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Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients（30%） were positive. The median time of follow-up was 38 months（6 to 85 months）. Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin（P=0.018）, recurrence（P=0.006） and distant metastasis（P=0.04）. Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.
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Humanos , Carcinoma Adenoide Cístico/patologia , Neoplasias dos Seios Paranasais/patologia , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia , PrognósticoRESUMO
Nasopharyngeal carcinoma (NPC) is a common malignant tumor in China. Radiotherapy is the first-line treatment. After appropriate radiotherapy, about 5%-15% patients experience recurrence. In view of the poor efficacy and high incidence of severe late toxicities associated with re-irradiation, salvage surgery by the transnasal endoscopic approach is recommended for recurrent NPC (rNPC). Compared with re-irradiation, endoscopic surgery can better prolong survival, improve the quality of life, and reduce complications and medical expenses of patients with rNPC. However, the complexity of the nasopharyngeal skull base enhances the difficulty and risk of surgery. Expanding the boundary of surgical resection remains a clinical challenge for otolaryngologists. In this regard, to help more advanced patients with rNPC, the surgical innovative system of NPC needs to be established by multi-disciplinary cooperation, involving skull base anatomy-based investigation, appropriate administration of the internal carotid artery (ICA), repair of skull base defect, and establishment of various types of endoscopic endonasal nasopharyngectomy.
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Objective@#To discuss the treatment, pathological subtypes and recurrence of sinonasal chondrosarcoma, and to identify the prognostic factors.@*Methods@#Between January 1994 and May 2018, 47 patients with sinonasal chondrosarcoma who were treated in Eye, Ear, Nose and Throat Hospital, Shanghai Medwal College, Fudan University were retrospectively reviewed, including 19 males and 28 females, aging from 7 months to 71 years old, with a median age of 38 years old. The clinical symptoms, location of tumor, surgical method, pathological subtype, recurrence and prognosis were collected and analyzed. Kaplan-Meier method was used to calculate the disease-specific survival rate, disease-free survival rate and draw survival curve. Log Rank was used to analyze the prognostic factors. Cox regression was used for multivariate analysis.@*Results@#Except for one patient who gave up treatment after tumor biopsy, other 46 patients underwent radical resection, including 31 cases of endoscopic resection and 15 cases of extranasal approach resection. Thirty-nine patients were diagnosed as conventional intramedullary chondrosarcoma with pathological grade Ⅰ of 24 cases and grade Ⅱ of 15 cases. Six cases were diagnosed as mesenchymal chondrosarcoma while 2 cases were diagnosed as myxoid chondrosarcoma. During an average follow-up period of 56.1 months (17-156 months), 23 patients had recurrence (54.8%, 23/42), among whom 9 patients had re-operations and 5 patients died. Thirty-seven patients survived, including 25 patients survived without tumors. In addition, 5 patients were lost to follow-up, including the patient who gave up treatment after tumor biopsy. Five-year overall survival rate and disease-free survival rate was 84.7% and 34.3%, respectively. Multivariate analysis showed that invasion of skull base was an independent risk factor affecting disease-free survival rate (95% confidence interval: 1.089-5.825, P=0.031).@*Conclusions@#Radical resection is the primary treatment for sinonasal chondrosarcoma. The most common pathological subtype is conventional intramedullary chondrosarcoma. Sinonasal chondrosarcoma has a high local recurrence rate. The long-term prognosis is well after complete excision of the lesion. The most important cause of death is uncontrollable local disease and invasion of adjacent key structures.
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Objective@#To discuss the surgical technique and outcome of nasal skull base schwannoma treated under endonasal endoscope.@*Methods@#Fifty-two patients with nasal skull base nonvestibular schwannoma were treated under endonasal endoscope from May 2006 to June 2017 in Shanghai E&ENT Hospital. Of the patients, there were 21 men and 31 women. The age of the patients ranged from 33 to 71 years.Schwannoma mainly came from trigeminal nerve.Clinical symptoms included facial numbness, facial pain, nasal obstruction, headache, hypopsia, diplopia and tinnitus. Surgical approaches included pure endonasal endoscope approach (18 cases) and endoscopic endonasal resection asissted with sublabial transmaxillary approach (34 cases).@*Results@#Total tumor resection was achieved in 42 patients(80.8%), subtotal resection in 8 patients, and partial resection in 2 patients. The relief rate of facial numbness, facial pain, nasal obstruction, headache, hypopsia, diplopia and tinnitus were 68.8%, 45.5%, 100.0%, 90.0%, 60.0%, 40.0% and 100.0%, respectively. During surgery, cerebrospinal fluid leakage was observed in 5 cases. All cases were successfully repaired with a nasoseptal flap or autologous fascia lata and fat obtained from thigh. Four cases with recurrence were observed in the follow-up period (6-134 months).@*Conclusion@#Endonasal endoscopic approach is a safe and feasible procedure for schwannoma in nasal cavity, paranasal sinus, orbital apex, pterygopalatine fossa, infratomporal fossa, cavernous sinus and Meckel cave.
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OBJECTIVE@#To investigate the effect and potential mechanisms about apoptosis induction and migration suppression of photodynamic therapy with a new photosensitizer, 9-hydroxypheophorbide-α (9-HPbD), and diode laser on HN-3 human laryngeal squamous cancer cells.@*METHOD@#The attached HN-3 cancer cells were photosesitized with 0.29 μg/ml and 0.59 μg/ml 9-HPbD for 6 h and irradiated by 664 nm diode laser for 15 min at an energy density of 2.0 J/cm for activating 9-HPbD. Wound healing assay and photographing was respectively performed immediately after laser irradiation. Photographing focusing on the same location was repeated 12 h, 24 h and 36 h after PDT and cells migration distance counted respectively. H2DCFDA staining was used to assess accumulation of reactive oxygen series (ROS) 1 h after PDT. MTT assay, Hoechst33342/PI double staining, western blotting were respectively performed to assess cellular viability, apoptosis and the expression of Enos, p-c-Jun, EGFR.@*RESULT@#Phototoxicity and apoptosis on HN-3 cells induced by 9-HPbD-PDT was exhibited in a dose-related manner. Neither 9-HPbD alone nor laser alone was cytotoxic to HN-3 cells. Generation of ROS was initiated immediately after PDT. The apoptotic cells, marked with condensed/fragmented blue or pink nuclei, and up-regulated expression of eNOS, p-c-Jun were subsequently induced 24 h after PDT. Coupled with a down-regulated expression of EGFR, a photosensitizer dose-ralated cell migration suppression was initiated by PDT. After pretreatment of GSH or ascorbic acid, a kind of antioxidant, the efficacy of PDT-induced apoptosis and migration suppression was partially inhibited.@*CONCLUSION@#Activation of p-c-Jun, eNOS and down-regulated expression of EGFR may respectively involve in the apoptosis induction and cell migration suppression after 9-HPbD-PDT. Generation of ROS may play an important role in the course of apoptosis induction and migration suppression of HN-3 cells initiated by 9-HPbD-PDT.