Radiation Oncology Department, The University of Milan, Milan.
the Head and Neck Medical Oncology Department, The University of Milan, Milan.
Laryngoscope. 2020 Apr;130(4):857-865. doi: 10.1002/lary.28202. Epub 2019 Aug 1.
Outcomes of locally advanced epithelial sinonasal cancers remain unsatisfactory; moreover, only limited and heterogeneous data exist on prognostic factors.
We reviewed all consecutive patients with American Joint Committee Cancer stage III to IV epithelial sinonasal cancers treated with platinum-based induction chemotherapy (IC) followed by locoregional treatment between 1996 and 2015.
We identified 69 patients treated with a multimodal approach (IC, surgery, radiotherapy). Overall, 44 patients recurred (64%). Of those, 19 patients received salvage surgery, but only four remained disease-free. Median overall survival (OS) was 62.5 months. Sinonasal neuroendocrine and small cell histotypes (P = 0.0085), neuroendocrine differentiation (P = 0.006), and lack of response to IC (P = 0.03) were associated with worse OS. In patients who recurred, median OS was 13 months since recurrence. Survival was longer in patients submitted to salvage surgery (44%) than in those receiving chemotherapy alone at recurrence (29.5 vs. 4.6 months). Patients with a clinical benefit after palliative chemotherapy had a longer median OS than those with disease progression (29.2 vs. 4.4 months; P < 0.0001).
Globally, the prognosis of locally advanced epithelial sinonasal cancers is dismal, with worse outcomes for neuroendocrine lesions. In the recurrent setting, feasibility of salvage surgery and clinical benefit from palliative chemotherapy are associated with longer OS. A multimodal treatment strategy with IC seems to offer improved OS when compared with other retrospective series not employing such a therapeutic tool.
4 Laryngoscope, 130:857-865, 2020.
局部晚期上皮性鼻窦癌的预后仍不理想；此外，关于预后因素的资料有限且存在异质性。
我们回顾了 1996 年至 2015 年间，连续收治的采用铂类为基础的诱导化疗（IC）联合局部区域治疗的美国癌症联合委员会（AJCC）分期 III 至 IV 期上皮性鼻窦癌患者。
我们共纳入 69 例接受多模式治疗（IC、手术、放疗）的患者。总的来说，44 例患者复发（64%）。其中 19 例患者接受挽救性手术，但仅有 4 例患者无疾病生存。中位总生存（OS）为 62.5 个月。鼻窦神经内分泌和小细胞组织学类型（P = 0.0085）、神经内分泌分化（P = 0.006）和对 IC 无反应（P = 0.03）与较差的 OS 相关。在复发的患者中，自复发以来的中位 OS 为 13 个月。接受挽救性手术的患者的生存时间（44%）长于单独接受化疗的患者（29.5 与 4.6 个月）。姑息化疗后有临床获益的患者的中位 OS 长于疾病进展的患者（29.2 与 4.4 个月；P < 0.0001）。
总体而言，局部晚期上皮性鼻窦癌的预后较差，神经内分泌病变的预后更差。在复发的情况下，挽救性手术的可行性和姑息化疗的临床获益与较长的 OS 相关。与未采用这种治疗方法的其他回顾性系列相比，采用 IC 的多模式治疗策略似乎可提高 OS。
4 级。《喉镜》，130：857-865，2020 年。
