Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Radiother Oncol. 2021 Nov;164:20-26. doi: 10.1016/j.radonc.2021.08.018. Epub 2021 Sep 4.
Primary radiotherapy is often preferred for early-stage cancer of the nasal vestibule (CNV), combining high disease control with preservation of nasal anatomy. However, due to practice variation and an absence of comparative trials, no consensus exists on preference for brachytherapy (BT) or external beam radiotherapy (EBRT). We compared these modalities in terms of disease control, nose preservation rates and toxicity.
Medical records of 225 patients with T1-T2 squamous cell carcinoma of the nasal vestibule treated with 3D image-guided primary radiotherapy between Jan 2010 and Dec 2016 in 6 Dutch institutions were reviewed retrospectively.
153 of 225 patients were treated with BT, 65 with EBRT and 7 with other modalities. Median follow-up was 46 months. Overall 3-year local control (LC) and regional control (RC) were 87% and 89%. Five-year disease-specific survival (DSS) and overall survival (OS) were 94% and 82%. Three-year survival with preserved nose (SPN) was 76%. BT provided higher 3-year LC (95% vs 71%, p < 0.01) and SPN compared with EBRT (82% vs 61%, p < 0.01). Multivariable and propensity-score-matched cohort analyses confirmed better outcomes after BT. No difference was seen in DSS or OS. Five-year incidence of CTCAE 5.0 grade ≥2 toxicity was higher after BT (20% vs 3%, p = 0.03) and consisted mostly of radiation ulcers. 50% of all late toxicity recovered.
In this largest-to-date multicenter analysis of T1-T2 CNV, BT achieved superior LC and SPN compared with EBRT. Grade 1-2 radiation ulcers occurred more frequently after brachytherapy, but were transient in half the cases. Considering these results, BT can be recommended as first-line treatment for T1-T2 CNV.
对于早期鼻前庭癌（CNV），常首选原发放疗，以实现高疾病控制率和保留鼻腔解剖结构。然而，由于实践差异和缺乏对照试验，对于近距离放疗（BT）和外照射放疗（EBRT）的选择，尚未达成共识。我们比较了这两种治疗模式在疾病控制、保鼻率和毒性方面的差异。
回顾性分析了 2010 年 1 月至 2016 年 12 月期间，6 家荷兰机构对 225 例 T1-T2 期鼻前庭鳞状细胞癌患者采用 3D 图像引导下原发放疗的治疗记录。
225 例患者中，153 例接受 BT，65 例接受 EBRT，7 例接受其他治疗。中位随访时间为 46 个月。整体 3 年局部控制率（LC）和区域控制率（RC）分别为 87%和 89%。5 年疾病特异性生存率（DSS）和总生存率（OS）分别为 94%和 82%。3 年保鼻生存率（SPN）为 76%。BT 较 EBRT 可提供更高的 3 年 LC（95% vs 71%，p < 0.01）和 SPN（82% vs 61%，p < 0.01）。多变量和倾向评分匹配队列分析均证实 BT 后生存结局更佳。DSS 或 OS 无差异。BT 后 5 年 CTCAE 5.0 级≥2 级毒性的发生率更高（20% vs 3%，p = 0.03），主要为放射性溃疡。50%的迟发性毒性完全缓解。
在这项迄今为止最大规模的 T1-T2 CNV 多中心分析中，BT 较 EBRT 可获得更高的 LC 和 SPN。BT 后更常发生 1-2 级放射性溃疡，但半数为一过性。考虑到这些结果，BT 可被推荐作为 T1-T2 CNV 的一线治疗方法。
