Roux F X, Pages J C, Nataf F, Devaux B, Laccourreye O, Menard M, Brasnu D
Service de Neurochirurgie, CH Sainte-Anne, Paris.
Neurochirurgie. 1997;43(2):100-10.
We report on 130 ethmoidal cancers. 96 (74%) were adenocarcinomas (ADKE). 110 were operated upon between 1984 and 1996: 9.1% T1 + T2, 27.7% T3, 36.2% T4a, 27% T4b. Neoadjuvant chemotherapy was administered in 93 patients (76 ADKE). Combined surgical route was performed 103 times, sub-fronto-orbito-nasal (SFON) route 7 times. Post-operative radiotherapy was performed in 36 patients. Complete clinical and radiological response to chemotherapy was noted in 21.5% of cases (23% of ADKE). Post-operative mortality concerned one patient who died from a pulmonary embolism during the third post-operative week. Morbidity included: 3 transient clinical rhinorrheas, 5 meningitis (one of which was responsible for heavy psycho-intellectual disability), 4 deep suppurations associated with osteitis of the bone flap and two superficial suppurations. 44 patients had a local recurrence (10 ADKE). No recurrence appeared in complete chemoresponders. Systematic preservation of intra-orbital contents did not increase the risk of local failure. Eleven patients (4 ADKE) developed cervical nodes and/or systemic metastasis. Death occurred after a mean of three months following the diagnosis of metastasis. Survival rate was: 60% at 3 years, 51.5% at 5 years, 32.5% at 10 years. ADKE survival rate was: 55% at 3 years, 51.5% at 5 years, 23% at 10 years. Survival ws related to tumoral extension: 75% at 5 and 10 years for T3, 45% at 5 years and 38% at 10 years for T4a, 40% at 3 years and null at 5 years for T4b, 5 and 10 years survival rate of complete chemoresponders are 100% whatever the tumour. Prognosis remained poor for epidermoid carcinomas (survival rate: 36% at 3 years, 0% at 5 years) and for melanomas (mean survival: 19.6 months). Post-operative radiotherapy should be indicated for large tumors T3, T4a and T4b).
我们报告了130例筛窦癌。其中96例（74%）为腺癌（ADKE）。1984年至1996年间对110例患者进行了手术：9.1%为T1 + T2期，27.7%为T3期，36.2%为T4a期，27%为T4b期。93例患者（76例ADKE）接受了新辅助化疗。联合手术路径实施了103次，额眶鼻下（SFON）路径实施了7次。36例患者接受了术后放疗。21.5%的病例（23%的ADKE）对化疗有完全的临床和影像学反应。术后死亡率为1例，该患者在术后第三周死于肺栓塞。并发症包括：3例短暂性临床鼻漏、5例脑膜炎（其中1例导致严重精神智力残疾）、4例与骨瓣骨炎相关的深部化脓和2例浅表化脓。44例患者出现局部复发（10例ADKE）。完全化疗反应者未出现复发。系统性保留眶内内容物并未增加局部失败的风险。11例患者（4例ADKE）出现颈部淋巴结和/或全身转移。转移诊断后平均三个月死亡。生存率为：3年时60%，5年时51.5%，10年时32.5%。ADKE的生存率为：3年时55%，5年时51.5%，10年时23%。生存率与肿瘤扩展有关：T3期5年和10年时为75%，T4a期5年时为45%，10年时为38%，T4b期3年时为40%，5年时为0%，无论肿瘤如何，完全化疗反应者的5年和10年生存率均为100%。表皮样癌（生存率：3年时36%，5年时0%）和黑色素瘤（平均生存期：19.6个月）的预后仍然很差。对于T3、T4a和T4b期大肿瘤应进行术后放疗。
