Radiotherapy for Squamous Cell Carcinoma of the Maxillary Sinus

上頷竇之鱗狀上皮細胞癌放射治療結果分析

趙勇全(Y. C. Jeffrey Chao) ； 詹建勝(Jian-Sheng Jan) ； 林進清(Jin-Ching Lin)

《放射治療與腫瘤學》 12卷1期 (2005/03) Pp. 39-45

https://doi.org/10.6316/TRO/200512(1)39

摘要

目的：在所有頭頸癌中，源自上顎竇的惡性腫瘤相對較罕見。本回溯性研究的目的是，分析一個醫學中心32例接受根治性放射治療之上顎竇鱗狀上皮細胞癌的治療結果。
材料與方法：病歷、放射治療資料、以及電腦斷層攝影均經仔細分析。其中男性有24人，女性8人。年齡分布從33到76歲，中位數63歲。大部分病人(84.4%)診斷時已屬局部嚴重侵犯(T4)。治療的方式有手術合併術後放射治療(20例)、放射治療合併(7例)或不合併(5例)化學治療。放射治療劑量範圍從50~90Gy，中位數為70Gy，大多以傳統分次方式治療。
結果：五年局部控制率為57.0%，五年總存活率及無病存活率分別為12.5%及40.7%。其中有13位病人(40.6%)腫瘤復發或遠處遠移，包括8例局部復發、1例頸部轉移、1例遠處遠移、1例局部復發合併遠處轉移、以及2例局部復發合併頸部及遠處轉移。Kaplan-Meier存活曲線分析顯示：年齡是無病存活率(P=0.018)及總存活率(P=0.059)最重要的預後因素。
結論：我們的資料顯示，治療失敗處以局部復發最常見，除了適當的手術切除，未來加強放射治療效果的方式（三度空間順形或強度調控放射治療、改變分次放射治療）、以及同步化學治療等值得進一步研究。

關鍵字

上頷竇 ； 鱗狀上皮細胞癌 ； 放射治療

並列摘要

Purpose: Malignant tumors arising from the maxillary sinus are relatively rare among head and neck cancer. The aim of this retrospective study is to analyze clinical outcome of 32 patients with squamous cell carcinoma of maxillary sinus treated by curative intent in a medical center.
Materials and Methods: Chart, radiotherapy data, and CT scan were reviewed in detail. There were 24 males and 8 females. Their age ranged from 33 to 76 (median 63) years old. Most patients (84.4%) presented with T4 disease. Treatment modalities were radical surgery + postoperative radiotherapy (20 cases), radiotherapy with (7 cases) or without (5 cases) chemotherapy. The range of radiation dose was 50-90 Gy with a median of 70 Gy by conventional fractionation.
Results: The estimated local control rate at 5 years was 57.0%. The 5-year overall and disease-free survival rates were 12.5% and 40.7% respectively. Thirteen of 32 (40.6%) patients developed tumor recurrence or metastasis. The failure pattern illustrated 8 local recurrences, 1 neck metastasis, 1 distant metastasis, 1 local recurrence with distant metastasis, and 2 local recurrences with neck and distant metastasis. Kaplan-Meier survival analyses and log-rank test showed that age was the most important prognostic factor affecting disease-free survival (P=0.018) and overall survival (P=0.059).
Conclusion: Our data suggest that primary recurrence is the major site of failure. Except for adequate surgical resection, approaches that can enhance radiation effect (3-D conformal or intensity-modulated radiotherapy and altered fractionated radiotherapy) and concurrent chemotherapy deserve to be tried in the future.

並列關鍵字

Maxillary sinus ； Squamous cell carcinoma ； Radiotherapy