Duthoy Wim, Boterberg Tom, Claus Filip, Ost Piet, Vakaet Luc, Bral Samuel, Duprez Frederic, Van Landuyt Marianne, Vermeersch Hubert, De Neve Wilfried
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
Cancer. 2005 Jul 1;104(1):71-82. doi: 10.1002/cncr.21100.
Carcinoma of the paranasal sinuses is rare. Standard therapeutic modalities consist of surgery and radiotherapy (RT). Because of the often advanced stage and the vicinity of optic structures, RT-induced ocular toxicity is a feared side effect of conventional RT. Intensity-modulated radiotherapy (IMRT) is a relatively new technique, which is implemented with the hypothesis that, compared with conventional RT, it would result in a lower rate of ocular toxicity for an equal local control (LC).
Between 1998 and 2003, 39 consecutive patients received postoperative irradiation by means of IMRT for an adenocarcinoma (n = 31) or squamous cell carcinoma (n = 8) of the paranasal sinuses (n = 36) or nasal cavity (n = 3). T-classification was T2 in 41%, T3 in 15%, T4a in 23%, and T4b in 21% of patients. Invasion through the cribriform plate was seen in 11 patients. Orbital invasion was present in 36% of patients. The median delivered dose was 70 gray (Gy) (range, 60-70 Gy). The authors compared the overall survival (OS) and LC of the patients with a historic cohort (HC) (n = 30), treated with conventional or 3-dimensional conformal RT.
The median follow-up was 31 months. The actuarial OS rates were 68% at 2 years and 59% at 4 years. The actuarial LC rates were 73% at 2 years and 68% at 4 years. Invasion through the cribriform plate was a significant prognostic factor for LC and OS, with a median time to local disease recurrence of 7 months if present, and a 2-year LC rate of 90% if not present. In the comparison between the IMRT and HC groups, no significant differences were found for LC and OS. Acute toxicity was mild. Two patients developed decreased vision after RT. No RT-induced blindness was observed.
Postoperative IMRT for sinonasal carcinoma resulted in good LC, with a low acute toxicity and no RT-induced blindness.
鼻窦癌较为罕见。标准治疗方式包括手术和放射治疗（RT）。由于鼻窦癌往往处于晚期且靠近眼部结构，放射治疗引起的眼部毒性是传统放疗令人担忧的副作用。调强放射治疗（IMRT）是一种相对较新的技术，其实施基于这样的假设：与传统放疗相比，在实现同等局部控制（LC）的情况下，它会导致较低的眼部毒性发生率。
1998年至2003年期间，39例连续患者接受了调强放射治疗的术后放疗，这些患者患有鼻窦（n = 36）或鼻腔（n = 3）的腺癌（n = 31）或鳞状细胞癌（n = 8）。41%的患者T分级为T2，15%为T3，23%为T4a，21%为T4b。11例患者可见穿过筛板的侵犯。36%的患者存在眼眶侵犯。中位给予剂量为70格雷（Gy）（范围60 - 70 Gy）。作者将这些患者的总生存期（OS）和局部控制情况与一个历史队列（HC）（n = 30）进行了比较，该历史队列接受的是传统或三维适形放疗。
中位随访时间为31个月。2年时的精算总生存率为68%，4年时为59%。2年时的精算局部控制率为73%，4年时为68%。穿过筛板的侵犯是局部控制和总生存期的一个重要预后因素，若存在该侵犯，局部疾病复发的中位时间为7个月，若不存在则2年局部控制率为90%。在调强放射治疗组和历史队列组的比较中，局部控制和总生存期未发现显著差异。急性毒性较轻。2例患者放疗后视力下降。未观察到放疗导致的失明。
鼻窦癌术后调强放射治疗可实现良好的局部控制，急性毒性低且无放疗导致的失明。
