Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):243-51. doi: 10.1016/j.ijrobp.2011.05.044. Epub 2011 Oct 20.
To report outcomes in patients treated with intensity-modulated radiotherapy (IMRT) for tumors of the paranasal sinuses and nasal cavity (PNS/NC).
METHODS/MATERIALS: Between June 2000 and December 2009, 52 patients with tumors of the PNS/NC underwent postoperative or definitive radiation with IMRT. Twenty-eight (54%) patients had squamous cell carcinoma (SCC). Twenty-nine patients (56%) received chemotherapy. The median follow-up was 26.6 months (range, 2.9-118.4) for all patients and 30.9 months for living patients.
Eighteen patients (35%) developed local-regional failure (LRF) at median time of 7.2 months. Thirteen local failures (25%) were observed, 12 in-field and 1 marginal. Six regional failures were observed, two in-field and four out-of-field. No patients treated with elective nodal radiation had nodal regional failure. Two-year local-regional control (LRC), in-field LRC, freedom from distant metastasis (FFDM), and overall survival (OS) were 64%, 74%, 71%, and 66% among all patients, respectively, and 43%, 61%, 61%, and 53% among patients with SCC, respectively. On multivariate analysis, SCC and >1 subsite involved had worse LRC (p = 0.0004 and p = 0.046, respectively) and OS (p = 0.003 and p = 0.046, respectively). Cribriform plate invasion (p = 0.005) and residual disease (p = 0.047) also had worse LRC. Acute toxicities included Grade ≥3 mucositis in 19 patients (37%), and Grade 3 dermatitis in 8 patients (15%). Six patients had Grade ≥3 late toxicity including one optic toxicity.
IMRT for patients with PNS/NC tumors has good outcomes compared with historical series and is well tolerated. Patients with SCC have worse LRC and OS. LRF is the predominant pattern of failure.
报告采用调强放疗（IMRT）治疗鼻窦和鼻腔（PNS/NC）肿瘤患者的结果。
方法/材料：2000 年 6 月至 2009 年 12 月，52 例 PNS/NC 肿瘤患者行术后或根治性放疗，采用 IMRT。28 例（54%）患者为鳞状细胞癌（SCC）。29 例（56%）患者接受化疗。所有患者的中位随访时间为 26.6 个月（范围 2.9-118.4），存活患者的中位随访时间为 30.9 个月。
18 例（35%）患者在中位时间 7.2 个月时出现局部区域复发（LRF）。13 例局部失败（25%），12 例为场内失败，1 例为边缘失败。6 例区域失败，2 例场内失败，4 例场外失败。未行选择性淋巴结放疗的患者无淋巴结区域复发。所有患者的 2 年局部区域控制（LRC）、场内 LRC、无远处转移（FFDM）和总生存率（OS）分别为 64%、74%、71%和 66%，SCC 患者分别为 43%、61%、61%和 53%。多因素分析显示，SCC 和>1 个部位受累与较差的 LRC（p=0.0004 和 p=0.046）和 OS（p=0.003 和 p=0.046）相关。筛板侵犯（p=0.005）和残留疾病（p=0.047）也与较差的 LRC 相关。急性毒性包括 19 例（37%）患者≥3 级黏膜炎和 8 例（15%）患者 3 级皮炎。6 例患者发生≥3 级迟发性毒性，包括 1 例视神经毒性。
与历史系列相比，PNS/NC 肿瘤患者采用 IMRT 治疗具有较好的疗效，且具有良好的耐受性。SCC 患者的 LRC 和 OS 较差。LRF 是主要的失败模式。
