Rubino Franco, Brahimaj Bledi, Hanna Ehab Y, Su Shirley Y, Phan Jack, Grosshans David R, DeMonte Franco, Raza Shaan M
Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
J Neurol Surg B Skull Base. 2023 Jul 28;85(5):445-457. doi: 10.1055/a-2114-4563. eCollection 2024 Oct.
It is unclear if the length of the time interval to initiation of adjuvant radiation therapy (RT) after endoscopic endonasal surgery affects reconstruction outcomes. In this study we present our experience with adjuvant RT after endoscopic endonasal procedures, to determine if the time to RT after surgery impacts post-RT reconstruction complication rates. A retrospective cohort study of 164 patients who underwent endoscopic endonasal surgery between 1998 and 2021 was conducted. Using Cox proportional hazard ratios (HRs), we evaluated several variables and the complications that occurred during the 1-year period after starting RT. Seventy-eight (47.5%) and eighty-six patients (52.5%) received RT before and after the sixth postoperative week, respectively. The overall post-RT complication rates were 28%, most of these were severe infections ( = 20, 12.2%) and delayed CSF leak ( = 4, 2.5%). There was no significant difference in the post-RT complications between the patients who received postoperative RT before or after the sixth operative week (HR: 1.13; 95% confidence interval: 0.63-2.02; ). Univariate analysis demonstrated negative impact associated with smoking history ( ), the use of neoadjuvant chemotherapy ( ), and the use of photon therapy ( ); and we found a positive impact with the use of multilayer reconstruction techniques (overall, ; with fat, ; and/or fascia graft, ). After a multivariate analysis only, smoking history was an independent risk factor for post-RT complications ( ). Delaying RT for more than 6 weeks after endoscopic endonasal surgery does not provide a significant benefit for reconstruction outcomes. However, special attention may be warranted in patients with smoking history who have received neoadjuvant chemotherapy, or in patients who will receive photon-based RT after surgery as these groups were found to have increased complication rates post-RT.
内镜鼻内手术后辅助放疗开始的时间间隔长短是否会影响重建效果尚不清楚。在本研究中，我们介绍了内镜鼻内手术后辅助放疗的经验，以确定手术后放疗时间是否会影响放疗后重建并发症发生率。
对1998年至2021年间接受内镜鼻内手术的164例患者进行了一项回顾性队列研究。我们使用Cox比例风险比（HR）评估了几个变量以及放疗开始后1年内发生的并发症。
分别有78例（47.5%）和86例（52.5%）患者在术后第6周之前和之后接受了放疗。放疗后总体并发症发生率为28%，其中大多数为严重感染（n = 20，12.2%）和延迟性脑脊液漏（n = 4，2.5%）。在术后第6周之前或之后接受术后放疗的患者之间，放疗后并发症无显著差异（HR：1.13；95%置信区间：0.63 - 2.02；P = 0.68）。单因素分析显示，吸烟史（P = 0.01）、新辅助化疗的使用（P = 0.04）和光子治疗的使用（P = 0.03）有负面影响；我们发现多层重建技术的使用有积极影响（总体，P = 0.01；使用脂肪时，P = 0.02；和/或筋膜移植时，P = 0.02）。仅在多因素分析后，吸烟史是放疗后并发症的独立危险因素（P = 0.01）。
内镜鼻内手术后将放疗推迟超过6周对重建效果没有显著益处。然而，对于有吸烟史且接受了新辅助化疗的患者，或术后将接受基于光子的放疗的患者，可能需要特别关注，因为这些组在放疗后并发症发生率增加。
