Padovani Laetitia, Pommier Pascal, Clippe S Sébastien, Martel-Lafay Isabelle, Malet Claude, Poupart Marc, Zrounba Philippe, Ceruse Philippe, Desmes Sophie, Carrie Christian, Montbarbon Xavier, Ginestet Chantal
Department of Radiation Oncology, Centre Léon Bérard, Lyon, France.
Int J Radiat Oncol Biol Phys. 2003 May 1;56(1):169-76. doi: 10.1016/s0360-3016(03)00078-6.
To assess local control, survival, and clinical and dosimetric prognostic factors in 25 patients with locally advanced maxillary or ethmoid sinus carcinoma treated by three-dimensional conformal radiotherapy (RT).
Surgery was performed in 22 patients and was macroscopically complete in 16. Seven patients received chemotherapy (concomitant with RT in four). The following quality indexes were defined for the 95% and 90% isodoses: tumor conformity index, normal tissue conformity index, and global conformity index.
The median radiation dose to the planned treatment volume was 63 Gy, with a minimal dose of 60 Gy, except in 2 patients whose cancer progressed during RT. The maximal doses tolerated by the structures involved in vision were respected, except for tumors that involved the optic nerve. After a median follow-up of 25 months, 14 local tumor recurrences developed. The major prognostic factors were central nervous system involvement by disease and the presence of nonresectable tumors. The radiation dose and tumor conformity index value were not significant prognostic indicators. Two patients died of acute infectious toxicity, and two developed late ipsilateral ocular toxicity.
Improving local control remains the main challenge in RT for paranasal tumors.
评估25例接受三维适形放疗（RT）的局部晚期上颌窦或筛窦癌患者的局部控制情况、生存率以及临床和剂量学预后因素。
22例患者接受了手术，其中16例在宏观上达到完全切除。7例患者接受了化疗（4例为同步放化疗）。为95%和90%等剂量线定义了以下质量指标：肿瘤适形指数、正常组织适形指数和总体适形指数。
计划治疗体积的中位放射剂量为63 Gy，最小剂量为60 Gy，但有2例患者在放疗期间癌症进展。除累及视神经的肿瘤外，视觉相关结构所耐受的最大剂量均得到了遵守。中位随访25个月后，出现了14例局部肿瘤复发。主要预后因素为疾病累及中枢神经系统和存在不可切除肿瘤。放射剂量和肿瘤适形指数值不是显著的预后指标。2例患者死于急性感染毒性，2例出现晚期同侧眼部毒性。
提高局部控制率仍然是鼻旁窦肿瘤放疗的主要挑战。
