RADIATION TREATMENT OF CANCER OF EYELIDS
RADIATION TREATMENT OF CANCER OF EYELIDS
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DOI：
10.1136/bjo.60.12.794
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发表时间：
1976-01-01
影响因子：
4.1
通讯作者：
LEDERMAN, M
中科院分区：
文献类型：
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作者：
LEDERMAN, M
眼睑癌并不是罕见的肿瘤，通常是基底细胞或更罕见的鳞状细胞。它们的重要性在于其特殊情况，因为与皮肤其他部位发生的癌症不同，它们可以通过自然进展或治疗效果导致视力受损甚至丧失。尽管这些肿瘤是恶性的，但患者的死亡很少是由于局部控制失败而导致的，除非疾病非常晚期或一开始就处理不当。就鳞状细胞癌而言，转移扩散有时可能导致死亡。如果有既定且同样有效的替代非手术程序可用，那么任何患者都不应接受大型外科手术，这应该是一条明显的道德格言。对于一般的皮肤癌，特别是眼睑癌，放射疗法提供了这样的替代方案，因为其治疗价值在过去 50 年中已得到牢固确立。眼科医生不愿建议使用辐射能似乎与本世纪初先锋眼科医生首次使用辐射能所带来的灾难有关。他们的眼部灾难遗产的故事代代相传，却忽视了放射治疗的进步这一事实：在现代条件下，大多数并发症，特别是更具可怕破坏性的并发症，在很大程度上是可以避免的。鉴于此，目前不考虑现有替代方案而将患有眼睑肿瘤的患者不加区别地接受简单的切除或整形外科手术的趋势似乎是不合理的。这份报告涉及 1945-70 年间在皇家马斯登医院就诊的 896 名患者（表 I），描述了眼睑癌自然史的一些特征，并通过给出放射治疗的结果、禁忌症和并发症来评估这种治疗眼睑癌的方法。该系列是一个相对较大的系列，“以前未经治疗”的病例比例很高，反映了皇家马斯登医院长期联络的价值
Eyelid cancers are not uncommon tumours and are usually basal cell or more rarely squamous cell in character. Their importance lies in their special situation since unlike cancer arising elsewhere in the skin they can by their natural progression or as a consequence of the effects of treatment cause impairment or even loss of vision. Although these tumours are'malignant', deathof the patient rarely results from failure of local control, unless the disease is very advanced or was mismanaged at the outset. In the case of squamous cell cancer, death may occasionally result from metastatic spread. It should be an obvious ethical maxim that no patient should be submitted to a major surgical operation if an established and equally effective alternative non-surgical procedure is available. In the case of skin cancer generally and the lids in particular radiotherapy provides such an alternative since its curative value has been firmly established during the past 50 years. The reluctance of ophthalmologists to advise the use of radiant energy appears to relate to the calamities that first attended its use by the pioneer ophthalmologists at the beginning of this century. The story of their heritage of ocular disasters has been transmitted from generation to generation ignoring the fact that progress in radiotherapy has been such that under modern conditions most of the complications, particularly the more gruesomely destructive ones, can largely be avoided. In view of this the present-day tendency to submit patients suffering from lid neoplasms indiscriminately to simple excisional or plastic surgical procedures without considering an established altemative would seem unjustifiable. This report on a series of 896 patients (Table I) seen at the Royal Marsden Hospital during the period 1945-70 describes some of the features of the natural history of lid cancer and by giving the results, contraindications, and complications of radiation treatment evaluates this method in the treatment of lid cancer. The series is a relatively large one and the high proportion of'previously untreated'cases reflects the value of thelong-standing liaison the Royal Marsden Hospital has