1 Houston Methodist Hospital, Houston TX.
2 The University of Texas MD Anderson Cancer Center, Houston, TX.
J Clin Oncol. 2019 Feb 20;37(6):504-512. doi: 10.1200/JCO.18.00353. Epub 2019 Jan 7.
Multimodal therapy is a well-established approach for the treatment of sinonasal undifferentiated carcinoma (SNUC); however, the optimal sequence of the various treatments modalities is yet to be determined. This study aimed to assess the role of induction chemotherapy (IC) in guiding definitive therapy in patients with SNUC.
Ninety-five previously untreated patients diagnosed with SNUC and treated between 2001 and 2018 at The University of Texas MD Anderson Cancer Center were included in the analysis. Patients were treated with curative intent and received IC before definitive locoregional therapy. The primary end point was disease-specific survival (DSS). Secondary end points included overall and disease-free survival, disease recurrence, and organ preservation.
A total of 95 treatment-naïve patients were included in the analysis. For the entire cohort, the 5-years DSS probability was 59% (95% CI, 53% to 66%). In patients who had partial or complete response to IC, the 5-year DSS probabilities were 81% (95% CI, 69% to 88%) after treatment with definitive concurrent chemoradiotherapy (CRT) after IC and 54% (95% CI, 44% to 61%) after definitive surgery and postoperative radiotherapy or CRT after IC (log-rank P = .001). In patients who did not experience at least a partial response to IC, the 5-year DSS probabilities were 0% (95% CI, 0% to 4%) in patients who were treated with concurrent CRT after IC and 39% (95% CI, 30% to 46%) in patients who were treated with surgery plus radiotherapy or CRT (adjusted hazard ratio of 5.68 [95% CI, 2.89 to 9.36]).
In patients who achieve a favorable response to IC, definitive CRT results in improved survival compared with those who undergo definitive surgery. In patients who do not achieve a favorable response to IC, surgery when feasible seems to provide a better chance of disease control and improved survival.
多模态治疗是治疗鼻腔鼻窦未分化癌（SNUC）的一种成熟方法；然而，各种治疗方式的最佳顺序尚未确定。本研究旨在评估诱导化疗（IC）在指导 SNUC 患者确定性治疗中的作用。
纳入 2001 年至 2018 年期间在德克萨斯大学 MD 安德森癌症中心接受治疗的 95 例未经治疗的 SNUC 患者。患者接受根治性治疗，并在局部区域治疗前接受 IC。主要终点为疾病特异性生存（DSS）。次要终点包括总生存、无病生存、疾病复发和器官保存。
共纳入 95 例未经治疗的患者进行分析。对于整个队列，5 年 DSS 概率为 59%（95%CI，53%至 66%）。在对 IC 有部分或完全反应的患者中，在 IC 后接受确定性同期放化疗（CRT）治疗的 5 年 DSS 概率为 81%（95%CI，69%至 88%），而在 IC 后接受确定性手术和术后放疗或 CRT 的 5 年 DSS 概率为 54%（95%CI，44%至 61%）（对数秩 P=0.001）。在对 IC 无至少部分反应的患者中，在 IC 后接受同期 CRT 治疗的患者 5 年 DSS 概率为 0%（95%CI，0%至 4%），而在 IC 后接受手术加放疗或 CRT 治疗的患者 5 年 DSS 概率为 39%（95%CI，30%至 46%）（调整后的危险比为 5.68[95%CI，2.89 至 9.36]）。
在对 IC 有良好反应的患者中，与接受确定性手术的患者相比，确定性 CRT 可提高生存率。在对 IC 无良好反应的患者中，手术可行时似乎提供了更好的疾病控制和提高生存率的机会。
