| Background nasal cavity and Paranasal sinus carcinoma scarcely to see these years.It accounts for 1% of all malignat tumor and 9.7%—11.9% of head and neck tumors. Most of the nasal cavity and paranasal sinus carcinoma lack of early symptom because of their special location. Even if there is symptom, it is nonspecific and is often treated as inflammation and delay diagnosis. So it is not easy to find them early. In this situation, most of nasal cavity and paranasal sinus carcinoma are found in their middle or late phase, when the patients need the comprehensive treatment including surgery and radiotherapy. The development of microinvasion operation these years opens a door to keep the patients' appearance fit and improve their quality of life in the treatment of head and neck tumors. The therapy that surgery plus radiotherapy becomes the chief one. In order to evaluate the effect and prognosis in postoperative radiotherapy for nasal cavity and paranasal sinus carcinoma. 95 postoperative radiotherapy for nasal cavity and paranasal sinus carcinoma patients treated in department of radiation oncology of our hospital were reviewed retrospectively.Methods From March 1975 to March 2000 95 patients have accepted operation for nasal cavity and paranasal sinus carcinoma in our hospital. Tumors encroached the orbit were treated with extraction of the contents of the orbit.3~5 weeks after operation, all the patients accept routine radiotherapy delivered by " L" field and the trouble side field. Based on the premise of sufficient dose, the critic structures were protected as much as possible, such as eyes cornea lens, lacrimal sac. 6MV X-ray and 15MeV election beams are used in the unilateral frontal face field;6MV X-ray irradiation is used in L field and the opposide and front field, and necessarily adopts wedge board technology. The total ofirradiation dose is 40~80Gy, in average 2Gy per fraction and conventional fractionation. One patient accepts chemoradiotherapy before and after radiotherapy respectively. The shortest follow-up time of 95 patients is 2 months, the longest is 14 years. The follow-up datum come from the re-examine record and termly follow-up data. Kaplan-Meier method is used to analyze the survival rate;Longrank test is used to compared the difference between groups, multivaries analysis is performed by Cox proportional hazard Model.Result The overall K 3> 5 and 10-year survival were 84.2%. 50.5%. 44.2% and 20% in the evaluation of effect to the 95 patients. Univariate analysis showed that sex. age. operation type and target dose were non-associated with survival. Histological type and clinical stage were associated with survival rate. The 5-year survival of squamous cell carcinoma is apparently lower than that of adenocarcinoma, other types as non-differentiated tumor, sarcoma are poor prognosis. The later in clinical stage ,the worse the result was (p=0.007), the 5-year survival of IK III. IV stage is 80.0%(12/15), 42.4%(14/33) and 34.0% (16/47)separately. Multivariate analysis indicated that histological type and clinical stage were independent prognosis factors. The side effects appear during treatment including nasal dogness, stomatitis and blush of irradiated area. The follow-up results show that 13 patients had visual disturbance , 11 patients had dysaudia and 11 patients had xerostomia . The injury of optic pathway and cataract caused by radiation of optic nerve, optic chiasm, lens are responsible for the happening of visual disturbance. Dysaudia might be caused by the over-radiation of vestibulocochlear nerve and the radioactive tympanitis. Xerostomia may have relationship with the injury of salivary gland.Conclusion The synthetical therapy of operation and postoperative radiotherapy is an effective method for nasal cavity and paranasal sinus carcinoma. Histological type and clinical stage are the independent prognostic factors fornasal cavity and paranasal sinus carcinoma. Postoperative radiotherapy would improved outcome in the treatment of nasal cavity and paranasal sinus carcinoma. |
