Jiang Wen, Mohamed Abdallah S R, Fuller Clifton David, Kim Betty Y S, Tang Chad, Gunn G Brandon, Hanna Ehab Y, Frank Steven J, Su Shirley Y, Diaz Eduardo, Kupferman Michael E, Beadle Beth M, Morrison William H, Skinner Heath, Lai Stephen Y, El-Naggar Adel K, DeMonte Franco, Rosenthal David I, Garden Adam S, Phan Jack
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
Pract Radiat Oncol. 2016 Jul-Aug;6(4):241-247. doi: 10.1016/j.prro.2015.10.023. Epub 2015 Nov 10.
Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node-negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiation therapy as a component of multimodality treatment.
Seventy-one N0 ENB patients irradiated at the University of Texas MD Anderson Cancer Center between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI.
The median follow-up time for our cohort is 80.8 months (range, 6-350 months). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5 years (regional control rate of 100% for ENI vs 82%, P < .001), but not overall survival or disease-free survival. Eleven patients without ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n = 10), radiation (n = 10), or chemotherapy (n = 5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow-up of 55.5 months.
ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck, but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings.
尽管有报道称对肿瘤床进行辅助放疗可改善嗅神经母细胞瘤（ENB）患者的临床结局，但选择性颈部照射（ENI）在临床淋巴结阴性（N0）患者中的作用仍存在争议。在此，我们评估了ENI对接受放疗作为多模式治疗一部分的ENB患者颈部淋巴结复发风险的影响。
确定了1970年至2013年间在德克萨斯大学MD安德森癌症中心接受放疗的71例N0 ENB患者。其中22例患者（31%）接受了ENI。进行生存分析，重点比较接受和未接受ENI的患者的结局。
我们队列的中位随访时间为80.8个月（范围6 - 350个月）。在N0患者中，13例（18.3%）出现颈部淋巴结复发，中位进展时间为62.5个月。这13例患者均未接受预防性颈部照射。ENI与5年时区域淋巴结控制显著改善相关（ENI组区域控制率为100%，未接受ENI组为82%，P <.001），但对总生存或无病生存无影响。11例未接受ENI的患者出现孤立性颈部复发。所有患者均对颈部疾病进行了进一步治疗，包括颈部清扫术（n = 10）、放疗（n = 10）或化疗（n = 5）。这11例患者中有6例（54.5%）在中位随访55.5个月时未显示进一步复发的证据。
ENI显著降低了临床N0颈部的ENB患者颈部淋巴结复发的风险，但这并未转化为生存获益。对孤立性颈部复发的多模式治疗提供了合理的挽救率。ENI的最大获益似乎出现在患有卡迪什C期疾病的年轻患者中。需要进一步研究来证实这些发现。
