Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands.
Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2019 Mar 15;103(4):913-921. doi: 10.1016/j.ijrobp.2018.11.018. Epub 2018 Nov 17.
To evaluate the efficacy of modern image guided brachytherapy for squamous cell carcinoma of the nasal vestibule, to explore tumor volume as a prognostic factor for local and regional recurrence, and to assess patient satisfaction with nasal function and appearance after treatment.
In a retrospective analysis, we reviewed the medical records of 102 patients with Wang T1-T2 nasal vestibule cancer treated at a single institution with brachytherapy as the sole treatment. Median follow-up time was 42 months (range, 3-210 months). A patient satisfaction study using the validated Nasal Appearance and Function Evaluation Questionnaire was conducted among 42 patients more than 1 year after treatment. A statistically significant cutoff point for tumor volume as a prognostic factor of local control was established using Youden's index method.
Seventy-seven of 102 patients were treated with interstitial implants, and 25 patients were treated by an intracavitary mould technique. The 5-year control rates were 95%, 91%, and 83% for local, regional, and locoregional control, respectively. Tumor volume ≥2.3 cm resulted in worse 3-year regional control compared to tumor volume <2.3 cm (62% vs 96%; P = .01). Ultimate regional control after salvage treatment was 96%, with no significant difference observed between subgroups by tumor volume (92% for ≥2.3 cm vs 96% for <2.3 cm; P = .57). Three patients with regional failure developed distant metastases. Five-year disease-specific survival and overall survival were 94% and 74%, respectively. Patient-assessed cosmetic and functional satisfaction were both rated high (mean 3.7 and 4.0 of 5, respectively).
We report the largest cohort to date treated with brachytherapy as the sole treatment for nasal vestibule carcinoma. Brachytherapy offers excellent local control for Wang T1-T2 tumors with high patient satisfaction. Tumor volume is an adequate predictive factor for patients at risk of regional recurrence, but ultimate control rates after salvage treatment are high. Therefore, we do not recommend elective treatment of the neck.
评估现代影像引导近距离放疗治疗鼻腔前庭鳞状细胞癌的疗效，探讨肿瘤体积作为局部和区域复发的预后因素，并评估患者对治疗后鼻功能和外观的满意度。
在一项回顾性分析中，我们对在一家机构接受近距离放疗作为单一治疗的 102 例 Wang T1-T2 鼻腔前庭癌患者的病历进行了回顾。中位随访时间为 42 个月（范围 3-210 个月）。对治疗 1 年以上的 42 例患者进行了经验证的鼻外观和功能评估问卷的患者满意度研究。使用 Youden 指数法确定肿瘤体积作为局部控制的预后因素的统计学显著截断点。
102 例患者中，77 例接受了间质植入治疗，25 例接受了腔内模具技术治疗。局部、区域和局部区域控制的 5 年控制率分别为 95%、91%和 83%。肿瘤体积≥2.3cm 与肿瘤体积<2.3cm 相比，3 年区域控制更差（62%对 96%；P=0.01）。挽救治疗后的最终区域控制率为 96%，肿瘤体积亚组之间无显著差异（≥2.3cm 为 92%，<2.3cm 为 96%；P=0.57）。3 例区域复发患者发生远处转移。5 年疾病特异性生存率和总生存率分别为 94%和 74%。患者评估的美容和功能满意度均较高（分别为 5 分中的 3.7 分和 4.0 分）。
我们报告了迄今为止最大的队列，接受近距离放疗作为鼻腔前庭癌的单一治疗。近距离放疗为 Wang T1-T2 肿瘤提供了优异的局部控制，患者满意度高。肿瘤体积是预测区域复发风险患者的充分预测因素，但挽救治疗后的最终控制率较高。因此，我们不建议对颈部进行选择性治疗。
