鼻咽癌放疗后咽旁组织坏死的临床特征及其手术干预后的转归。

Clinical features of post-radiation nasopharyngeal necrosis and their outcomes following surgical intervention in nasopharyngeal cancer patients.

机构信息

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

Oral Oncol. 2021 Mar;114:105180. doi: 10.1016/j.oraloncology.2021.105180. Epub 2021 Jan 23.

DOI:10.1016/j.oraloncology.2021.105180

PMID:33497910

Abstract

PURPOSE

To investigate the incidence and clinical features of post-radiation nasopharyngeal necrosis (PRNN), and effectiveness of surgical intervention for its treatment.

MATERIALS AND METHODS

Retrospectively, we reviewed 380 NPC patients who underwent high dose radiotherapy (RT) (single RT in 355 and re-RT in 25) from January 2008 till December 2017 at the authors' institute, among who 22 developed Grade ≥ 3 PRNN. The management of PRNN was discussed through weekly multidisciplinary head and neck oncology conference, and surgical debridement was performed when feasible.

RESULTS

The incidence of PRNN was significantly higher following re-RT than in single RT (11/355, 3.1% vs. 11/25, 44.0%, p < 0.001). The PRNN patients in single RT group tended to be older and had more advanced initial tumor extents. The intervals from the latest RT start till PRNN assignment were similar between groups (7.3 vs. 6.6 months, p = 0.140). Nineteen patients underwent surgical debridement: two open; and 17 endoscopic approach, respectively. Endoscopic mucosal reconstruction was performed in eight patients. Resolution of PRNN was achieved in 11 patients (64.7%). The rates of 3-year overall survivals (OS) from the initial RT, latest RT (adjusting re-RT), and PRNN assignment were 84.4%, 70.9%, and 54.7%, respectively. Eight patients (36.4%) succumbed to death: NPC progression in three (13.6%); evidently PRNN-related events in two (9.1%), probably PRNN-related events in two (9.1%); and inter-current death in one (4.5%), respectively.

CONCLUSION

PRNN needs close collaboration among head and neck oncologists and could be successfully recovered, without compromising survival, following timely surgical intervention.

摘要

目的

研究放射性鼻咽坏死（PRNN）的发生率和临床特征，以及手术干预治疗的效果。

材料和方法

回顾性分析 2008 年 1 月至 2017 年 12 月在作者所在机构接受高剂量放疗（RT）的 380 例 NPC 患者（单次 RT355 例，再 RT25 例），其中 22 例发生 3 级及以上 PRNN。通过每周多学科头颈部肿瘤会议讨论 PRNN 的治疗管理，当可行时进行手术清创。

结果

再 RT 组的 PRNN 发生率明显高于单次 RT 组（11/355，3.1% vs. 11/25，44.0%，p<0.001）。单次 RT 组的 PRNN 患者年龄较大，且初始肿瘤范围较广。两组患者从最新 RT 开始到 PRNN 发生的时间间隔相似（7.3 与 6.6 个月，p=0.140）。19 例患者接受手术清创：分别为 2 例开放手术和 17 例内镜下手术。8 例患者行内镜下黏膜重建。11 例（64.7%）患者的 PRNN 得到缓解。从初始 RT、最新 RT（调整再 RT）和 PRNN 发生时间的 3 年总生存率（OS）分别为 84.4%、70.9%和 54.7%。8 例（36.4%）患者死亡：3 例（13.6%）为 NPC 进展；2 例（9.1%）明显与 PRNN 相关；2 例（9.1%）可能与 PRNN 相关；1 例（4.5%）为并发死亡。