Castelnau-Marchand Pauline, Levy Antonin, Moya-Plana Antoine, Mirghani Haïtham, Nguyen France, Del Campo Eleonor Rivin, Janot François, Kolb Frédéric, Ferrand François-Régis, Temam Stéphane, Blanchard Pierre, Tao Yungan
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
INSERM U1030, Molecular Radiotherapy, Gustave-Roussy, Université Paris-Saclay, F-94805, 94800, Villejuif, France.
Strahlenther Onkol. 2016 Aug;192(8):537-44. doi: 10.1007/s00066-016-0997-5. Epub 2016 Jun 20.
The purpose of this work was to report outcomes of patients with nonmetastatic sinonasal squamous cell carcinoma (SNSCC) and to discuss the impact of elective neck irradiation (ENI) and selective neck dissection (SND) in clinically negative lymph node (N0) patients.
Data from 104 nonmetastatic SNSCC patients treated with curative intent were retrospectively analysed. Uni- and multivariate analyses were used to assess prognostic factors of overall survival (OS) and locoregional control (LRC).
Median follow-up was 4.5 years. Eighty-five percent of tumours were stage III-IV. Treatments included induction chemotherapy (52.9 %), surgery (72 %) and radiotherapy (RT; 87 %). The 5‑year OS, progression-free survival, and LRC rates were 48, 44 and 57 %, respectively. Absence of surgery predicted a decrease of OS (hazard ratio [HR] 2.6; 95 % confidence interval [CI] 1.4-4.7), and LRC (HR 3.5; 95 % CI 1.8-6.8). Regional relapse was observed in 13/104 (13 %) patients and most common sites were level II (n = 12; 70.6 %), level III (n = 5; 29.4 %) and level Ib (n = 4; 23.5 %). Management of the neck in N0 patients (n = 87) included 11 % SND alone, 32 % ENI alone, 20 % SND + ENI and 37 % no neck treatment. In this population, a better LRC was found according to the management of the neck in favour of SND (94 % vs. 47 %; p = 0.002) but not ENI.
SND may detect occult cervical positive nodes, allowing selective postoperative RT. ENI (ipsilateral level II, ±Ib and III or bilateral) needs to be proposed in selected patients, especially when SND has not been performed.
本研究旨在报告非转移性鼻窦鳞状细胞癌（SNSCC）患者的治疗结果，并探讨选择性颈部放疗（ENI）和选择性颈部清扫术（SND）对临床淋巴结阴性（N0）患者的影响。
回顾性分析104例接受根治性治疗的非转移性SNSCC患者的数据。采用单因素和多因素分析评估总生存（OS）和局部区域控制（LRC）的预后因素。
中位随访时间为4.5年。85%的肿瘤为Ⅲ-Ⅳ期。治疗方法包括诱导化疗（52.9%）、手术（72%）和放疗（RT；87%）。5年总生存率、无进展生存率和局部区域控制率分别为48%、44%和57%。未接受手术预示总生存率（风险比[HR] 2.6；95%置信区间[CI] 1.4 - 4.7）和局部区域控制率（HR 3.5；95% CI 1.8 - 6.8）降低。104例患者中有13例（13%）出现区域复发，最常见部位为Ⅱ区（n = 12；70.6%）、Ⅲ区（n = 5；29.4%）和Ⅰb区（n = 4；23.5%）。N0患者（n = 87）的颈部处理包括单纯SND占11%、单纯ENI占32%、SND + ENI占20%以及未进行颈部处理占37%。在该人群中，根据颈部处理方式，SND组的局部区域控制效果更好（94%对47%；p = 0.002），而ENI组则不然。
SND可能检测出隐匿性颈部阳性淋巴结，从而允许进行选择性术后放疗。对于部分患者，尤其是未进行SND的患者，需要考虑采用ENI（同侧Ⅱ区，±Ⅰb区和Ⅲ区或双侧）。
