Department of Radiation Oncology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
Department of Otolaryngology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
Pract Radiat Oncol. 2013 Jul-Sep;3(3):e113-e120. doi: 10.1016/j.prro.2012.07.001. Epub 2012 Aug 9.
To identify the patterns of local failure for sinonasal malignancies treated with radiation therapy (RT).
We retrospectively identified 79 patients with sinonasal malignancies treated between 2000 and 2011. The median follow-up was 34 months (7-137). Fifty patients (63%) had surgery and RT with or without chemotherapy, and 29 (37%) received definitive chemoradiation therapy. Twenty-six of 79 patients (33%) failed locally; 11 had persistent disease and 15 had local recurrence (LR). The patients with LR had at least a 3-month disease-free interval posttreatment. Imaging of the 15 LR was registered to the treatment planning computed tomography. Failures were categorized as in-field, marginal, or out-of-field if >95%, 20%-95%, or <20% of the LR was within the 95% prescription isodose line, respectively.
Of the 15 patients with LR, 7 were in-field, 2 were marginal, and 6 were out-of-field. For 3 patients, treatment plans were not retrievable; however, it was apparent from clinical records that 2 had in-field LR and 1 had an out-of-field LR (untreated contralateral maxillary sinus). No patient with a marginal or out-of-field recurrence had more than 39% of their recurrent tumor volume within 95% of the prescribed dose. Coverage of the LR by 54 Gy and 45 Gy was suboptimal in 7/7 and 5/7 patients with LR, respectively. Marginal and out-of-field LR were predominantly above the pretreatment tumor location and at the level of or superior to the eyes.
Sinonasal malignancies failed marginally or out-of-field in 53% (8/15) of LR and 31% (8/26) of all local failures. The anatomic location of these marginal and out-of field LR are predominately at, or superior to, the level of the eyes. This pattern of failure may be directly related to efforts to minimize RT to the optic structures and the degree of difficulty of skull base operations.
确定经放射治疗（RT）治疗的鼻窦恶性肿瘤局部失败的模式。
我们回顾性地确定了 79 例在 2000 年至 2011 年间接受鼻窦恶性肿瘤治疗的患者。中位随访时间为 34 个月（7-137）。50 例（63%）患者接受手术和 RT 联合或不联合化疗，29 例（37%）患者接受单纯放化疗。79 例患者中有 26 例（33%）局部失败；11 例为持续性疾病，15 例为局部复发（LR）。LR 患者在治疗后至少有 3 个月的无疾病间隔期。对 15 例 LR 的影像学检查与治疗计划 CT 进行了配准。如果 LR 超过 95%、20%-95%或 <20%的范围在 95%处方等剂量线内，则将失败分别归类为场内、边缘或场外。
15 例 LR 患者中，7 例为场内，2 例为边缘，6 例为场外。有 3 例患者无法检索治疗计划；然而，从临床记录中可以明显看出，2 例为场内 LR，1 例为场外 LR（未治疗的对侧上颌窦）。无边缘或场外复发患者的复发肿瘤体积有超过 39%在处方剂量的 95%范围内。LR 分别覆盖 54 Gy 和 45 Gy 的比例在 7/7 和 5/7 例 LR 患者中均不理想。边缘和场外 LR 主要位于治疗前肿瘤位置之上，以及眼水平或以上。
在 15 例 LR 中，53%（8/15）的 LR 和所有局部失败的 31%（8/26）为边缘或场外失败。这些边缘和场外 LR 的解剖位置主要在眼睛水平或以上。这种失败模式可能与尽量减少视神经结构放射治疗和颅底手术难度的努力直接相关。
