Neuroendocrine tumors of the sinonasal tract - Results of a prospective study incorporating chemotherapy, surgery, and combined proton-photon radiotherapy
Neuroendocrine tumors of the sinonasal tract - Results of a prospective study incorporating chemotherapy, surgery, and combined proton-photon radiotherapy
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DOI：
10.1002/cncr.10537
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发表时间：
2002-05-15
期刊：
影响因子：
6.2
通讯作者：
Amrein, P
中科院分区：
文献类型：
--
作者：
Fitzek, MM;Thornton, AF;Amrein, P
背景。作者报告了一项对鼻窦恶性神经内分泌肿瘤患者进行的前瞻性研究的结果，这些患者接受了高剂量质子光子放射治疗的多模式治疗。 1992 年至 1998 年间，一项前瞻性研究对 19 名嗅神经母细胞瘤 (ONB) 或神经内分泌癌 (NEC) 患者进行了治疗。 4 名患者患有 Kadish B 期疾病，15 名患者患有 Kadish C 期疾病。患者中位年龄为 44 岁。患者接受 2 个疗程的顺铂和依托泊苷化疗，随后接受高剂量质子光子放射治疗至 69.2 钴格雷当量 (CGE)，每次剂量 1.6-1.8 CGE，每日两次，同时加强治疗。对有反应者进行了另外两个疗程的化疗。结果。在 19 名患者中，有 15 名患者在撰写本报告时还活着，中位随访时间为 45 个月（范围为 20-92 个月）。 4 名患者在最初诊断后 8-47 个月内死于播散性疾病。 5年生存率为74%。有两次局部复发，两名患者均接受了挽救手术。初次治疗5年局部控制率为88%。化疗的急性毒性是可以忍受的，没有患者出现超过3级的血液学毒性。十三名患者对化疗表现出部分或完全反应。一名患者在第一个疗程化疗后出现单侧视力丧失；除此之外，所有患者均实现了视力保护。根据磁共振成像标准，四名临床完好的患者出现了额叶或颞叶辐射引起的损伤。两名患者出现软组织和/或骨坏死，其中一名患者需要手术修复脑脊液漏。结论。新辅助化疗和大剂量质子光子放疗是 ONB 和 NEC 患者的成功治疗方法。根治性手术仅适用于无反应者。由于立体定向装置和质子的辐射传递精确，没有观察到辐射引起的视力丧失。 (C) 2002 年美国癌症协会。
BACKGROUND. The authors report the results of a prospective study of patients with malignant neuroendocrine tumors of the sinonasal tract who received multimodality treatment incorporating high-dose proton-photon radiotherapy.METHODS. Nineteen patients with olfactory neuroblastoma (ONB) or neuroendocrine carcinoma (NEC) were treated between 1992 and 1998 on a prospective study. Four patients had Kadish Stage B disease, and 15 patients had Kadish Stage C disease. The median patient age was 44 years. Patients received chemotherapy with 2 courses of cisplatin and etoposide followed by high-dose proton-photon radiotherapy to 69.2 cobalt-Gray equivalents (CGE) using 1.6-1.8 CGE per fraction twice daily in a concomitant boost schedule. Two further courses of chemotherapy were given to responders.RESULTS. Of 19 patients, 15 patients were alive at the time of this report with a median follow-up of 45 months (range, 20-92 months). Four patients died from disseminated disease 8-47 months after their original diagnosis. The 5-year survival rate was 74%. There were two local recurrences, and both patients underwent salvage surgery. The 5-year local control rate of initial treatment was 88%. Acute toxicity of chemotherapy was tolerable, with no patient sustaining more than Grade 3 hematologic toxicity. Thirteen patients showed a partial or complete response to chemotherapy. One patient developed unilateral visual loss after the first course of chemotherapy; otherwise, visual preservation was achieved in all patients. Four patients who were clinically intact developed radiation-induced damage to the frontal or temporal lobe by magnetic resonance imaging criteria. Two patients showed soft tissue and/or bone necrosis, and one of these patients required surgical repair of a cerebrospinal fluid leak.CONCLUSIONS. Neoadjuvant chemotherapy and high-dose proton-photon radiotherapy is a successful treatment approach for patients with ONB and NEC. Radical surgery is reserved for nonresponders. Due to the precision of delivery of radiation with stereotactic setup and protons, no radiation-induced visual loss was observed. (C) 2002 American Cancer Society.