颞骨鳞癌的治疗.doc

额骨鳞癌33例远期疗效分析
中华耳鼻咽喉科杂志1998年第5期第。卷 头颈部肿瘤
作者：张彬屠规益徐章胡郁华 单位：100021北京中国医学科学院中国协和医科大学肿瘤医院头 颈外科（张彬、屠规益、唐平章），放射治疗科（徐国镇、胡e 5-year survival rate for the whole series was % by the life table analysis. The estimat ed 5-year survival rates for 3 subgroups were 100%, %,and 19. 6%, respectively (P=). Radiation alone had a % survival r ate and combined therapy % (P=). For patients treated with planned combined therapy, the actua 5-year survival rates were 72.
7% (8/11) for Group II and % (1/8) for Group III (P=).
Twelve patients died of local recurrence (10 cases), cervical metasta ses(l case) and liver metastases (1 case) with %(8/12) succumb ed to their diseases within two years. Complications included osteon ecrosis (n=l), osteitis (n=3), radiation dermatitis (n=2), facial palsy (n=2), and delayed healing (n=2).Conclusion The 5-year survival r ates in patients with mastoidectomy with removal of gross tumor, c ombined with planned perioperative irradiation therapy,are similar or higher than those from literature. This protocol can be used in pat ients with squamous cell carcinoma confined to the middle ear or t he mastoid.
[Key Words] Temporal bone Ear neoplasms Ca
rcinoma , squamous cell
Combined modality therapy
额骨鳞癌少见，侵袭性强，预后较差，多有外耳道骨壁和中耳同 时受侵，不易区分其外耳道或中耳来源。临床治疗方式包括手术、放 射治疗、手术和放射综合治疗。手术从局部切除、乳突根治术到鼬骨 “整块”切除等。额骨及其附近的重要器官多，额骨整块切除困难，且 手术风险大，并发症多。基于此，我们尝试采取乳突根治术配合手术 前后放射治疗的方式，现将
33例患者的治疗效果加以分析和评价。
材料和方法
一、 临床资料
本院头颈外科及放射治疗科1958〜1995年共收治额骨恶性肿瘤 72例，其中初治鳞癌33例，均经病理证实。33例中男24例，女9 例。发病年龄从24〜72岁，平均51岁。根据Prasad等⑴文献综述 中采用的分期方法分为3个亚组。I组3例：肿瘤局限于外耳道；II 组17例：肿瘤侵犯到中耳腔或乳突，或导致面神经麻痹；III组13 例：肿瘤侵及岩尖、脑膜或脑组织等。肿瘤回顾性分期主要依据临床 表现、X线和CT检查，以及术中所见。
二、 症状和体征
患者就诊时的症状和体征见表I-最常见的症状为耳溢液，耳痛, 其次为面神经麻痹和听力减退，而眩晕和耳鸣较少见。% (17/33) 患者有长期的中耳或外耳道炎历史。初次就诊时淋巴结转移率为12.
1% (4/33)-
三、治疗方式
放射治疗：分为术前、术后或术前加术后放射治疗。常用远距离
6°钻或8 MeV直线加速器放射治疗。耳前后两野线束中心轴以40。 角倾向中耳。照射面积为(4 cmx5 cm)〜(10 cmxl5 cm),当有上颈 淋巴结转移时另设颈上部照射野。一般为每周照射5、6次，每日肿 瘤量175〜200 cGy-放射治疗剂量在3 500〜10 000 cGy之