Outcomes of Sinonasal Cancer Treated With Proton Therapy
Outcomes of Sinonasal Cancer Treated With Proton Therapy
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DOI：
10.1016/j.ijrobp.2016.02.019
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发表时间：
2016-05-01
影响因子：
7
通讯作者：
Mendenhall, William M.
中科院分区：
文献类型：
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作者：
Dagan, Roi;Bryant, Curtis;Mendenhall, William M.
目的：报告后质子治疗（PT）sinonasal cancer.Methods和材料的疾病结局：84例成人患者没有转移接受原发性（13%）或辅助（87%）PT鼻窦癌（不包括黑色素瘤，肉瘤和淋巴瘤）。常见的组织学类型为嗅神经母细胞瘤（23%）、鳞状细胞癌（22%）和腺样囊性癌（17%）。晚期（T3 25%，T4 69%）和高级别组织学（51%）是常见的。外科手术包括单纯内镜切除术（45%）、内镜切除术联合开颅术（12%）或开放性切除术（30%）。26%的患者存在大体残留病变。大多数患者接受超分割PT（1.2戈伊[相对生物学有效性（RBE）]，每日2次，99%）和化疗（75%）。中位PT剂量为73.8戈伊（RBE），85%的患者接受超过70戈伊（RBE）。采用Kaplan-Meier分析和比例风险回归进行多元回归分析。使用逻辑回归评价剂量学参数。使用美国国家癌症研究所不良事件通用术语标准（第4版）报告严重、晚期3级或以上毒性。所有患者的中位随访时间为2.4年，存活患者的中位随访时间为2.7年。结果：3年时，局部控制（LC）、颈部控制、无远处转移、无病生存、病因特异性生存和总生存率分别为83%、94%、73%、63%、70%和68%。大体全切除和PT导致90%的3年LC率。原发性放射治疗的3年LC率为61%，肉眼病变患者的3年LC率为59%。在多变量分析中，大体病变是LC的唯一显著因素，而分级和连续LC是总生存率的预后因素。12例局部复发中有6例为边缘性复发。硬膜播散占远端复发的26%。晚期毒性发生在24%的患者（3级或更高的单侧视力丧失2%）。结论：剂量强化，超分割PT与或不同步化疗的结果在良好的LC后，总全切除术，结果在患者的总疾病是令人鼓舞的。组织学分级高的患者因远处转移而死亡的风险更大。连续LC是生存的一个主要决定因素，几乎在所有情况下都证明了积极的局部治疗是合理的。(C)2016 Elsevier Inc. All rights reserved.
Purpose: To report disease outcomes after proton therapy (PT) for sinonasal cancer.Methods and Materials: Eighty-four adult patients without metastases received primary (13%) or adjuvant (87%) PT for sinonasal cancers (excluding melanoma, sarcoma, and lymphoma). Common histologies were olfactory neuroblastoma (23%), squamous cell carcinoma (22%), and adenoid cystic carcinoma (17%). Advanced stage (T3 in 25% and T4 in 69%) and high-grade histology (51%) were common. Surgical procedures included endoscopic resection alone (45%), endoscopic resection with craniotomy (12%), or open resection (30%). Gross residual disease was present in 26% of patients. Most patients received hyperfractionated PT (1.2 Gy [relative biological effectiveness (RBE)] twice daily, 99%) and chemotherapy (75%). The median PT dose was 73.8 Gy (RBE), with 85% of patients receiving more than 70 Gy (RBE). Prognostic factors were analyzed using Kaplan-Meier analysis and proportional hazards regression for multiple regression. Dosimetric parameters were evaluated using logistic regression. Serious, late grade 3 or higher toxicity was reported using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4. The median follow-up was 2.4 years for all patients and 2.7 years among living patients.Results: The local control (LC), neck control, freedom from distant metastasis, disease-free survival, cause-specific survival, and overall survival rates were 83%, 94%, 73%, 63%, 70%, and 68%, respectively, at 3 years. Gross total resection and PT resulted in a 90% 3-year LC rate. The 3-year LC rate was 61% for primary radiation therapy and 59% for patients with gross disease. Gross disease was the only significant factor for LC on multivariate analysis, whereas grade and continuous LC were prognostic for overall survival. Six of 12 local recurrences were marginal. Dural dissemination represented 26% of distant recurrences. Late toxicity occurred in 24% of patients (with grade 3 or higher unilateral vision loss in 2%).Conclusions: Dose-intensified, hyperfractionated PT with or without concurrent chemotherapy results in excellent LC after gross total resection, and results in patients with gross disease are encouraging. Patients with high-grade histology are at greater risk of death from distant dissemination. Continuous LC is a major determinant of survival justifying aggressive local therapy in nearly all cases. (C) 2016 Elsevier Inc. All rights reserved.