Paulino A C, Fisher S G, Marks J E
Department of Radiotherapy and the Cardinal Bernardin Cancer Center, Loyola University of Chicago, Maywood, IL 60153, USA.
Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):283-9. doi: 10.1016/s0360-3016(97)00293-9.
To determine the proportion of patients with squamous cell carcinoma of the maxillary sinus who will fail in regional nodes without elective neck treatment and to identify any prognostic factors that may influence neck control.
From 1971-1995, 42 consecutive patients with squamous cell carcinoma of the maxillary sinus were seen at our department for curative treatment. There were 35 males and 7 females, with a median age at diagnosis of 63.5 years (range, 42-77 years). One tumor was classified as T1, 5 had T2, 15 had T3, and 21 had T4 disease. Four of 42 patients (9.5%) had cervical lymphadenopathy at initial presentation. Thirty-three patients had surgical resection and radiotherapy and nine had radiotherapy alone. None of the 38 patients with clinical N0 necks received elective treatment to the cervical nodes.
Median overall survival was 30 months for all patients. Of the 38 patients with N0 disease, 11 (28.9%) had neck recurrence. Of the 11 neck failures, 9 were ipsilateral only, 1 was contralateral, and 1 had bilateral neck recurrence. The most common site of neck failure was in the upper neck (submandibular and jugulodigastric lymph nodes). Four of the 38 patients (10.5%) had isolated neck failure. Only tumor stage was found to be significant for neck relapse, with T1 and T2 doing worse compared to T3 and T4 tumors. Location of tumor (infrastructure vs. suprastructure), involvement of the oral cavity/oropharynx, nasal cavity, nasopharynx or orbit did not predict for cervical node relapse. Local control at the primary site was likewise not prognostic. The median overall survival for patients who remained N0 was 80 months and for those with initial cervical involvement or recurred in the neck without elective neck irradiation was 25 months (p = 0.05).
Based on the 28.9% rate of neck recurrence and the poor median survival of patients who recur in the neck, we recommend prophylactic ipsilateral neck irradiation in patients with T1-T4 squamous cell carcinoma of the maxillary sinus.
确定上颌窦鳞状细胞癌患者在未接受选择性颈部治疗的情况下区域淋巴结发生转移的比例，并识别可能影响颈部控制的任何预后因素。
1971年至1995年期间，我科连续收治了42例上颌窦鳞状细胞癌患者进行根治性治疗。其中男性35例，女性7例，诊断时的中位年龄为63.5岁（范围42 - 77岁）。1例肿瘤分类为T1，5例为T2，15例为T3，21例为T4期。42例患者中有4例（9.5%）初诊时即有颈部淋巴结肿大。33例患者接受了手术切除和放疗，9例仅接受了放疗。38例临床颈部N0的患者均未接受颈部淋巴结的选择性治疗。
所有患者的中位总生存期为30个月。38例N0期疾病患者中，11例（28.9%）出现颈部复发。11例颈部转移患者中，9例仅为同侧复发，1例为对侧复发，1例为双侧颈部复发。颈部转移最常见的部位是上颈部（下颌下和颈内静脉二腹肌淋巴结）。38例患者中有4例（10.5%）出现孤立性颈部转移。仅发现肿瘤分期对颈部复发有显著影响，T1和T2期肿瘤与T3和T4期肿瘤相比，颈部复发情况更差。肿瘤位置（下部结构与上部结构）、口腔/口咽、鼻腔、鼻咽或眼眶受累情况均不能预测颈部淋巴结转移。原发部位的局部控制同样不具有预后意义。颈部仍为N0的患者中位总生存期为80个月，初诊时颈部受累或未接受选择性颈部放疗而颈部复发的患者中位总生存期为25个月（p = 0.05）。
基于28.9%的颈部复发率以及颈部复发患者较差的中位生存期，我们建议对上颌窦T1 - T4期鳞状细胞癌患者进行同侧预防性颈部放疗。
