Yu Yao, El-Sayed Ivan H, McDermott Michael W, Theodosopoulos Philip V, van Zante Annemieke, Kased Norbert, Glastonbury Christine M, Garsa Adam A, Yom Sue S
Department of Radiation Oncology, University of California-San Francisco, San Francisco, California, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
Laryngoscope. 2018 Oct;128(10):2226-2233. doi: 10.1002/lary.27126. Epub 2018 Feb 10.
To quantify the rate of late intracranial recurrences among esthesioneuroblastoma patients treated with surgical resection and postoperative radiation.
Retrospective review.
All patients receiving definitive-intent therapy for esthesioneuroblastoma between March 1995 and September 2015 were reviewed. Presenting disease extent was categorized based on radiologic, operative, and pathologic findings. Between-group survival differences were assessed using Kaplan-Meier method and log-rank test. Multivariate analyses were performed using Cox proportional hazards model.
Of 38 patients initially treated at our institution, 53% (20 of 38) presented with intracranial extension. At a median follow-up of 90 months (range, 6-199), 37% (14 of 38) recurred; 5- and 8-year disease-free survival rates were 69% and 54%; and overall survival rates were 81% and 72%, respectively. Among these patients, the dura was the most commonly involved site of relapse (8), followed by local (6), regional (5), and distant extracranial (3) sites; and five patients had ≥ two categories of failure. Eight-year dural disease-free survival was 57% versus 90% (P = 0.017) and 0% versus 87% (P < 0.0001), with and without intracranial extension and subtotal resection, respectively. Of six patients treated at recurrence, five (83%) experienced dural-based failure such that, among all 44 patients, 13 (65%) of 20 recurrences involved the dura. After dural recurrence, the median survival time was 42 months (range, 12-125); salvage treatments were effective in rare cases of isolated low-volume recurrence.
Esthesioneuroblastoma patients presenting with intracranial extension are at substantial and unique risk for long-term dural-based relapse.
量化接受手术切除和术后放疗的嗅神经母细胞瘤患者颅内晚期复发率。
回顾性研究。
回顾了1995年3月至2015年9月间所有接受确定性治疗的嗅神经母细胞瘤患者。根据影像学、手术和病理结果对疾病范围进行分类。采用Kaplan-Meier法和对数秩检验评估组间生存差异。使用Cox比例风险模型进行多变量分析。
在我院最初治疗的38例患者中，53%（38例中的20例）出现颅内扩展。中位随访90个月（范围6 - 199个月），37%（38例中的14例）复发；5年和8年无病生存率分别为69%和54%；总生存率分别为81%和72%。在这些患者中，硬脑膜是最常见的复发部位（8例），其次是局部（6例）、区域（5例）和远处颅外（3例）部位；5例患者有≥2种失败类型。有和无颅内扩展及次全切除的患者，8年硬脑膜无病生存率分别为57%和90%（P = 0.017），以及0%和87%（P < 0.0001）。在6例复发时接受治疗的患者中，5例（83%）出现基于硬脑膜的失败，因此在所有44例患者中，20例复发中有13例（65%）累及硬脑膜。硬脑膜复发后，中位生存时间为42个月（范围12 - 125个月）；挽救性治疗在罕见的孤立小体积复发病例中有效。
出现颅内扩展的嗅神经母细胞瘤患者存在长期硬脑膜复发的重大且独特风险。
4。《喉镜》，2018年，第128卷，第2226 - 2233页。
