在局部晚期T3或T4期鼻窦鳞状细胞癌中，根治性放射治疗能否替代手术切除？

Can Definitive Radiation Therapy Substitute Surgical Resection in Locally Advanced T3 or T4 Sinonasal Squamous Cell Carcinoma?

作者信息

Kim Kangpyo, Ahn Yong Chan, Oh Dongryul, Noh Jae Myoung, Jeong Han-Sin, Chung Man Ki, Hong Sang Duk, Baek Chung-Hwan

机构信息

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

出版信息

Int J Radiat Oncol Biol Phys. 2023 Nov 15;117(4):893-902. doi: 10.1016/j.ijrobp.2023.05.038. Epub 2023 May 27.

DOI:10.1016/j.ijrobp.2023.05.038

PMID:37245536

Abstract

PURPOSE

This study aimed to compare oncologic outcomes between definitive radiation therapy (RT) and upfront surgical resection in patients with sinonasal squamous cell carcinoma (SCC).

METHODS AND MATERIALS

Between 2008 and 2021, 155 patients with T1-4b, N0-3 sinonasal SCC were analyzed. The 3-year overall survival (OS), local progression-free survival (LPFS), and overall progression-free survival (PFS) were evaluated using the Kaplan Meier method and compared using a log-rank test. A pattern of regional neck lymph node (LN) failure and treatment-related toxicity profiles were investigated.

RESULTS

A total of 63 and 92 patients underwent upfront RT (RT group) and surgical resection (Surgery group), respectively. The RT group included significantly more patients with T3-4 disease than the Surgery group (90.5% vs 39.1%, P < .001). The rates of 3-year OS, LPFS, and PFS in the RT and Surgery groups were 68.6% versus 81.7% (P = .073), 62.3% versus 73.8% (P = .187), and 47.4% versus 66.1% (P = .005), respectively. However, the corresponding rates in patients with T3-4 disease were 65.1% versus 64.8% (P = .794), 57.4% versus 56.8% (P = .351), and 43.2% versus 46.5% (P = .638), respectively, demonstrating no statistically significant differences between the 2 treatment modalities. Among the 133 N0 patients, regional neck LN progression was observed in 17 patients, and the most common sites of regional neck LN failure were ipsilateral levels Ib (9 patients) and II (7 patients). The 3-year neck node recurrence-free rate in cT1-3N0 patients was 93.5%, while that in cT4N0 patients was 81.1% (P = .025).

CONCLUSIONS

Upfront RT may be considered in selected patients with locally advanced sinonasal SCC, as we have demonstrated similar oncologic outcomes to those of surgery. Prophylactic neck treatment in T4 disease requires further investigation to evaluate its efficacy.

摘要

目的

本研究旨在比较鼻窦鳞状细胞癌（SCC）患者接受根治性放射治疗（RT）和 upfront 手术切除后的肿瘤学结局。

方法和材料

对 2008 年至 2021 年间 155 例 T1 - 4b、N0 - 3 期鼻窦 SCC 患者进行分析。采用 Kaplan - Meier 方法评估 3 年总生存率（OS）、局部无进展生存率（LPFS）和总无进展生存率（PFS），并使用对数秩检验进行比较。研究区域颈部淋巴结（LN）转移模式和治疗相关毒性特征。

结果

分别有 63 例和 92 例患者接受了 upfront RT（RT 组）和手术切除（手术组）。RT 组中 T3 - 4 期疾病患者显著多于手术组（90.5%对 39.1%，P <.001）。RT 组和手术组的 3 年 OS、LPFS 和 PFS 率分别为 68.6%对 81.7%（P =.073）、62.3%对 73.8%（P =.187）和 47.4%对 66.1%（P =.005）。然而，T3 - 4 期疾病患者的相应率分别为 65.1%对 64.8%（P =.794）、57.4%对 56.8%（P =.351）和 43.2%对 46.5%（P =.638），表明两种治疗方式之间无统计学显著差异。在 133 例 N0 患者中，17 例观察到区域颈部 LN 进展，区域颈部 LN 转移最常见的部位是同侧 Ib 区（9 例）和 II 区（7 例）。cT1 - 3N0 患者的 3 年颈部淋巴结无复发生存率为 93.5%，而 cT4N0 患者为 81.1%（P =.025）。