Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
University of Zurich, Zurich, Switzerland.
Eur Arch Otorhinolaryngol. 2019 Aug;276(8):2259-2265. doi: 10.1007/s00405-019-05458-w. Epub 2019 May 16.
To present outcome measures of sinonasal mucosal melanoma (SMM) patients with particular focus on current radiological and therapeutic options, especially in the non-curative setting (immunotherapy).
Retrospective study on SMM patients treated at our institution between January 1992 and December 2018.
FDG-PET/MRI has emerged as the new hybrid imaging modality, addressing the need for high local tissue contrast in the paranasal sinuses and the skull base, while allowing for whole-body staging in search for distant metastases, including the brain. Primary treatment protocols consisted of tumor resection in 30/34 patients (88%), palliative radiation therapy (RT) in 3/34 patients (9%) and best supportive care therapy in 1/34 patient (3%). Of all the initially operated patients, 25/30 patients (83%) received adjuvant RT. A total of 9/34 patients (26%) was treated with immunotherapy after the previous combined therapy. For patients treated in curative intention, we observed a 1-year overall survival (OS) of 60% (18/30 patients) and a 3-year OS of 40% (12/30 patients). For patients treated with immunotherapy, median progression-free survival (PFS) was 5 months (IQR 0-13.75), with a maximum PFS of 16 months (combination of nivolumab and ipilimumab). However, there was no difference in OS in patients treated with immunotherapy vs. no immunotherapy (log rank 0.99).
Sinonasal mucosal melanoma is a highly aggressive tumor, requiring multimodal therapy and developing a substantial incidence of distant metastases. The introduction of FDG-PET/MRI offers new possibilities in the radiological assessment of the tumor and immunotherapy has altered the management in the non-curative setting, resulting in a substantial progression-free survival in selected cases.
介绍鼻腔鼻窦黑色素瘤（SMM）患者的结局评估指标，特别关注当前的放射治疗和治疗选择，尤其是在非治愈性环境（免疫治疗）中。
对 1992 年 1 月至 2018 年 12 月在我院治疗的 SMM 患者进行回顾性研究。
FDG-PET/MRI 已成为新的混合成像方式，满足了鼻窦和颅底高局部组织对比度的需求，同时允许进行全身分期以寻找远处转移，包括脑转移。主要治疗方案包括 34 例患者中的 30 例（88%）进行肿瘤切除术，34 例患者中的 3 例（9%）进行姑息性放疗（RT），34 例患者中的 1 例（3%）接受最佳支持治疗。所有初始接受手术的患者中，25/30 例（83%）患者接受了辅助 RT。共有 9/34 例（26%）患者在前次联合治疗后接受免疫治疗。对于以治愈为目的进行治疗的患者，我们观察到 1 年总生存率（OS）为 60%（18/30 例），3 年 OS 为 40%（12/30 例）。对于接受免疫治疗的患者，中位无进展生存期（PFS）为 5 个月（IQR 0-13.75），最大 PFS 为 16 个月（纳武单抗和伊匹单抗联合治疗）。然而，接受免疫治疗与未接受免疫治疗的患者之间的 OS 无差异（对数秩检验 0.99）。
鼻腔鼻窦黑色素瘤是一种侵袭性很强的肿瘤，需要多模式治疗，并出现大量远处转移。FDG-PET/MRI 的引入为肿瘤的影像学评估提供了新的可能性，免疫治疗改变了非治愈性环境下的治疗管理，在选定病例中显著提高了无进展生存期。
Zotero 插件