機能と形態を保存する上顎癌の治療
1972 年 18 巻 4 号 p. 238-245
詳細
1972 年 18 巻 4 号 p. 238-245
Combined therapy of surgery, irradiation and regional chemotherapy were done in 30 cases of carcinoma of the paranasal sinuses 1967 to 1969. They were divided into two groups: one was treated with MMC and the other with 5FU as an anticancer drug. No recurrence of the tumor after six months was noticed only in 25% of the former 12 cases and in 93% of the latter 15 cases. In all cases of 5FU-group, removal of the necrotizing tumor by suction in the paranasal sinuses was daily done in course of the irradiation. The total or partial maxillectomy was carried out after the irradiation in 11 cases, 10 of which survived for more than 2 years except one case died of liver sclerosis. In 4 cases, such a surgical procedure was not done, because the tumor disappeared clinically and histologically for 6 months; however, all of them died of local recurrence within 2 years. It was concluded from above mentioned results that 1) Surgical complete removal of the tumor was necessary, 2) Infusion of 4000mg of 5FU was a minimal amount to obtain good results, 3) Irradiation of more than 4000 rads should be delivered in cases the surgical procedure was carried out.
The author's present method of the combined therapy to retain the function and the normal form of the face was proposed as follows.
1) A window is created at the anterior wall of the maxillary sinus. Necrotic masses in the paranasal sinuses are sucked out through the window.
2) Infusion of 250mg of 5FU through the superfical temporal artery and irradiation of 200 rads from 2 directions are daily delivered.
3) At the time when 2000 rads or 3000 rads has been irradiated, the tumor is completely salvaged with forceps and curette through the window under general anesthesia. The ethmoid sinus is also salvaged. The bone structure of the maxilla is not removed except the lateral wall of the nasal cavity.
4) Irradiation and infusion of 5FU are continuously delivered with a pause of one or two days for salvage operation till the dosis of irradiation reaches to 6000 rads and the amount of 5 FU to 5000mg.
This therapy has been done in 20 cases for one year from 1971. No evidence of recurrence of the tumor has been noticed clinically and histologically in 19 cases up to date.
