Singh Narinder, Wong Eugene, Huang Johnson, Riffat Faruque
Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia.
BMJ Case Rep. 2018 Oct 24;2018:bcr-2018-226234. doi: 10.1136/bcr-2018-226234.
Sinonasal adenocarcinoma has traditionally been treated with surgery (craniofacial or endoscopic) and adjuvant radiotherapy. Two large series have demonstrated favourable 5-year survival using surgery with adjuvant topical chemotherapy applied repeatedly over several weeks. The authors describe a novel, transnasal application of topical 5-fluorouracil. However, complete coverage of the frontal region of the anterior skull base can be difficult to achieve with a purely transnasal approach in an outpatient setting. We present a novel adjunct method of delivering chemotherapeutic agents into this key area used in a 37-year-old man with T2N0M0 ethmoid adenocarcinoma. The procedure was well tolerated in an outpatient setting and remains disease free at 3 years postoperatively. We suggest that frontal trephination is a useful adjunct to aid accurate placement of adjuvant topical chemotherapeutic agents in the treatment of sinonasal adenocarcinoma.
传统上，鼻窦腺癌采用手术（颅面手术或内镜手术）及辅助放疗进行治疗。两项大型研究系列表明，采用手术并在数周内反复应用辅助局部化疗，5年生存率良好。作者描述了一种新型的经鼻局部应用5-氟尿嘧啶的方法。然而，在门诊环境中，单纯经鼻途径很难完全覆盖前颅底的额部区域。我们介绍了一种将化疗药物输送至这一关键区域的新型辅助方法，该方法应用于一名患有T2N0M0筛窦腺癌的37岁男性患者。该手术在门诊环境中耐受性良好，术后3年仍无疾病复发。我们认为额部钻孔术是辅助鼻窦腺癌治疗中辅助局部化疗药物精确放置的一种有用方法。
