Raza Shaan M, Ramakrishna Rohan, Weber Randal S, Kupferman Michael E, Gidley Paul W, Hanna Ehab Y, DeMonte Franco
Departments of 1 Neurosurgery and.
Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Neurosurg. 2015 Sep;123(3):781-8. doi: 10.3171/2014.10.jns141037. Epub 2015 Apr 24.
A relative paucity of information exists regarding outcomes from craniofacial resection for advanced nonmelanoma skin cancers involving the skull base. In light of advances in surgical technique and adjuvant therapy protocols, the authors reviewed their surgical experience to determine disease control rates, overall survival (OS), morbidity, and mortality.
A retrospective review of 24 patients with nonmelanoma cutaneous cancers with skull base involvement treated with craniofacial resection at The University of Texas MD Anderson Cancer Center from 1994 to 2012 was performed. Of these patients, 19 (79%) had squamous cell carcinoma (SCC), 4 (17%) had basosquamous carcinoma (BSCC), and 1 patient (4%) had adenocarcinoma. Factors as assessed were prior treatment, TNM staging, tumor involvement, extent of intracranial extension, margin status, postoperative complications, recurrence, disease status at last follow-up, and long-term survival. The majority of tumors were T4 (67%) according to the TNM classification; perineural extension was noted in 58%, cavernous sinus involvement in 25%, and dural involvement in 29%.
Postoperative complications occurred in 4 patients (17%) including 1 death. Kaplan-Meier estimates were calculated for OS and progression-free survival (PFS). Median OS was 43.2 months with an 82% 1-year OS and 37% 5-year OS; the median PFS was 91.2 months. Margin status was positively associated with median OS in SCC (91 months [for negative margins] vs 57 months, p = 0.8) and in BSCC (23.7 vs 3.2 months, p < 0.05). Postoperative radiotherapy was associated with improved median OS (43.2 vs 22 months, p = 0.6). Brain involvement was uniformly fatal after 1 year, while cavernous sinus involvement (31 vs 43 months, p = 0.82), perineural disease (31 vs 54 months, p = 0.30), and T4 stage (22 vs 91.2 months, p = 0.09) were associated with worsened OS. Similar associations were found with median PFS.
Aggressive multimodality management with surgery and postoperative radiotherapy can positively impact locoregional control and OS. With improvements in technique and adjuvant therapy protocols, treatment can still be considered in situations of perineural disease and cavernous sinus involvement and as a salvage option for patients in whom prior treatment has failed. As patients with advanced NMSCs often have few options, craniofacial resection, as part of a coordinated multimodal management plan, is justified if it can be performed safely.
关于颅面切除术治疗累及颅底的晚期非黑色素瘤皮肤癌的疗效，现有信息相对较少。鉴于手术技术和辅助治疗方案的进展，作者回顾了他们的手术经验，以确定疾病控制率、总生存率（OS）、发病率和死亡率。
对1994年至2012年在德克萨斯大学MD安德森癌症中心接受颅面切除术治疗的24例累及颅底的非黑色素瘤皮肤癌患者进行回顾性研究。其中，19例（79%）为鳞状细胞癌（SCC），4例（17%）为基底鳞状细胞癌（BSCC），1例（4%）为腺癌。评估的因素包括既往治疗、TNM分期、肿瘤累及情况、颅内扩展范围、切缘状态、术后并发症、复发、末次随访时的疾病状态和长期生存情况。根据TNM分类，大多数肿瘤为T4期（67%）；58%有神经周围侵犯，25%累及海绵窦，29%累及硬脑膜。
4例患者（17%）发生术后并发症，其中1例死亡。计算了OS和无进展生存期（PFS）的Kaplan-Meier估计值。OS中位数为43.2个月，1年OS率为82%，5年OS率为37%；PFS中位数为91.2个月。在SCC中，切缘状态与OS中位数呈正相关（阴性切缘为91个月 vs 57个月，p = 0.8），在BSCC中也呈正相关（23.7个月 vs 3.2个月，p < 0.05）。术后放疗与OS中位数改善相关（43.2个月 vs 22个月，p = 0.6）。脑受累1年后均死亡，而海绵窦受累（31个月 vs 43个月，p = 0.82）、神经周围疾病（31个月 vs 54个月，p = 0.30）和T4期（22个月 vs 91.2个月，p = 0.09）与OS恶化相关。在PFS中位数方面也发现了类似的关联。
积极的多模式治疗，包括手术和术后放疗，可对局部区域控制和OS产生积极影响。随着技术和辅助治疗方案的改进，对于神经周围疾病和海绵窦受累的情况仍可考虑进行治疗，并且可作为既往治疗失败患者挽救治疗的选择。由于晚期非黑色素瘤皮肤癌患者的选择通常较少，如果能安全实施，作为协调多模式管理计划一部分的颅面切除术是合理的。
