Clinicopathologic features, treatment, and prognosis of postirradiation osteosarcoma in patients with nasopharyngeal cancer
Clinicopathologic features, treatment, and prognosis of postirradiation osteosarcoma in patients with nasopharyngeal cancer
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DOI：
10.1097/01.mlg.0000173166.48440.e4
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发表时间：
2005-09-01
期刊：
影响因子：
2.6
通讯作者：
Zeng, ZY
中科院分区：
文献类型：
--
作者：
Liu, WW;Wu, QL;Zeng, ZY
目的：鼻咽癌放疗后发生的放疗后骨肉瘤（PIOS）极为罕见，报道甚少。在这篇文章中，我们报告其临床病理特征，结果和预后因素。研究设计：回顾性队列研究。方法。在回顾了426例骨肉瘤患者后，15例鼻咽癌患者被确定为PIOS。收集患者的临床记录、影像、病理切片及治疗后随访资料进行分析。结果。PIOS在NIPC中的发生率约为0.037%(15/40,719)，在各类成骨肉瘤中约占3.5%（15/426）。鼻咽癌放疗后PIOS潜伏期为4 ~ 27年，平均13.3年。上颌出现PIOS的部位占33.3%(5/15)，下颌骨出现46.7%(7/15)，鼻腔和鼻窦混合出现的部位占20%（3/15）。放射学上，软组织肿块、骨破坏和肿瘤新生骨形成是主要特征。病理亚型中纤维母细胞骨肉瘤占53.3%(8/15)，软骨母细胞骨肉瘤占33.3%(5/15)，混合型骨肉瘤占13.3%（2/15）。在15例PIOS患者中，12例患者的治疗目的是治愈，其余3例患者的治疗目的是姑息。12例患者行消融手术，1例肿瘤残留，6例肿瘤复发。所有患者治疗后生存时间7 ~ 41个月，平均18个月。Kaplan-Meier估计1年和2年生存率分别为60%和24%。统计分析显示，性别和肿瘤骨形成是影响预后的重要因素。结论：鼻咽癌PIOS是一种高度恶性疾病，预后较其他部位差。手术联合术前和术后化疗可能是提高生存率的有效方法。
Objectives: Postirradiation osteosarcoma (PIOS) arising after radiation of nasopharyngeal cancer (NPC) is rare and seldom reported. In this article, we report its clinicopathologic features, outcome, and prognostic factors. Study Design: Retrospective cohort study. Methods. Fifteen patients with NPC were determined to have PIOS after reviewing 426 patients with osteogenic sarcomas. Their clinical records, image and pathologic slides, and follow-up data after treatment were collected to perform analysis. Results. The incidence rate of PIOS in NIPC was approximately 0.037% (15/40,719), which occupied approximately 3.5% (15/426) among all kinds of osteogenic sarcomas. The latent time of PIOS after irradiation for NPC ranged from 4 to 27 years, with a mean of 13.3 years. The location where PIOS arose included 33.3% (5/15) from maxilla, 46.7% (7/15) from mandible, and 20% (3/15) from a mixture of nasal cavity and paranasal sinuses. Radiologically, soft tissue mass, bone destruction, and tumor new bone formation were the main characteristics. Pathologic subtypes included 53.3% (8/15) of fibroblastic osteosarcoma, 33.3% (5/15) of chondroblastic osteosarcoma, and 13.3% (2/15) of mixed type osteosarcoma. Of 15 patients with PIOS, 12 patients were treated with curative intent, and the remaining 3 patients with palliative intent. For 12 patients who had undertaken ablative surgery, I patient had residual tumor, and 6 patients had tumor recurrence. The survival time after treatment for all patients ranged from 7 to 41 months, with a mean of 18 months. Kaplan-Meier estimates of 1 year and 2 year survival rates were 60% and 24%, respectively. Statistical analysis showed that sex and tumor bone formation are significant prognostic factors. Conclusions: PIOS in NPC is a highly malignant disease with poorer prognosis than in other sites. Surgery combined with pre and postoperative chemotherapy might be an effective way to improve survival.