McCollough W M, Mendenhall N P, Parsons J T, Mendenhall W M, Stringer S P, Cassisi N J, Million R R
Dept. of Radiation Oncology, University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):73-9. doi: 10.1016/0360-3016(93)90175-u.
To examine patterns of failures and complications in invasive squamous cell carcinoma of the nasal vestibule treated with radiotherapy alone.
Thirty-nine patients are reported with two-year minimum follow-up. Twenty-nine patients had tumors that were previously untreated; 10 were recurrent after prior surgical resection. Twelve patients received external beam alone, 18 had external beam followed by a radium implant, and nine had radium implant alone.
Local control in patients eligible for analysis was as follows: T1, 11 of 13; T2, 6 of 6; and T4, 12 of 17 (1988 AJCC skin cancer staging classification). Previously untreated tumors and tumors recurrent after surgical excision alone had similar local control, stage for stage. Among T4 tumors, local control with radiotherapy was achieved in 11 of 13 lesions measuring < 4 cm in diameter versus 1 of 4 of those measuring > or = 4 cm. Of 37 patients with clinically negative regional nodes at presentation, 32 were managed with observation alone; of those eligible for 1-year minimum follow-up, 4 (15%) of 27 developed disease in the regional lymphatics. All regional node failures have been salvaged. In general, cosmesis was very good and complications were minimal.
Radiotherapy in this series proved to be an effective and cosmetically favorable alternative to surgery for nasal vestibule carcinoma. Elective treatment of the regional lymphatics is not warranted in early stage, previously untreated patients, but should be considered for selected advanced and recurrent lesions.
研究单纯放疗治疗鼻前庭浸润性鳞状细胞癌的失败模式和并发症情况。
报告39例患者，随访至少两年。29例患者肿瘤为初治；10例为先前手术切除后复发。12例患者仅接受外照射，18例先接受外照射后行镭植入，9例仅行镭植入。
符合分析条件患者的局部控制情况如下：T1期，13例中的11例；T2期，6例中的6例；T4期，17例中的12例（1988年美国癌症联合委员会皮肤癌分期分类）。初治肿瘤和单纯手术切除后复发的肿瘤，各分期的局部控制情况相似。在T4期肿瘤中，直径<4 cm的13个病灶中有11个通过放疗实现局部控制，而直径≥4 cm的4个病灶中只有1个实现局部控制。37例初诊时区域淋巴结临床阴性的患者中，32例仅接受观察；在符合至少1年随访条件的患者中，27例中有4例（15%）区域淋巴结出现疾病。所有区域淋巴结失败均已得到挽救。总体而言，美容效果非常好，并发症极少。
本系列研究表明，放疗是鼻前庭癌手术的一种有效且美容效果良好的替代方法。对于早期初治患者，无需对区域淋巴结进行选择性治疗，但对于部分晚期和复发病灶应予以考虑。
