Brahimaj Bledi C, Contrera Kevin J, Rubino Franco, Almeida Romulo Andrade de, Ferrarotto Renata, Phan Jack, Su Shirley Y, Hanna Ehab Y, DeMonte Franco, Raza Shaan M
Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Texas, United States.
Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Texas, United States.
J Neurol Surg B Skull Base. 2023 Sep 25;85(6):650-658. doi: 10.1055/s-0043-1774792. eCollection 2024 Dec.
The aim of this study was to investigate the safety of induction chemotherapy (IC) for patients with sinonasal malignancies with brain invasion or a neurological deficit. We conducted a retrospective analysis of patients who underwent IC for sinonasal malignancies with intracranial invasion or a neurological deficit at a single tertiary cancer center from 1992 to 2020. In total, 460 patients with sinonasal malignancies were included in the study. Of the patients reviewed, 341 underwent IC and within this group 40 had brain invasion (BI) and 31 had a neurological deficit (ND) at presentation. The most prevalent malignancy was sinonasal undifferentiated carcinoma (BI 40%, ND 41.9%), followed by esthesioneuroblastoma (BI 27.5%, ND 9.7%). All tumors were stage T4 with the majority lacking nodal metastases (BI N0: 72.5%, ND N0: 77.5%). All patients completed at least two cycles of IC. Partial or complete response to IC was seen in 80% of BI and 71% of ND patients. No patients had cessation of treatment due to neurologic decline and none required urgent surgery. Five patients (12.5%) with BI and 2 (6.5%) with ND had interruption of IC for reasons other than neurological decline. In patients with ND, IC led to improvement of 54.5% NDs. In patients with sinonasal malignancies with BI or ND who underwent IC, no patients had cessation of treatment due to neurologic decline. In contrast, most patients had improvement of neurologic symptoms with IC. IC was safely administered without interruption due to neurological decline or symptom progression.
本研究的目的是调查诱导化疗（IC）用于伴有脑侵犯或神经功能缺损的鼻窦恶性肿瘤患者的安全性。我们对1992年至2020年在一家单一的三级癌症中心接受IC治疗的伴有颅内侵犯或神经功能缺损的鼻窦恶性肿瘤患者进行了回顾性分析。本研究共纳入460例鼻窦恶性肿瘤患者。在纳入回顾的患者中，341例接受了IC治疗，其中40例在就诊时伴有脑侵犯（BI），31例伴有神经功能缺损（ND）。最常见的恶性肿瘤是鼻窦未分化癌（BI占40%，ND占41.9%），其次是嗅神经母细胞瘤（BI占27.5%，ND占9.7%）。所有肿瘤均为T4期，大多数无区域淋巴结转移（BI组N0：72.5%，ND组N0：77.5%）。所有患者均完成了至少两个周期的IC治疗。80%的BI患者和71%的ND患者对IC治疗有部分或完全反应。没有患者因神经功能下降而停止治疗，也没有患者需要紧急手术。5例（12.5%）BI患者和2例（6.5%）ND患者因神经功能下降以外的原因中断了IC治疗。在ND患者中，IC治疗使54.5%的神经功能缺损得到改善。在接受IC治疗的伴有BI或ND的鼻窦恶性肿瘤患者中，没有患者因神经功能下降而停止治疗。相反，大多数患者的神经症状通过IC治疗得到改善。IC治疗安全实施，未因神经功能下降或症状进展而中断。
