Hafström Anna, Brun Eva, Persson Simon, Sjövall Johanna, Wahlberg Peter, Greiff Lennart
Department of ORL, Head & Neck Surgery Skåne University Hospital Lund Sweden.
Department of Clinical Sciences Lund University Lund Sweden.
Laryngoscope Investig Otolaryngol. 2019 Nov 22;4(6):624-631. doi: 10.1002/lio2.317. eCollection 2019 Dec.
The aim of the study was to review a local treatment protocol for sinonasal mucosal melanoma (SNMM) focusing on triple modality treatment (TMT), that is, neoadjuvant concomitant chemoradiotherapy (CRT) and surgery.
In a retrospective design, data on clinical presentation, treatment, and survival were retrieved for 22 consecutive patients from a tertiary referral center.
The mean overall survival (OS) for all patients (3 stage III, 16 stage IVA, and 3 stage IVB) was 62 months, and the 5-year OS rate 50%. Four of the 22 patients received treatment with palliative intention. Of the 18 patients who received treatment with curative intention, patients with stage IVA disease who received TMT (n = 10) had a 5-year OS of 70% and 10-year OS of 20%. The median disease-free survival for these patients was 51 months compared with 9 months for stage IVA not receiving TMT (n = 4).
A seemingly favorable survival outcome for a disease with characteristically poor prognosis was observed. The lead finding was a high survival rate (70% 5-year OS) for stage IVA patients who received neoadjuvant TMT. The observations suggest the possibility that patients with advanced SNMM (stage IVA) might benefit from concomitant CRT before surgery by delaying the onset of local recurrences and distant metastases.
Level 4, case series (with or without comparison).
本研究旨在回顾一项针对鼻窦黏膜黑色素瘤（SNMM）的局部治疗方案，重点关注三联疗法（TMT），即新辅助同步放化疗（CRT）和手术。
采用回顾性设计，从一家三级转诊中心检索了连续22例患者的临床表现、治疗和生存数据。
所有患者（3例III期、16例IVA期和3例IVB期）的平均总生存期（OS）为62个月，5年OS率为50%。22例患者中有4例接受了姑息性治疗。在18例接受根治性治疗的患者中，接受TMT的IVA期患者（n = 10）的5年OS为70%，10年OS为20%。这些患者的无病生存期中位数为51个月，而未接受TMT的IVA期患者（n = 4）为9个月。
对于一种预后通常较差的疾病，观察到了看似良好的生存结果。主要发现是接受新辅助TMT的IVA期患者生存率较高（5年OS为70%）。这些观察结果表明，晚期SNMM（IVA期）患者可能通过术前同步CRT延迟局部复发和远处转移的发生而获益。
4级，病例系列（有或无对照）。
