Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting - The MSKCC experience
Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting - The MSKCC experience
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DOI：
10.1016/j.ijrobp.2006.09.023
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发表时间：
2007-03-01
影响因子：
7
通讯作者：
Lee, Nancy Y.
中科院分区：
文献类型：
--
作者：
Hoppe, Bradford S.;Stegman, Lauren D.;Lee, Nancy Y.
目的：对在纪念斯隆 - 凯特琳癌症中心接受术后放疗（RT）的鼻窦（PNS）癌患者进行回顾性分析。
方法和材料：1987年1月至2005年7月期间，85例鼻窦和鼻腔癌患者接受了术后放疗。大多数患者患有鳞状细胞癌（49%；n = 42），T4肿瘤（52%；n = 36），且原发疾病部位为上颌窦（53%；n = 45）。中位放疗剂量为63Gy。85例患者中，76例进行了CT模拟定位，53例接受了三维适形放疗（27%；n = 23）或调强放疗（35%；n = 30）。根据放射治疗肿瘤学组的放射损伤评分标准对急性和晚期毒性进行评分。
结果：存活患者的中位随访时间为60个月，局部无进展、区域无进展、无远处转移、无疾病进展和总生存率的5年估计值分别为62%、87%、82%、55%和67%。多变量分析显示，鳞状细胞组织学类型和筛板受累预示局部复发可能性增加，鳞状细胞组织学特征预示总生存期较差。接受CT模拟定位并采用现代技术治疗的患者中，无一人出现3 - 4级眼部晚期并发症。
结论：完全手术切除后辅以放疗是治疗鼻窦癌的一种有效且安全的方法。新兴的工具，如三维适形治疗，特别是针对鼻窦肿瘤的调强放疗，可能会减少与传统放疗技术相关的晚期并发症的发生。局部复发仍然是一个重大问题。（c）2007爱思唯尔公司
Purpose: To perform a retrospective analysis of patients with paranasal sinus (PNS) cancer treated with postoperative radiotherapy (RT) at Memorial Sloan-Kettering Cancer Center.Methods and Materials: Between January 1987 and July 2005, 85 patients with PNS and nasal cavity cancer underwent postoperative RT. Most patients had squamous cell carcinoma (49%; n = 42), T4 tumors (52%; n = 36), and the maxillary sinus (53%; n = 45) as the primary disease site. The median radiation dose was 63 Gy. Of the 85 patients, 76 underwent CT simulation and 53 were treated with either three-dimensional conformal RT (27%; n = 23) or intensity-modulated RT (35%; n = 30). Acute and late toxicities were scored according to the Radiation Therapy Oncology Group radiation morbidity scoring criteria.Results: With a median follow-up for surviving patients of 60 months, the 5-year estimates of local progression-free, regional progression-free, distant metastasis-free, disease-free, and overall survival rates were 62%, 87%, 82%, 55%, and 67%, respectively. On multivariate analysis, squamous cell histology and cribriform plate involvement predicted for an increased likelihood of local recurrence, and squamous cell histologic features predicted for worse overall survival. None of the patients who underwent CT simulation and were treated with modern techniques developed a Grade 3-4 late complication of the eye.Conclusion: Complete surgical resection followed by adjuvant RT is an effective and safe approach in the treatment of PNS cancer. Emerging tools, such as three-dimensional conformal treatment and, in particular, intensity-modulated RT for PNS tumors, may minimize the occurrence of late complications associated with conventional RT techniques. Local recurrence remains a significant problem. (c) 2007 Elsevier Inc.