had previous resections and 4 of 18 with associated squamous cell carcinoma had history of prior surgical excisions of inverted papilloma only (three patients) or inverted papilloma with squamous cell carcinoma in situ (one patient). Sixteen patients underwent radiation treatment following gross total resection, eight patients after subtotal tumor resection and one patient was inoperable by local invasion and received radiation therapy alone.
Local control was achieved in 6 of 7 patients with inverted papilloma only and one patient required additional resection for persistent disease. Of 18 patients with associated squamous cell carcinoma, 17 were locally controlled after radiation therapy and one had persistent tumor. One patient failed locally 3 years after treatment. With a mean observation time of 4.8 years (range: 0.5-12.9 years) all seven (100%) patients with inverted papilloma only and 15 of 18 (83%) patients with associated invasive carcinoma are alive and without evidence of disease. Three patients with inverted papilloma associated with squamous cell carcinoma died, two patients as a result of their disease (one patient with persistent disease, one patient after local failure) and one patient of intercurrent disease. No failure in either regional lymph nodes or at distant sites was recorded. In the majority of cases radiation therapy was well-tolerated.
Combined radiation therapy and surgery can offer excellent long-term control and should be considered in patients with history of recurrent disease, in the presence of suspected residual disease, after incomplete resection or for unresectable lesions. Patients with associated squamous cell carcinoma have a more aggressive course, however radiation therapy still has the prospect of permanent disease-free survival in patients who achieve local control.
局部晚期内翻性乳头状瘤以及与鳞状细胞癌相关的内翻性乳头状瘤，由于手术切除存在局限性，导致需重复手术，局部复发风险较高。辅助性放射治疗的作用尚不明确。本研究回顾了一家机构对该疾病进行放射治疗的经验。
1977年至1990年间，25例鼻腔及鼻窦内翻性乳头状瘤（7例）和与鳞状细胞癌相关的内翻性乳头状瘤（18例）患者在麻省总医院及麻省眼耳医院接受放射治疗。所有患者均表现为局部晚期浸润性肿瘤；7例内翻性乳头状瘤患者中有5例曾接受过手术切除，18例与鳞状细胞癌相关的患者中，4例既往仅接受过内翻性乳头状瘤手术切除（3例）或内翻性乳头状瘤合并原位鳞状细胞癌手术切除（1例）。16例患者在肿瘤全切后接受放射治疗，8例在肿瘤次全切除后接受放射治疗，1例因局部浸润无法手术，仅接受放射治疗。
仅患有内翻性乳头状瘤的7例患者中，6例实现局部控制，1例因疾病持续存在需再次切除。18例与鳞状细胞癌相关的患者中，17例在放射治疗后实现局部控制，1例仍有肿瘤残留。1例患者在治疗3年后局部复发。平均观察时间为4.8年（范围：0.5 - 12.9年），仅患有内翻性乳头状瘤的所有7例患者（100%）以及18例与浸润性癌相关患者中的15例（83%）存活且无疾病证据。3例与鳞状细胞癌相关的内翻性乳头状瘤患者死亡，2例因疾病死亡（1例疾病持续存在，1例局部复发后死亡），1例因并发疾病死亡。未记录到区域淋巴结或远处转移失败的情况。在大多数病例中，放射治疗耐受性良好。
放射治疗与手术联合应用可实现良好的长期控制，对于有复发病史、怀疑有残留疾病、切除不完全或无法切除的病变患者应考虑采用。与鳞状细胞癌相关的患者病程更具侵袭性，然而，对于实现局部控制的患者，放射治疗仍有望实现无病长期生存。
