Dubey P, Ha C S, Ang K K, El-Naggar A K, Knapp C, Byers R M, Morrison W H
Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1998 Apr 15;82(8):1556-62. doi: 10.1002/(sici)1097-0142(19980415)82:8<1556::aid-cncr18>3.0.co;2-3.
Lymphoepithelioma (squamous cell carcinoma with associated lymphoid stroma) commonly occurs in the nasopharynx, rarely at other sites. As a result, the clinical course and optimal treatment of nonnasopharyngeal lymphoepithelioma of the head and neck have not been well described. This retrospective study was undertaken to analyze the clinical course of the disease in patients treated at a single institution and to formulate recommendations for treatment based on that experience as well as results reported in the literature.
Between 1950 and 1994, 34 patients with nonnasopharyngeal lymphoepithelioma of the head and neck were treated at the University of Texas M. D. Anderson Cancer Center. The patients' medical records were reviewed and their pathologic specimens evaluated. The primary tumor sites were: oropharynx (24 patients), salivary gland (4), laryngohypopharynx (4), and the maxillary sinus/nasal cavity (2). Assessed in accordance with the 1992 American Joint Committee Against Cancer TNM staging system, T classifications were TX-2, T1-7, T2-8, T3-10, and T4-7, and N classifications were N0-8, N1-5, N2-15, and N3-6. Treatment consisted of radiotherapy for 24 patients, excisional biopsy of the primary tumor followed by radiotherapy for 7 patients, and surgery for 3 patients. Of the patients treated with radiotherapy, neck dissections were performed on only two, both of whom had persistent lymph node masses after completing radiotherapy. The median dose delivered to the primary tumor was 65 gray (Gy) (range, 46-78 Gy). The median fraction size was 2.1 Gy (range, 1.6-3.2 Gy).
The 5-year actuarial disease specific survival and overall survival rates were 59% and 39%, respectively. The 5-year actuarial local control rate for all patients was 94%. For the irradiated patients, the 5-year regional control rates were 77% overall and 83% within the radiation field. The 5-year actuarial rate of distant metastasis for all patients was 30%. For patients who presented with and without regional adenopathy, the 5-year rates of distant metastasis were 36% and 12%, respectively (P = 0.27).
Nonnasopharygeal lymphoepithelioma is a radiosensitive disease. High rates of locoregional tumor control were achieved with radiotherapy at all head and neck sites. The main cause of treatment failure was distant metastasis, which occurred more frequently in patients with lymph node involvement. Radiotherapy is appropriate initial locoregional therapy for patients with this disease. Surgery should be reserved for patients who have persistent disease after completing radiotherapy. Systemic therapy is a reasonable approach for patients who present with regional adenopathy because they have a relatively high rate of distant metastasis.
淋巴上皮瘤（伴有相关淋巴间质的鳞状细胞癌）常见于鼻咽部，很少发生于其他部位。因此，头颈部非鼻咽部淋巴上皮瘤的临床病程及最佳治疗方法尚未得到充分描述。本回顾性研究旨在分析在单一机构接受治疗的患者的疾病临床病程，并根据该经验以及文献报道的结果制定治疗建议。
1950年至1994年间，德克萨斯大学MD安德森癌症中心治疗了34例头颈部非鼻咽部淋巴上皮瘤患者。回顾了患者的病历并评估了其病理标本。原发肿瘤部位为：口咽（24例患者）、唾液腺（4例）、喉下咽（4例）和上颌窦/鼻腔（2例）。根据1992年美国癌症联合委员会TNM分期系统进行评估，T分类为TX - 2例、T1 - 7例、T2 - 8例、T3 - 10例和T4 - 7例，N分类为N0 - 8例、N1 - 5例、N2 - 15例和N3 - 6例。24例患者接受了放射治疗，7例患者接受了原发肿瘤切除活检后再进行放射治疗，3例患者接受了手术治疗。在接受放射治疗的患者中，仅2例进行了颈部清扫，这2例患者在完成放射治疗后均有持续性淋巴结肿块。给予原发肿瘤的中位剂量为65戈瑞（Gy）（范围为46 - 78 Gy）。中位分次剂量为2.1 Gy（范围为1.6 - 3.2 Gy）。
5年精算疾病特异性生存率和总生存率分别为59%和39%。所有患者的5年精算局部控制率为94%。对于接受放疗的患者，5年区域控制率总体为77%，放疗野内为83%。所有患者的5年精算远处转移率为30%。对于有和无区域淋巴结病的患者，5年远处转移率分别为36%和12%（P = 0.27）。
非鼻咽部淋巴上皮瘤是一种对放疗敏感的疾病。在头颈部所有部位，放疗均能实现较高的局部区域肿瘤控制率。治疗失败的主要原因是远处转移，在有淋巴结受累的患者中更常见。放疗是该病患者合适的初始局部区域治疗方法。手术应保留给完成放疗后仍有持续性疾病的患者。对于有区域淋巴结病的患者，全身治疗是一种合理的方法，因为他们有相对较高的远处转移率。
