Samant Sandeep, Robbins K Thomas, Vang M, Wan Jim, Robertson J
Department of Otolaryngology--Head and Neck Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Arch Otolaryngol Head Neck Surg. 2004 Aug;130(8):948-55. doi: 10.1001/archotol.130.8.948.
To report the long-term efficacy of a combined regimen of intra-arterial high-dose cisplatin chemotherapy and concomitant radiation therapy followed by organ-sparing surgery when possible in the treatment of advanced paranasal sinus cancer.
Review of prospectively collected data.
Academic referral center. Patients Nineteen patients with advanced paranasal sinus malignancies with a minimum follow-up of 2 years. Malignancies included 14 squamous cell carcinomas (74%), 2 adenocarcinomas (10%), 2 adenoid cystic carcinomas (10%), and 1 undifferentiated carcinoma (5%). Sixteen patients (84%) had T4 disease. Intervention Treatment consisted of preoperative radiation therapy (2.0 Gy/fraction per day; total dose, 50 Gy in 5 weeks) given concomitantly with 3 to 4 weekly infusions of intra-arterial cisplatin (150 mg/m(2) per week) and systemic sodium thiosulfate neutralization. The regimen included planned surgery performed approximately 8 weeks after completion of radiation therapy. Ten patients underwent a transcranial anterior craniofacial resection; 1, a medial maxillectomy; and 1, an endoscopic restaging only.
After a median follow-up of 53 months, actuarial overall survival at 2 and 5 years was 68% and 53%, respectively. One patient died of myocardial infarction during treatment. No other treatment-limiting toxic effect was noted. Although 3 patients had persistence of disease, delayed local failure occurred only in 2 and distant metastasis in 3. Except for cataract in 2 patients, no visual loss developed.
Despite the advanced stage and unfavorable nature of cancer in this cohort, our results indicate that this regimen holds promise and merits further study.
报告动脉内大剂量顺铂化疗联合同步放疗并在可能时进行保留器官手术治疗晚期鼻窦癌的长期疗效。
回顾前瞻性收集的数据。
学术转诊中心。患者19例晚期鼻窦恶性肿瘤患者，最少随访2年。恶性肿瘤包括14例鳞状细胞癌（74%）、2例腺癌（10%）、2例腺样囊性癌（10%）和1例未分化癌（5%）。16例患者（84%）有T4期疾病。干预治疗包括术前放疗（每天2.0 Gy/分次；总剂量，5周内50 Gy），同时每周3至4次动脉内输注顺铂（150 mg/m²每周）和全身硫代硫酸钠中和。该方案包括放疗完成后约8周进行的计划性手术。10例患者接受经颅前路颅面切除术；1例接受上颌骨内侧切除术；1例仅接受内镜再分期。
中位随访53个月后，2年和5年的精算总生存率分别为68%和53%。1例患者在治疗期间死于心肌梗死。未观察到其他限制治疗的毒性作用。虽然3例患者疾病持续存在，但仅2例出现延迟性局部失败，3例出现远处转移。除2例患者出现白内障外，未发生视力丧失。
尽管该队列中的癌症处于晚期且性质不佳，但我们的结果表明该方案有前景，值得进一步研究。
