Spot Scanning Proton Therapy for Sinonasal Malignant Tumors.
Spot Scanning Proton Therapy for Sinonasal Malignant Tumors.
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DOI：
10.14338/ijpt-d-20-00043.1
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发表时间：
2021
影响因子：
1.7
通讯作者：
Shibamoto Y
中科院分区：
文献类型：
--
作者：
Nakajima K;Iwata H;Hattori Y;Nomura K;Hashimoto S;Toshito T;Hayashi K;Kuroda Y;Fukano H;Ogino H;Shibamoto Y
鼻窦恶性肿瘤的治疗具有挑战性，确立标准治疗的证据有限。我们的目的是评估点扫描质子治疗（SSPT）对鼻窦恶性肿瘤的疗效和安全性。
我们回顾性分析了2014年5月至2019年9月期间接受SSPT治疗的鼻窦恶性肿瘤（T1 - 4bN0 - 2M0）患者。对于黏膜黑色素瘤，处方剂量通常为15次分割共60 GyRBE或16次分割共60.8 GyRBE，对于其他组织学亚型为26次分割共70.2 GyRBE。终点包括局部控制（LC）、无进展生存期、总生存期（OS）以及毒性发生率。使用卡普兰 - 迈耶方法和对数秩检验分析预后因素。
在62例入组患者中，常见的组织学亚型为黏膜黑色素瘤（35%）、鳞状细胞癌（27%）、腺样囊性癌（16%）和嗅神经母细胞瘤（10%）。局部晚期较为常见（T3占42%，T4占53%）。初治肿瘤和术后复发肿瘤分别占73%和27%。没有患者既往接受过放疗。所有患者的中位随访时间为17个月（范围，6 - 66个月），幸存者为21.5个月（范围，6 - 66个月）。所有患者的2年局部控制率、无进展生存率和总生存率分别为92%、50%和76%。单因素分析显示组织学是总生存期的一个预后因素，腺样囊性癌和嗅神经母细胞瘤的总生存期高于其他肿瘤。在12例患者（19%）中观察到16例≥3级晚期毒性反应，包括11例导致视力损害的事件；最常见的是白内障。有1例4级毒性反应，无5级毒性反应。
SSPT对鼻窦恶性肿瘤耐受性良好，并取得了良好的局部控制效果。尽管我们认为SSPT是一种主要的治疗方式，但还需要进一步研究以确立其作为标准治疗的地位。
Treatment of sinonasal malignant tumors is challenging, and evidence to establish a standard treatment is limited. Our objective was to evaluate the efficacy and safety of spot scanning proton therapy (SSPT) for sinonasal malignant tumors. We retrospectively analyzed patients with sinonasal malignant tumors (T1-4bN0-2M0) who underwent SSPT between May 2014 and September 2019. The prescription dose was typically either 60 GyRBE in 15 fractions or 60.8 GyRBE in 16 fractions for mucosal melanoma and 70.2 GyRBE in 26 fractions for other histologic subtypes. Endpoints included local control (LC), progression-free survival, overall survival (OS), and incidence of toxicity. Prognostic factors were analyzed using the Kaplan-Meier method and log-rank test. Of 62 enrolled patients, the common histologic subtypes were mucosal melanoma (35%), squamous cell carcinoma (27%), adenoid cystic carcinoma (16%), and olfactory neuroblastoma (10%). Locally advanced stages were common (T3 in 42% and T4 in 53%). Treatment-naïve tumors and postsurgical recurrent tumors accounted for 73% and 27%, respectively. No patient had previous radiotherapy. The median follow-up was 17 months (range, 6-66) for all patients and 21.5 months (range, 6-66) for survivors. The 2-year LC, progression-free survival, and OS rates of all patients were 92%, 50%, and 76%, respectively. Univariate analysis revealed histology as a prognostic factor for OS, being higher in adenoid cystic carcinoma and olfactory neuroblastoma than in other tumors. Sixteen grade ≥3 late toxicities were observed in 12 patients (19%), including 11 events resulting in visual impairment; the most common was cataract. There was 1 grade 4 toxicity, and there were no grade 5 toxicities. SSPT was well tolerated and yielded good LC for sinonasal malignant tumors. Although we consider SSPT to be a leading treatment modality, further studies are required to establish its status as a standard treatment.