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目的:评价基于现代放疗技术条件下鼻腔鼻窦恶性肿瘤的生物学行为差异及其治疗和疗效。方法:回顾性分析2004-2007年间治疗的200例鼻腔鼻窦恶性肿瘤患者病例资料。全部病例采用CT模拟定位及三维适形放疗技术。结果:在鼻腔鼻窦各种恶性肿瘤中,以发病部位计,发生率鼻腔>上颌窦>筛窦>蝶窦。从病理学角度分析,以鳞状细胞癌发病率最高,约占全部病例的54.5%,鼻窦鳞状细胞癌(主要是上颌窦鳞状细胞癌)多于鼻腔鳞状细胞癌;其他病理类型的发病率依次为腺癌>嗅(母细胞)神经上皮瘤>恶性黑色素瘤>胚胎型横纹肌肉瘤。颈淋巴结转移发生率胚胎型横纹肌肉瘤>嗅(母细胞)神经上皮瘤>恶性黑色素瘤>鳞状细胞癌>腺癌;从全身转移角度比较,发生率胚胎型横纹肌肉瘤>恶性黑色素瘤>腺癌>鼻腔鼻窦鳞状细胞癌和嗅(母细胞)神经上皮瘤。3年生存率:嗅上皮(嗅母细胞)瘤>腺癌>鼻腔鼻窦鳞状细胞癌>胚胎性横纹肌肉瘤>恶性黑色素瘤。无病例发生放疗相关的严重后遗症。结论:预后与病理类型、性别及疾病分期相关;综合治疗是鼻腔鼻窦恶性肿瘤应首选的治疗方法;以CT模拟定位为基础的三维适形放疗技术提高了鼻腔鼻窦恶性肿瘤的治疗效果,并能很好地保护正常组织。
OBJECTIVE: To evaluate the differences in biological behavior of nasal sinus malignant tumors under modern radiotherapy and its therapeutic and curative effects. Methods: A retrospective analysis of 200 cases of patients with nasal sinus cancer treated between 2004 and 2007 were included. All cases using CT simulation and three-dimensional conformal radiotherapy technology. Results: In various malignant tumors of the nasal cavity and paranasal sinuses, the incidence of nasal cavity> maxillary sinus> ethmoid sinus> sphenoid sinus in terms of incidence. From the pathological point of view, the highest incidence of squamous cell carcinoma, accounting for 54.5% of all cases, squamous cell carcinoma of the sinuses (mainly maxillary sinus squamous cell carcinoma) than nasal squamous cell carcinoma; other pathological types The incidence rates were adenocarcinoma> olfactory (blast cell) neuroepithelioma> malignant melanoma> embryonal rhabdomyosarcoma. The incidence of cervical lymph node metastasis Embryonic rhabdomyosarcoma> olfactory (blast cell) neuroepithelioma> Malignant melanoma> Squamous cell carcinoma> Adenocarcinoma; incidence from systemic metastasis, incidence Embryonal rhabdomyosarcoma> Malignant melanoma> Adenocarcinoma > Nasal sinus squamous cell carcinoma and olfactory (blast) neuroepithelioma. 3-year survival rate: olfactory epithelium (OTC) tumor> adenocarcinoma> nasal sinus squamous cell carcinoma> embryonal rhabdomyosarcoma> malignant melanoma. No cases of radiotherapy-related serious sequelae. Conclusions: The prognosis is related to the pathological type, gender and stage of the disease. Comprehensive treatment is the first choice for the treatment of nasal sinus malignant tumors. Three-dimensional conformal radiotherapy based on CT simulation and localization can improve the therapeutic effect of nasal sinus cancer. Well protected normal tissue.