Department of Radiation Oncology, Institut Curie, Paris, France.
Proton Therapy Center, Institut Curie, Orsay, France.
Head Neck. 2023 Jul;45(7):1619-1631. doi: 10.1002/hed.27371. Epub 2023 Apr 25.
Sinonasal adenoid cystic carcinomas (SNACC) have high propensity for skull base (SB) infiltration. Unresectability or incomplete surgical resection in such cases make radiotherapy treatment paramount. Curative dose escalation is challenging because of adjacent organs at risk, especially in locally advanced cases.
Eighteen patients that had locally advanced SB SNACC with unresectable or incomplete surgical resection treated by proton therapy and/or helical tomotherapy at Institut Curie between 3/2010 and 8/2020 were retrospectively included.
After median follow-up of 52 months, 5-year OS, LRRFS, DMFS, DFS rates were, respectively, 47% (95%CI: 26-83), 50% (95%CI: 36-88), 39% (95%CI: 26-81), 33% (95%CI: 22-73). One patient had grade 4 late optic nerve disorder. Eight patients had grade 3 late toxicity including mainly hearing impairments.
Proton therapy and helical tomotherapy are effective and safe methods for curative dose escalation of locally advanced SB SNACC, which are a poor prognosis subgroup. Available literature suggests carbon-ion therapy could be an efficient alternative.
鼻腔鼻窦腺样囊性癌（SNACC）具有较高的颅底（SB）浸润倾向。在这种情况下，如果无法切除或手术切除不完全，则需要进行放射治疗。由于存在危及器官，特别是在局部晚期病例中，因此很难实现治愈剂量的提升。
回顾性纳入了 2010 年 3 月至 2020 年 8 月期间在居里研究所接受质子治疗和/或螺旋断层放疗的 18 例局部晚期 SB SNACC 患者，这些患者无法切除或手术切除不完全。
中位随访 52 个月后，5 年总生存率、局部无复发生存率、无远处转移生存率和无进展生存率分别为 47%（95%CI：26-83）、50%（95%CI：36-88）、39%（95%CI：26-81）和 33%（95%CI：22-73）。1 例患者出现 4 级迟发性视神经病变。8 例患者出现 3 级迟发性毒性反应，主要包括听力损伤。
质子治疗和螺旋断层放疗是局部晚期 SB SNACC 患者实现治愈剂量提升的有效且安全的方法，这些患者的预后较差。现有文献表明，碳离子治疗可能是一种有效的替代方法。
