颞骨放射性骨坏死：18 年单中心经验。
Temporal Bone Osteoradionecrosis: An 18-year, Single-Institution Experience.
机构信息
Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.
出版信息
Laryngoscope. 2021 Nov;131(11):2578-2585. doi: 10.1002/lary.29758. Epub 2021 Jul 20.
OBJECTIVES/HYPOTHESIS: To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes.
STUDY DESIGN
Retrospective chart review.
METHODS
Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease.
RESULTS
TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful.
CONCLUSIONS
TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2578-2585, 2021.
目的/假设：报告最大的单机构颞骨放射性骨坏死（TBORN）回顾，并描述该疾病的自然病史、预后因素、治疗方法和结果。
研究设计
回顾性图表回顾。
方法
对患有 TBORN 的患者进行回顾性分析。提取相关数据。使用描述性统计来总结患者、肿瘤和治疗特征。进行多变量分析以探讨这些特征与 TBORN 诊断时间和发生弥漫性疾病风险之间的关联。
结果
在 128 名患者的 145 个颞骨中发现了 TBORN。诊断时的平均年龄为 62 岁，放射治疗后诊断的平均时间为 10 年。年龄大于 50 岁与较早诊断相关。根据 Ramsden 标准，76%的 TB 最初诊断为局限性疾病，24%为弥漫性疾病；37%在最后一次随访时为弥漫性疾病。多变量分析显示，糖尿病、三维适形放疗（3D-CRT）和耳周皮肤恶性肿瘤是发生弥漫性疾病的显著危险因素。局限性疾病采用保守治疗成功管理，而弥漫性疾病通常需要手术。当 TBORN 扩散到乳突或颞下窝之外时，保守措施总是无效。
结论
TBORN 在老年患者中发生得更早。虽然弥漫性疾病比局限性疾病少见，但它在患有糖尿病、3D-CRT 病史和耳周皮肤恶性肿瘤的患者中更为常见。保守治疗适用于局限性疾病，而弥漫性疾病通常需要手术。确定的预后因素有助于提出 TBORN 分期系统和治疗指南，这可能会改善患者的风险分层和疾病管理。
证据水平
4 级喉镜，131：2578-2585，2021 年。
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