新辅助放疗对鼻窦非鳞状细胞癌切缘的影响。

Impact of neoadjuvant radiation on margins for non-squamous cell carcinoma sinonasal malignancies.

作者信息

Fu Terence, Chin Christopher J, Xu Wei, Che Jiahua, Huang Shao Hui, Monteiro Eric, Alghonaim Yazeed, Ringash Jolie, Witterick Ian J

机构信息

Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario.

Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, Dalhousie Medicine New Brunswick, St. John, New Brunswick.

出版信息

Laryngoscope. 2018 Dec;128(12):2796-2803. doi: 10.1002/lary.27316. Epub 2018 Oct 16.

DOI:10.1002/lary.27316

PMID:30325030

Abstract

OBJECTIVES/HYPOTHESIS: Treatment of non-squamous cell carcinoma sinonasal malignancies (NSCCSMs) typically involves surgery and radiotherapy (RT), but optimal sequencing remains controversial.

STUDY DESIGN

Retrospective chart review.

METHODS

Patients with NSCCSM treated with combined surgery and RT between 2000 and 2011 were identified. Margin control, overall survival, disease-free survival, local recurrence-free survival, and regional recurrence-free survival were compared between neoadjuvant and adjuvant RT groups.

RESULTS

Eight-four patients were included (23 neoadjuvant and 61 adjuvant RT). A higher proportion of patients receiving neoadjuvant RT achieved negative/close resection margins compared to those receiving adjuvant RT (83% vs. 41%, P = .003). Multivariable analysis also showed that neoadjuvant RT was associated with an 81% decreased odds of positive margins odds ratio: 0.19, 95% confidence interval: 0.05-0.77, P = .02).

CONCLUSIONS

Neoadjuvant RT may be associated with improved margin status among patients with NSCCSM treated with surgery and RT. Future prospective studies with larger, more homogeneous populations are needed to clarify optimal treatment strategies.

LEVEL OF EVIDENCE

4 Laryngoscope, 128:2796-2803, 2018.

摘要

目的/假设：非鳞状细胞癌性鼻窦恶性肿瘤（NSCCSMs）的治疗通常包括手术和放疗（RT），但最佳的治疗顺序仍存在争议。

研究设计

回顾性病历审查。

方法

确定2000年至2011年间接受手术和RT联合治疗的NSCCSM患者。比较新辅助放疗组和辅助放疗组的切缘控制、总生存率、无病生存率、无局部复发生存率和无区域复发生存率。

结果

纳入84例患者（23例新辅助放疗和61例辅助放疗）。与接受辅助放疗的患者相比，接受新辅助放疗的患者实现阴性/切缘接近切除的比例更高（83%对41%，P = 0.003）。多变量分析还显示，新辅助放疗与切缘阳性几率降低81%相关（优势比：0.19，95%置信区间：0.05 - 0.77，P = 0.02）。