Hanna Ehab Y, Cardenas Alvaro Diaz, DeMonte Franco, Roberts Dianna, Kupferman Michael, Weber Randal, Rosenthal David, Kies Merrill
Department of Head and Neck Surgery, Head and Neck Center, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
Arch Otolaryngol Head Neck Surg. 2011 Jan;137(1):78-81. doi: 10.1001/archoto.2010.231.
To review the oncologic outcomes in patients with advanced (stage III-IV) squamous cell carcinoma of the paranasal sinuses treated with induction chemotherapy prior to definitive local therapy.
The medical records of 46 consecutive patients with previously untreated, biopsy-proved squamous cell carcinoma of the paranasal sinuses who received induction chemotherapy during the course of their treatment were reviewed for demographics, tumor types and stages, treatment details, and oncologic outcomes.
Of the 46 patients (median age, 59 years), the tumor epicenter was in the maxillary sinus in 31 (67%), ethmoid sinus in 9 (20%), nasal cavity in 4 (9%), and sphenoid sinus in 2 (4%). All patients had T3 or T4 tumors, and 12 (26%) patients had clinical evidence of nodal metastasis, with an overall stage of III (20%) or IV (80%). Induction chemotherapy regimens consisted of a combination of a taxane and platinum in 80% of patients, by themselves (14 patients) or in combination with a third agent, such as ifosfamide (14 patients) or 5-fluorouracil (9 patients). The combination of a taxane and 5-fluorouracil was used in the remaining 9 patients. More than two-thirds (67%) of the patients achieved at least a partial response to induction chemotherapy, 24% had progressive disease, and 9% had stable disease. Subsequent treatment after induction chemotherapy consisted of surgery, usually followed by radiation or chemoradiation or by definitive radiation or chemoradiation with surgical salvage of any residual disease. Overall, surgical resection was performed in only 24 of 46 patients (52%) treated with induction chemotherapy. The 2-year survival for patients with at least a partial response or stable disease after induction chemotherapy was 77% in contrast to only 36% for patients with progressive disease.
Tumor response to induction chemotherapy in patients with advanced squamous cell carcinoma of the paranasal sinuses may be predictive of treatment outcome and prognosis. Favorable response to induction chemotherapy is associated with better survival and a reasonable chance of organ preservation.
回顾在确定性局部治疗前接受诱导化疗的晚期（III-IV期）鼻窦鳞状细胞癌患者的肿瘤学结局。
回顾了46例连续的、先前未经治疗且经活检证实为鼻窦鳞状细胞癌的患者的病历，这些患者在治疗过程中接受了诱导化疗，内容包括人口统计学资料、肿瘤类型和分期、治疗细节以及肿瘤学结局。
46例患者（中位年龄59岁）中，肿瘤中心位于上颌窦31例（67%），筛窦9例（20%），鼻腔4例（9%），蝶窦2例（4%）。所有患者均为T3或T4肿瘤，12例（26%）患者有淋巴结转移的临床证据，总体分期为III期（20%）或IV期（80%）。80%的患者诱导化疗方案为紫杉烷和铂类联合，单独使用（14例患者）或与第三种药物联合使用，如异环磷酰胺（14例患者）或5-氟尿嘧啶（9例患者）。其余9例患者使用紫杉烷和5-氟尿嘧啶联合方案。超过三分之二（67%）的患者对诱导化疗至少达到部分缓解，24%疾病进展，9%疾病稳定。诱导化疗后的后续治疗包括手术，通常随后进行放疗或放化疗，或进行确定性放疗或放化疗并对任何残留疾病进行手术挽救。总体而言，46例接受诱导化疗的患者中仅24例（52%）进行了手术切除。诱导化疗后至少有部分缓解或疾病稳定的患者2年生存率为77%，而疾病进展的患者仅为36%。
晚期鼻窦鳞状细胞癌患者对诱导化疗的肿瘤反应可能预示治疗结果和预后。对诱导化疗的良好反应与更好的生存率和合理的器官保留机会相关。
