颞骨鳞癌的治疗

颞骨鳞癌33例远期疗效分析

中华耳鼻咽喉科杂志1998年第5期第0卷头颈部肿瘤

作者：张彬屠规益徐国镇唐平章胡郁华单位：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、胡郁华）关键词：颞骨；；耳肿瘤；；癌；鳞状细胞；；综合疗法【摘要】目的评价乳突根治术加手术前或手术后放射治疗颞骨鳞癌的疗效。方法回顾性分析33例颞骨鳞癌治疗的远期疗效。根据病变范围分为3个亚组：鳞癌局限于外耳道3例（I组）；病变侵及中耳乳突腔17例（II组）；更晚期病变13例（III组）。治疗方式分为：手术2例，放射治疗11例，综合治疗（手术加术前或术后放射治疗）20例。手术采用乳突根治术19例，外耳道局部切除2例，颞骨次全切除1例；放射治疗剂量3 500～10 000 cGy，平均6 560 cGy。生命表法计算生存率。结果全组33例患者5年预期生存率为51.7%。3个亚组（I组，II组及III组）5年预期生存率分别为100%，68.8%和19.6%，3个亚组的生存状况统计学差异有显著性（P=0.012）。综合治疗和放射治疗组5年预期生存率分别是59.6%和28.7%（P=0.800）。综合治疗组II组的患者5年治愈率高达72.7%（8/11），III组患者仅12.5%（1/8，P=0.02）。全组33例中12例死于肿瘤复发，67.0%(8/12)患者于首次治疗后2年内死亡。其中10例

死于局部复发，1例颈淋巴结转移，1例肝转移。治疗并发症包括放射性颞骨坏死1例，放射性颞骨骨髓炎3例，放射性皮炎2例，面神经麻痹2例及伤口延迟愈合2例。结论乳突根治手术配合术前或术后放射治疗的综合治疗，取得了与文献报告同样，甚至更好的5年生存率，并发症少，特别适合于病变局限于中耳和乳突的颞骨鳞癌病变。

Squamous cell carcinoma of temporal bone: an analysis of long-term treatment results in 33 patients Zhang Bin, Tu G uiyi,Xu Guozhen, et al. Chinese Academy of Medical Sciences, Peki ng Union Medical College, Beijing 100021.

【Abstract】Objective To evaluate the long-term results in patients with squamous cell carcinoma of the temporal bone and tre ated by of mastoidectomy combined with perioperative radiation the rapy.Methods Thirty-three patients with squamous cell carcinoma invading the temporal bone were reviewed retrospectively. Accordi ng to the tumor extent, the patients were staged into three subgrou ps, 3 with lesions confined to the auditory canal(Group I), 17 with involvement of the middle ear or mastoid(Group II) and 13 with more extensive disease(Group III). Two patients were treated by sur gery, 11 by irradiation and the remaining 20 by the combined surg ery and perioperative radiotherapy. The surgical procedures included sleeve resection for group I patients , mastoidetomy for all other

patients except one who had subtotal temporal bone resection. The radiation doses were in the range of 3 500 to 10 000 cGy, with a n average dose of 6 560 cGy.Results the 5-year survival rate for the whole series was 51.7% by the life table analysis. The estimat ed 5-year survival rates for 3 subgroups were 100%, 68.8%,and 19. 6%, respectively (P=0.012). Radiation alone had a 28.7% survival r ate and combined therapy 59.6% (P=0.80). For patients treated with planned combined therapy, the actua 5-year survival rates were 72. 7% (8/11) for Group II and 12.5% (1/8) for Group III (P=0.02）. Twelve patients died of local recurrence (10 cases), cervical metasta ses(1 case) and liver metastases (1 case) with 67.0%(8/12) succumb ed to their diseases within two years. Complications included osteon ecrosis (n=1), 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