鼻副鼻腔腺様嚢胞癌に対する集学療法

抄録

On 20 patients who had adenoid cystic carcinoma of the nose and paranasal sinuses, the effects of difference of therapeutic modalities on the prognosis of the patients and the effects of preoperative fast neutron irradiation and intraarterial infusion of cisplatin microcapsule (CDDP m. c) on histopathological changes of the tumors were evaluated. Out of 13 patients for whom more than 5 years had elapsed after initial therapy, local recurrences and distant metastases without local recurrence were observed in 2 and 3 patients respectively. In the two patients with T1-2N0 carcinoma of the nasal cavities on whom en bloc resection could be performed easily and securely could survive free of cancer for more than 5 years after surgery alone. Both of the two patients who had operative procedures within the tumor developed distant metastases. Significant clinical and histopathological effect could not be induced by preoperative intraarterial infusion of CDDP m. c. (40-100 mg) and distant metastasis developed in one out of 3 patients. In 6 patients on whom the total dosis (TDF) of preoperative fast neutron irradiation was 100-120, histopathological effects were grade M in 3, grade II b in 2 and grade II a in one patient, classified according to Shimosato's criteria. However, in 5 patients on whom total dosis (TDF) of fast neutron irradiation was 60-80, histopathological effects were confined to grade M in one patient, grade II b in another and grade II a in 3 patients. One patient on whom irradiation effect was grade Ill, treated by irradiation alone, showed recurrence after one year. Although the present study could not clarify the effect of postoperative fast neutron irradiation on the residual tumor, the data suggested the sufficient inhibition effect of full dosis preoperative fast neutron irradiation on occurrence of distant metastasis which may be induced by the operative procedure.