Selection Of Comprehensive Treatment Scheme For Rare Malignant Tumor In Sinus And Nasal Region And Clinical Analysis Of Prognostic Factors

Objective:To summarize the clinical characteristics of rare malignant tumors in sinuses and nasal cavity,analyze the therapeutic effect of rare malignant tumors in sinuses and nasal cavity and the relevant factors affecting prognosis,so as to summarize and explore the rational use of comprehensive treatment schemes.Methods:A total of 118 cases of patients with rare malignant tumor of sinus and nasal cavity were confirmed by pathology from January 2008 to December 2016 in the department of Otorhinolaryngology Head and Neck Surgery of the First Hospital of Shanxi Medical University and the Head and Neck Surgery of Shanxi Cancer Hospital.There were 85 male patients and 33 female patients.70 patients(75.3%)were younger than 65 years old,57 patients(24.7%)were older than 65 years old,the youngest patient was 8 years old,the oldest patient was 83 years old.There were 67 patients who received comprehensive treatment,among which the combination of surgery with chemotherapy and radiotherapy was the most common,with 24 patients(35.8%).21 patients(31.3%)received surgery combined with radiotherapy,12 patients(17.9%)received surgery combined with chemotherapy,and 10 patients(14.9%)received chemotherapy combined with radiotherapy.26 cases were treated by operation,chemotherapy and radiotherapy alone.Results:The primary cause of treatment failure was local recurrence,accounting for 35.4%of the total data,which was mainly found in malignant melanoma(18.1%),extranodal NK / T-cell lymphoma(18.1%),adenoid cystic carcinoma(24.2%),rhabdomyosarcoma(9.0%),diffuse large B-cell lymphoma(9.0%).The second is distant metastasis,accounting for 10.7%,which is more common in rhabdomyosarcoma(30%),malignant melanoma(20%),and in stage III and IV patients.In stage III and IV patients,local recurrence and distant metastasis accounted for 72.7% and 70% respectively.Lymph node metastasis was rare(7.5%).This study found that concurrent radiotherapy and chemotherapy could significantly improve the local control rate(76.0%)and prolong the OS of patients for 5 years(60.4%)compared with conventional chemoradiotherapy combined with radiotherapy(67.1%).It was the independent influencing factor of total OS in Cox multivariate analysis.Cox regression analysis showed that age,TNM stage(stage IV),sphenoid sinus involvement,intracranial invasion,lymph node metastasis,distant metastasis,recurrence and concurrent radiotherapy and chemotherapy were independent risk factors.The overall OS of 3 and 5 years were 53% and 49%respectively.Conclusion:Nasal sinus is rare malignant tumor,local recurrence is the primary cause of failure,distant metastasis is second,lymph node metastasis is rare.local recurrence is more common in malignant melanoma,extranodal NK/T cell lymphoma,adenoid cystic carcinoma,rhabdomyosarcoma and so on.Distant metastases are common in rhabdomyosarcoma and malignant melanoma,mostly in stage III and IV patients.Combination of surgery and radiotherapy is the preferred treatment for malignant tumors of the nasal cavity and sinus.However,in this study,no significant statistical difference was found between surgery combined with radiotherapy and other treatments for rare malignant tumors of the nasal cavity and sinus.Among the rare malignant tumors in the nasal cavity and paranasal sinuses,it is recommended to add chemotherapy in the treatment of stage ? and ? patients or highly malignant tumors such as rhabdomyosarcoma and malignant melanoma,or combine with synchronous chemotherapy.For those who lose the opportunity of operation in stage ? and ?patients,synchronous chemotherapy can be tried to improve local control and OS.The patients with rare advanced clinical malignant tumor of nasal cavity and paranasal sinuses,T3 / T4,tumor diameter ? 2cm,malignant melanoma and striated muscle,which are prone to cause lymph node metastasis,can choose the same side of neck lymph node i,II,III preventive radiotherapy,but the patients who have received chemotherapy can not do it.Age,late clinical stage(?),sphenoid sinus involvement,intracranial invasion,lymph node metastasis,distant metastasis,recurrence and chemoradiation for the independent risk factors affecting prognosis.