Pala Miloslav, Vrana Antonin, Novakova Pavla, Drbohlavova Tereza, Podlesak Tomas
Department of Radiation Oncology, Bulovka University Hospital, Institute of Radiation Oncology, Prague, Czech Republic.
Radiophysics Department, Bulovka University Hospital, Prague, Czech Republic.
Rep Pract Oncol Radiother. 2023 Jun 26;28(2):147-158. doi: 10.5603/RPOR.a2023.0017. eCollection 2023.
The objective was to evaluate the efficacy and toxicity of curative radiotherapy in patients with sinonasal carcinoma and to identify prognostic factors influencing treatment outcomes.
The authors conducted a retrospective study of 61 consecutive patients treated with postoperative or definitive radiotherapy from 2002 to 2018 (median age 59 years, current/former smokers 71%, maxillary sinus 67%, nasal cavity 26%). The majority of patients were diagnosed with locally advanced disease (85% clinical stage ≥ III). Regional cervical metastases were initially diagnosed in 23% of patients. The most common histology was squamous cell carcinoma (61%). Radiation therapy was preceded by radical surgery in 64% of patients. 29 patients received chemotherapy (48%).
The median follow-up was 53 months. The median total dose of radiotherapy achieved was 70 Gy. The 5- and 10-year locoregional control, distant control, overall survival, and disease-free survival were 74% and 64%, 90% and 90%, 51% and 35%, and 38% and 25%, respectively. Severe acute toxicity occurred in 36%, severe late toxicity in 23% of patients. Severe unilateral visual impairment occurred in 6 patients, temporal lobe necrosis in 1 patient, and osteoradionecrosis requiring surgery in 2 patients.
The results of the study demonstrated the high effectiveness of curative treatment in patients with sinonasal carcinoma with long-term locoregional and distant control. The multivariate analysis indicated that N-staging, age, comorbidity score [as assessed by Adult Comorbidity Evaluation 27 (ACE-27)] and initial response to treatment were the strongest prognostic factors.
目的是评估鼻窦癌患者根治性放疗的疗效和毒性，并确定影响治疗结果的预后因素。
作者对2002年至2018年接受术后或根治性放疗的61例连续患者进行了回顾性研究（中位年龄59岁，当前/既往吸烟者占71%，上颌窦癌占67%，鼻腔癌占26%）。大多数患者被诊断为局部晚期疾病（85%临床分期≥III期）。23%的患者最初被诊断有区域颈部转移。最常见的组织学类型是鳞状细胞癌（61%）。64%的患者在放疗前接受了根治性手术。29例患者接受了化疗（48%）。
中位随访时间为53个月。放疗达到的中位总剂量为70 Gy。5年和10年的局部区域控制率、远处控制率、总生存率和无病生存率分别为74%和64%、90%和90%、51%和35%、38%和25%。36%的患者出现严重急性毒性，23%的患者出现严重晚期毒性。6例患者出现严重单侧视力损害，1例患者出现颞叶坏死，2例患者出现需要手术的放射性骨坏死。
研究结果表明鼻窦癌患者根治性治疗在长期局部区域和远处控制方面具有高效性。多变量分析表明，N分期、年龄、合并症评分[通过成人合并症评估27（ACE - 27）评估]和对治疗的初始反应是最强的预后因素。
