上咽頭悪性腫瘍の集計分析と今後の指針

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Fifty patients of the nasopharyngeal carcinoma and 27 patients of the nasopharyngeal sarcoma who visited our hospital from 1955 to 1979 were statistically examined.Histologically the carcinoma was mainly squamous cell carcinoma (27 cases) followed by epidermoid carcinoma (10 cases) and undifferentiated carcinoma (8 cases). One case each of the basal cell carcinoma, papillary adenocarcinoma and cystic carcinoma was also found. The sex ratio was 1.35 in favour of males. The age distribution was from 18 to 77 and the incidence showed one peak in the 60-70 age range. The most frequent first signwas a lump in the neck followed by nasal obstruction, nasal bleeding, hearing impairment, double vision and others along this line. The period from the first awareness of the symptomsto visiting the doctors was 8 months on an average, being significantly longer than that for the sarcoma patient (3.9 months on an average). This is perhaps because of the invasive tendency of the cancer when growing. In the past, in some cases, we had treated cancer patient surgically. However, knowing the discouraging results of this treatment, at the moment we treat them primarily by tele-60Co irradiation with the combination of chemotherapy (5FU+Vitamin A). Adjuvantive immunotherapy is also applied. Thus the net five-year survival rate over these last ten years has improved to 29% (4/14).The histology of the sarcoma was mainly the malignant lymphoma (21 cases) followed by the reticulum cell sarcoma (4 cases). One case each of Hodgkins disease and fibrosarcoma was also found. The sex ratio was 1.45 in favour of male. The age distribution was from 8 to 84 and the incidence showed two peaks at 10 years and 50 years. The most frequent first sign was nasal obstruction followed by a lump in the neck, pharyngeal symptoms, blocked ear and other symptoms along this line. The percent distribution of these first signs was significantly different from that of the cancer by χ2-test. This difference may be explained by the difference in the way of growth of the two kinds of tumors. The carcinoma grows invasively and the sarcoma grows exophitically. In the past, the sarcoma was also treated surgically. However, around ten years ago this method was abandanded because of its discouraging results. At the moment the sarcoma is primarily treated with tele-60Co irradiation or chemotherapy, depending on its clinical stage of An Arbor Classification; the first stage patients are treated by the irradiation, only the second stage patients are treated by the irradiation followed by VEP (combination of vincristine, endoxan and predonisolone) chemotherapy, while the over third stage patients are treated only by VEMP (VEP + mitomycin C). Thus the net five year survival over on these last ten years has improved to 57.1% (4/7).Since the survival rate of the nasopharyngeal tumors in our hospital, especially in the carcinoma, is not satisfactory, further improvement of treatment methods including adjuvantive immunotherapy or the use of interferon is necessary, as well as early diagnosis and treatment.
社団法人日本耳鼻咽喉科学会の論文

上咽頭悪性腫瘍の集計分析と今後の指針

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