Konno A, Ishikawa K, Numata T, Nagata H, Terada N, Okamoto Y
Department of Otorhinolaryngology, Chiba University, School of Medicine, Japan.
Acta Otolaryngol Suppl. 1998;537:67-74. doi: 10.1080/00016489850182387.
At Akita University Hospital (from 1971 to 1987) and at Chiba University Hospital (from 1983 to 1988), 17 patients with adenoid cystic carcinoma of the nose and paranasal sinuses were treated by en bloc tumor resection followed by primary reconstruction of the maxilla. Pre- and postoperative radiation was combined in 5 and 6 patients, respectively. Ten-year cancer-free survival rates were 59.3% in the 12 patients with maxillary sinus tumors and 50% in the 4 patients with nasal tumors. One patient with a sphenoid sinus tumor died within 5 years. Ten-year cancer-free survival was affected markedly by grade of tumor extension. Among T1N0M0 and T2N0M0 patients (of which there were 1 and 7, respectively), only 1 died of unrelated causes, and 6 patients survived cancer-free for more than 10 years. However, 4 of the 6 T3N0M0 patients died, and the cause of death was distant metastasis in 2, intracranial tumor extension in 1, and unrelated causes in 1. All 3 T4N0M0 patients died, 2 due to intracranial tumor extension and 1 of unrelated causes. The cause of death was distant metastasis in 3, local recurrence in 3, 2 of whom had intracranial tumor extension, and unrelated causes in 2. Prevention of distant metastasis and intracranial tumor extension was considered to be crucial for improving treatment results after en bloc tumor resection. Preoperative radiation was thought to decrease incidence of distant metastasis. In 5 patients who had preoperative radiation. 4 survived cancer-free for more than 10 years, and only 1 patient died of unrelated cause. However. of the 6 patients who had postoperative radiation, 2 died of distant metastasis and another 2 died of intracranial tumor extension. Of the 6 patients who did not have radiation therapy, the causes of death were local recurrence in 1, distant metastasis in 1 and unrelated causes in 1. Preoperative radiation in 5 patients showed histopathologically moderate or marked degeneration and necrosis of tumors in all patients. Although the number of patients in this study is too small to allow statistical analysis of the data, our present modality of treatment for adenoid cystic carcinoma of the nose and paranasal sinuses is routine combination of preoperative full dose radiation, en bloc tumor resection and primary reconstruction, including en bloc resection of the cranial base in selected T4 patients.
在秋田大学医院（1971年至1987年）和千叶大学医院（1983年至1988年），17例鼻及鼻窦腺样囊性癌患者接受了肿瘤整块切除，随后进行上颌骨一期重建。分别有5例和6例患者在术前和术后接受了放疗。12例上颌窦肿瘤患者的10年无癌生存率为59.3%，4例鼻腔肿瘤患者的10年无癌生存率为50%。1例蝶窦肿瘤患者在5年内死亡。肿瘤扩展程度对10年无癌生存率有显著影响。在T1N0M0和T2N0M0患者中（分别有1例和7例），仅1例死于无关原因，6例患者无癌生存超过10年。然而，6例T3N0M0患者中有4例死亡，死亡原因分别为远处转移2例、颅内肿瘤扩展1例、无关原因1例。3例T4N0M0患者均死亡，2例死于颅内肿瘤扩展，1例死于无关原因。死亡原因包括远处转移3例、局部复发3例（其中2例伴有颅内肿瘤扩展）、无关原因2例。预防远处转移和颅内肿瘤扩展被认为是提高肿瘤整块切除术后治疗效果的关键。术前放疗被认为可降低远处转移的发生率。在5例接受术前放疗的患者中，4例无癌生存超过10年，仅1例死于无关原因。然而，在6例接受术后放疗的患者中，2例死于远处转移，另外2例死于颅内肿瘤扩展。在6例未接受放疗的患者中，死亡原因分别为局部复发1例、远处转移1例、无关原因1例。5例接受术前放疗的患者在组织病理学上均显示肿瘤有中度或明显的变性和坏死。尽管本研究中的患者数量太少，无法对数据进行统计学分析，但我们目前对鼻及鼻窦腺样囊性癌的治疗方式是术前全量放疗、肿瘤整块切除和一期重建的常规联合，包括对部分T4患者进行颅底整块切除。
