上顎癌の組織型,進展度と三者併用療法後の組織学的効果との相関について

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Fourty cases of maxillary carcinoma, treated by combined therapy of irradiation, intra-arterial infusion of 5-FU and aspiration of necrotized mass through the control window in the gingivobuccal fold, in Akita University Hospital in a three years period between 1971 and 1974, were investigated clinically and histopathologically. Fourteen cases of squamous cell carcinoma, treated by the combined therapy and surgery and followed up for a period of 1-3years, were all alive without recurrence or metastasis. Incidence of cervical lymph node and distant metastsis was closely related to histological typeof the tumor, and highly frequent distant metastasis was found in anaplastic carcinoma. Twenty-eight surgical specimens obtained by partial, total or extended total maxillectomy after combined therapy were examined microscopically to evaluate histological effectiveness of the combined therapy and its relationship to histological type and staging of the tumor. Evidence of high correlation between them might help us in selecting the mode of treatment, conservative or radical operation, in individual cases. Histological classification used in this study was as follows: 1) Squamous cell carcinoma well differentiated type (9 cases) moderately differentiated type (3 cases) poorly differentiated type (10 cases) 2) Anaplastic cell carcinoma (5 cases) 3) Basal cell carcinoma (0 cases) 4) Transitional cell carcinoma (0 cases) 5) Adenocarcinoma (1 cases) In 12 cases out of 28 specimens (43%) tumor cells were not found in histopathological serial sections In poorly differentiated squamous cell carcinoma, no tumor cells were found in 8 out of 10 cases (80%), in moderately differentiated type, in 1 out 3 cases (33%), in well differentiated type, in no case out of 9 (0%), and in anaplastic carcinoma, in 3 out of 5 cases (60%). In regard to "T" category of TNM classification, in 5 out of 7 cases (71, 70) tumor was free in T2 squamous cell carcinoma, but in only 4 out of 13 cases (31%) in T3. In T2 of poorly differentiated sqamous cell carcinoma and anaplastic caroinoma, the combined therapy is the treatment of choice, but in T3 it is recommended to be followed by some modified surgery with functional and cosmetic care in order to ascertain histologically no residual tumor after the combined therapy. In well differentiated squamous cell carcinoma radical operation of ample extent should be performed depending upon the staging of the tumor.

上顎癌の組織型,進展度と三者併用療法後の組織学的効果との相関について

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