顔面神経温存を優先した耳下腺癌治療の検討

Abstract

Based on clinical features in 34 cases of parotid gland cancer treated between January 1997 and December 2007, tumor, node, and metastasis classification found 5 subjects to be T1, 12 to be T2, 7 to be T3, and 10 to be T4a. Of these, 25 were staged for N0, 3 for N1, and 6 for N2. Histopathologically, 10 different tumor types were observed, with carci-noma ex pleomorphic adenoma the most common. Preoperative fine-needle aspiration cytology (FNAC) of parotid gland tumor was done on 126 and cytological findings compared to histopathologic diagnoses of surgically resected specimens. Sensitivity for malignancy was 76.0%, specificity 95.4%, and overall accuracy 91.1%. Six malignant tumors were diagnosed as benign and 4 benign as malignant by FNAC, indicating that FNAC results alone may not be sufficient for diagnosing malignancy definitively. Among subjects, 25 underwent surgical resection, with the facial nerve preserved in 15 of 29. Postoperative radiotherapy was indicated if lymph node metastasis, intermediate or high-grade malignancy, or positive margins were seen. Of 15 subjects undergoing postoperative radiotherapy, 3 experienced recurrence. For unresectable tumors, concurrent chemoradiotherapy was used for 3 subjects and 2 underwent radiotherapy alone, with all 5 current survivors. The 5-year overall survival (OS) was 87.4% and progression-free survival (PFS) 71.4%. In terms of 5-year PFS, significant differences were seen between stage I/II (91.7%) and stage III/IW (51.6%) (P=0.032), and between N0 (86.2%) and N+ (38.1%) (P=0.002).