Teudt Ingo U, Meyer Jens E, Ritter Matthias, Wollenberg Barbara, Kolb Torsten, Maune Steffen, Kovàcs György
Department of Otolaryngology, Head and Neck Surgery, Asklepios Klinik Altona, Hamburg, Germany.
Department of Otolaryngology, Head, Neck and Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Brachytherapy. 2014 Mar-Apr;13(2):178-86. doi: 10.1016/j.brachy.2013.10.009. Epub 2013 Nov 7.
Sinonasal malignancies are a rare group of cancers often associated with late presentation and poor prognosis. In the past, there was little progress regarding survival rate, and often, multimodal treatment regimens are required. The aim of this study was to evaluate the clinical outcome of perioperative image-adapted brachytherapy (IABT) as part of a multidisciplinary treatment regimen for the therapy of sinonasal cancer.
Since 2006, patients with sinonasal cancer at the University Hospital of Schleswig-Holstein Campus Luebeck, Germany, were offered a multimodal treatment concept including head and neck surgery, perioperative IABT with or without external beam radiation therapy, and chemotherapy. In a retrospective study, such patients were analyzed for survival rate, tumor control, and toxicity of the interdisciplinary treatment.
Thirty-five consecutive patients were analyzed. The majority of patients (63%) were treated for a primary tumor and 62% presented with tumor Stages III-IV. The mean follow-up time with IABT was 28 months. Overall survival estimate was 72% after 3 years. Disease-specific survival, disease-free survival, and local control rates were 83%, 63%, and 67%, respectively. On univariate analysis, a significant better disease-free survival rate was found in patients treated for primary, but not recurrent, sinonasal cancer (p = 0.006). The overall treatment toxicities were mainly classified Grade I.
Interdisciplinary perioperative IABT is associated with excellent locoregional control and survival rates. IABT is well tolerated and shows low toxicity. Furthermore, visual acuity can be preserved in advanced cases. The implementation of perioperative IABT into multimodal treatment regimens improves the oncologic outcome.
鼻窦恶性肿瘤是一组罕见的癌症，通常表现较晚且预后较差。过去，生存率方面进展甚微，通常需要多模式治疗方案。本研究的目的是评估围手术期影像适配近距离放疗（IABT）作为鼻窦癌多学科治疗方案一部分的临床疗效。
自2006年起，德国石勒苏益格-荷尔斯泰因大学吕贝克校区大学医院的鼻窦癌患者接受了包括头颈外科手术、有或无外照射放疗的围手术期IABT以及化疗在内的多模式治疗方案。在一项回顾性研究中，对这些患者的生存率、肿瘤控制情况及多学科治疗的毒性进行了分析。
对连续35例患者进行了分析。大多数患者（63%）接受原发性肿瘤治疗，62%的患者肿瘤分期为III-IV期。IABT的平均随访时间为28个月。3年后总体生存估计率为72%。疾病特异性生存率、无病生存率和局部控制率分别为83%、63%和67%。单因素分析发现，接受原发性而非复发性鼻窦癌治疗的患者无病生存率显著更高（p = 0.006）。总体治疗毒性主要分级为I级。
多学科围手术期IABT具有出色的局部区域控制和生存率。IABT耐受性良好且毒性低。此外，在晚期病例中可保留视力。将围手术期IABT纳入多模式治疗方案可改善肿瘤治疗效果。
