嗅神经母细胞瘤手术后失败模式。

Patterns of failures after surgical resection in olfactory neuroblastoma.

机构信息

Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

出版信息

J Neurooncol. 2019 Jan;141(2):459-466. doi: 10.1007/s11060-018-03056-0. Epub 2018 Nov 30.

DOI:10.1007/s11060-018-03056-0

PMID:30506150

Abstract

INTRODUCTION

Patterns of failure in patients with olfactory neuroblastoma (ONB) according to two surgical approaches, craniofacial resection (CFR) and endoscopic surgery (ENDO), have yet to be analyzed.

METHODS

We retrospectively reviewed 28 patients with surgically treated ONB between January 1995 and October 2017. Fourteen (50.0%) patients underwent CFR (9 CFR alone, 5 ENDO-assisted CFR) and 14 (50.0%) underwent ENDO. Nineteen (67.9%) patients underwent post-operative radiotherapy (RT).

RESULTS

At a median follow-up of 53.8 months (range 10.4-195.3), the 5-year progression-free survival (PFS) and 10-year overall survival were 37.3% and 57.5%, respectively. Patients with adjuvant RT had a 5-year PFS of 46.7%, whereas those treated with surgery alone had a 5-year PFS of 19.4% (p = 0.01). Locoregional failure (LRF) occurred in ten patients (median 59.6 months after initial diagnosis; range 12.7-59.7). Neck node metastasis occurred in 25.0% (7 of 28). Five patients with ENDO showed LRF and underwent proper subsequent treatments with either surgery or adjuvant RT. Approximately 35.7% patients (five patients) in the CFR group experienced distant metastasis in the intracranial dura region (median 116.4 months after initial diagnosis; range 2.6-142.4). Three of four patients who developed LRF after CFR developed dura-based metastasis.

CONCLUSIONS

Both dura-based and neck node metastasis in the delayed phase were distinct patterns of failure in ONB. Patterns of recurrence differed based on surgical approach; dura-based metastases were common after CFR. LRF was the distinct failure pattern in ENDO, but could be successfully salvaged. Treatment outcome was improved considerably with RT following surgical resection.

摘要

介绍

根据两种手术方法，颅面切除术（CFR）和内镜手术（ENDO），对嗅神经母细胞瘤（ONB）患者的失败模式进行了分析。

方法

我们回顾性分析了 1995 年 1 月至 2017 年 10 月期间接受手术治疗的 28 例 ONB 患者。14 例（50.0%）患者接受 CFR（9 例单纯 CFR，5 例 ENDO 辅助 CFR），14 例（50.0%）患者接受 ENDO。19 例（67.9%）患者接受术后放疗（RT）。

结果

中位随访时间为 53.8 个月（范围 10.4-195.3），5 年无进展生存率（PFS）和 10 年总生存率分别为 37.3%和 57.5%。接受辅助 RT 的患者 5 年 PFS 为 46.7%，而单纯手术治疗的患者 5 年 PFS 为 19.4%（p=0.01）。10 例患者发生局部区域复发（LRF）（中位初始诊断后 59.6 个月；范围 12.7-59.7）。28 例患者中颈部淋巴结转移发生率为 25.0%（7 例）。5 例接受 ENDO 的患者发生 LRF，并随后接受适当的手术或辅助 RT 治疗。CFR 组约 35.7%（5 例）患者在初始诊断后 116.4 个月（范围 2.6-142.4）出现颅内硬脑膜区域远处转移。4 例 CFR 后发生 LRF 的患者中有 3 例发生硬脑膜转移。