Radiotherapy in the Treatment of Paranasal Sinuses Cancer－The Experience of Tri-Service General Hospital

副鼻竇癌之放射治療－三軍總醫院之經驗

陳昌明(Chang-Ming Chen) ； 許文林(Wen-Lin Hsu) ； 任益民(Yee-Min Jen) ； 黃經民(Jing-Min Hwang) ； 熊佩韋(Pei-Wei Shueng) ； 吳錦榕(Chin-Jung Wu) ； 張立平(Li-Ping Chang) ； 林曜祥(Yaoh-Shiang Ling)

《放射治療與腫瘤學》 5卷3期 (1998/09) Pp. 171-177

https://doi.org/10.6316/TRO/199805(3)171

摘要

目的：報告本院放射腫瘤部自成立以來治療副鼻竇癌之成效。
材料與方法：本研究收集1968至1996共83例於本院接受放射治療之副鼻竇癌病患，多數病患接受鈷60照射，腫瘤劑量從60~130葛雷，中數70葛雷，採用傳統照射方法。存活率分析採用Kaplan-Meier，相關預後因子採用Log-rank test 比較其差異之顯著程度。
結果：本院接受放射治療之副鼻竇癌病患，5年存活率為53.0%，10年存活率為30.9%；放射治療前接受根除切除手術者顯示出較佳之5年存活率；接受放射治療之後腫瘤完全消失佔30%，部分消失佔22%；局部復發率為35%，遠處轉移率為13%；藉由電腦斷層影像之幫助，可延長其5年及10年存活率，但未達統計學之意義(p=0.2867)。晚期併發症包括：口乾症，牙關緊閉，頭痛，局部疼痛腫脹，流鼻血，結膜充血，眼盲等，臨床上不常見到。
結論：由於解剖學上的特殊位置，本研究所有副鼻竇癌均侵犯一處以上之部位。其原發部位以上頷竇及篩竇最為常見；分別佔（81.7%及16.4%）。以單獨放射治療作為主要治療的患者往往兼具較差之預後因子也較不易意單獨以傳統放射治療達到治癒。且由於晚期無法以手術切除之副鼻竇癌，單獨以傳統放射治療其局部控制率仍不理想，本院採用多種新的治療方式，如每日兩次多分次照射法併三度空間順形放射治療以提高腫瘤計量，降低周邊正常組織副作用，合併放射治療及化學治療；藉由這些新的治療方式，應可獲得更佳治療效果、減少短期及長期之副作用、提昇生活品質。

關鍵字

副鼻竇癌 ； 放射治療 ； 存活

並列摘要

Purpose: To present our experience in the treatment of paranasal sinuses cancer using radiotherapy.
Materials and Methods: Between 1968 and 1996, 83 patients with cancer of paranasal sinuses received radiotherapy in the Radiation Oncology department of the Tri-Service General Hospital. Most of the patients were treated using Co-60 gamma irradiation. A Cs-137 teletherapy unit was used in 7% of the patients in the 60's. The median prescribed tumor dose was 70 GY with a range of 60~130 GY and the daily fraction size was 1.8-2.0 Gy, 5 fractions per week. Survival was calculated using the Kaplan-Meier actuarial method. Differences between survival curves were compared using the log rank test.
Results: The 5- and 10-year survivals are 53.0% and 30.9%, respectively. Patients receiving radical surgery before radiotherapy showed a better 5-year survival. The complete response rate is 30% and partial response rate is 22% in our study after radiotherapy. The overall local failure and distant metastasis rate are about 35% and 13%. No correlation could be made between the survival and histology, staging group, and sex in our study. The magnitude of improved survival by the aid of CT scanning is not significant in our study (p=0.2867). Late complications are not common, including xerostomia, trismus, headache, local tenderness and swelling, epistaxis, conjunctival congestion, and blindness.
Conclusion: All of the patients in our study had the tumor involving more than one site. The maxillary and ethmoid sinuses were the most common primary tumor sites in our study (81.7% and 14.6%). Patients receiving radiotherapy alone had relative poor prognostic factors and the cure was not achieved by conventional radiotherapy alone in most patients. In view of the poor local control for advanced unresectable paranasal sinuses cancer and relative low morbidity with standard-dose irradiation, we have conducted cancer and relative low morbidity with standard-dose irradiation, we have conducted dose escalation using hyperfractionation regiment and CT based 3-D conformal treatment planning in recent years. Concurrent chemo-irradiation may be a reasonable approach.

並列關鍵字

Paranasal sinuses cancer ； Radiotherapy ； Survival