上顎癌の分類と治療方針について
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概要
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1) Of the total 161 cases of cancer of the maxilla which were diagnosed in our hospital, 115 cases were treated according to our approach and the remaining 23 cases received conservative treatment alone. All cases was followed up for more than one year.2) We estimated the size and the direction of extension of the tumor mainly from X-ray findings, and later necessary corrections were added with operative findings.3) Six types were classified according to the presumptive site of origin. According to the direction of extension, antral type was divided into 5 types in frontal plane (medio-superior, laterosuperior, medio-inferior, latero-inferior and antrum diffuse and into 4 types in sagittal plane (central, anterior, posterior and bipolar). Size of the tumor was expressed in 4 grades (localized, relatively localized, extensive and highly extensive).Presence or absence of metastasis was also mentioned.4) 98% of all cases was the type of antral origin, among which relatively localized type was 33%, extensive type 61%, medio superior type 36% and antrum diffuse type 39%.Metastasis, wich was present in 16% of all cases, was associated in comparatively higher percentage with medio superior, antrum diffuse and posterior types.5) Routinely employed policy of treatment in our hospital was preoperative irradiation, total resection of maxilla and postoperative intracavitary irradiation, with the exception of radiation therapy alone for inoperable and in cases where the operation was refused.6) When treated in our routine sandwich method, three year survival rates for relatively localized and extensive types were 40%(4/10) and 33% (3/9), respectively. The former, when treated with radiation alone, showed three year survival rate of 36% (4/11).Thus, the results fall within the range of 30 to 40%.When the extensive type was treated with radiation alone, three year survival rate of 12% (3/25) was obtained. Over-all three year and five year survival rates were 24% (14/58) and 36% (5/14), respectively.7) It is felt that closer cooperation of surgeons and radiologists is essential to attain better therapeutic results.
- 社団法人 日本耳鼻咽喉科学会の論文
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