McCary W S, Levine P A, Cantrell R W
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, USA.
Arch Otolaryngol Head Neck Surg. 1996 Jun;122(6):657-9. doi: 10.1001/archotol.1996.01890180063015.
To continue the retrospective analysis reported in 1988 that supported preservation of the eye in the treatment of sinonasal cancers when bony erosion of the orbit was noted on pretreatment radiographic analysis.
Using the eye-sparing protocol previously reported, which included preoperative radiotherapy (with or without chemotherapy, depending on tumor size, involvement, or other characteristic) for malignant neoplasms of the superior nasal vault that had eroded the bony orbit, retrospective analysis of the results of therapy for the additional 33 patients treated between 1986 and 1993 was performed. These data were added to those from the original series to provide a total of 74 patients. Forty-one patients (55%) showed bony erosion at initial evaluation and 14 (19%) had periorbital involvement. During surgery, the periorbita was evaluated by frozen section control. If tumor was found, that region of periorbita was resected and, if necessary, replaced with fascia or split-thickness graft.
Five patients from the original series had orbital sacrifice. Of the remaining 36 patients, 4 (11%) had recurrent disease involving the orbit, but not at the primary site. Twenty (55%) of the 36 patients had no orbital complications, and only 1 (3%) had a permanent motility disturbance and 4 (13%) developed cataracts after radiotherapy.
With the use of preoperative radiotherapy in resection of involved periorbita with frozen section control in tumors of the sinonasal vault that involve the bony orbit, the eye can be spared in most instances without compromising oncologic safety.
继续进行1988年报道的回顾性分析，该分析支持在术前影像学分析发现眼眶骨质侵蚀时，在鼻窦癌治疗中保留眼球。
采用先前报道的保眼方案，该方案包括对侵蚀眼眶骨质的鼻顶恶性肿瘤进行术前放疗（根据肿瘤大小、累及范围或其他特征决定是否联合化疗），对1986年至1993年间接受治疗的另外33例患者的治疗结果进行回顾性分析。这些数据与原始系列的数据相加，共计74例患者。41例患者（55%）在初始评估时显示骨质侵蚀，14例（19%）有眶周累及。手术期间，通过冰冻切片检查评估眶骨膜。如果发现肿瘤，切除该区域的眶骨膜，必要时用筋膜或断层皮片移植替代。
原始系列中有5例患者牺牲了眼眶。在其余36例患者中，4例（11%）出现累及眼眶但非原发部位的复发性疾病。36例患者中有20例（55%）无眼眶并发症，放疗后仅1例（3%）出现永久性眼球运动障碍，4例（13%）发生白内障。
对于累及眼眶骨质的鼻窦顶肿瘤，在切除受累眶骨膜并进行冰冻切片检查的情况下，使用术前放疗，在大多数情况下可以保留眼球，而不影响肿瘤学安全性。
