Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Otorhinolaryngology-Head and Neck Surgery, Juntendo University, Tokyo, Japan.
Radiat Oncol. 2021 Jan 6;16(1):2. doi: 10.1186/s13014-020-01726-w.
The aim of this study was to evaluate the long-term treatment results of combined superselective intraarterial chemotherapy and radiation therapy for advanced maxillary sinus cancer (MSC) and the incidence of regional lymph node failure, and to reveal the clinical and anatomical predictive factors for metastasis.
We retrospectively evaluated 55 consecutive patients with locally advanced squamous cell carcinoma of the maxillary sinus who were treated with external radiotherapy and superselective intraarterial chemotherapy. Elective nodal irradiation (ENI) was performed only in the clinical node-positive (cN+) cases and not in the clinical node-negative (cN0) cases.
Thirty-eight patients were cN0, and 17 were cN+ at diagnosis. Regional lymph node metastases occurred in 7 of 38 patients with cN0, and 2 of 17 with cN+ during the median follow-up period of 36 months. There were more cases of high-grade (3 or 4) late adverse events in the ENI group than in the non-ENI group (13% vs. 41%, respectively; p = 0.03). In cN0 cases without ENI, invasion of the pterygoid plates (57% vs. 90%; p < 0.01) and oral cavity (35% vs. 92%, with invasion vs without invasion, respectively; p = 0.02) was significantly correlated with a low 5-year regional recurrence-free rate.
Patients with MCS and invasion of the pterygoid plates and oral cavity can be considered appropriate candidates for ENI.
本研究旨在评估联合超选择性动脉内化疗和放疗治疗晚期上颌窦癌（MSC）的长期治疗效果和区域淋巴结失败的发生率，并揭示转移的临床和解剖预测因素。
我们回顾性评估了 55 例接受外部放疗和超选择性动脉内化疗的局部晚期上颌窦鳞状细胞癌连续患者。选择性淋巴结照射（ENI）仅在临床淋巴结阳性（cN+）病例中进行，而不在临床淋巴结阴性（cN0）病例中进行。
38 例患者为 cN0，17 例患者为 cN+。在中位随访 36 个月期间，7 例 cN0 患者和 2 例 cN+患者发生区域淋巴结转移。ENI 组发生高级（3 或 4 级）晚期不良事件的病例多于非 ENI 组（分别为 13%和 41%；p=0.03）。在未行 ENI 的 cN0 病例中，翼板侵犯（57%比 90%；p<0.01）和口腔侵犯（35%比 92%，有侵犯与无侵犯相比；p=0.02）与 5 年区域无复发生存率较低显著相关。
翼板和口腔侵犯的 MSC 患者可考虑行 ENI。
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