Bhattacharyya N, Thornton A F, Joseph M P, Goodman M L, Amrein P C
Department of Otolaryngology, Massachusetts, Eye & Ear Infirmary and Harvard Medical School, Boston, USA.
Arch Otolaryngol Head Neck Surg. 1997 Jan;123(1):34-40. doi: 10.1001/archotol.1997.01900010038005.
To study the efficacy of a newly designed treatment strategy for esthesioneuroblastoma and neuroendocrine carcinoma of the paranasal sinuses.
Nonrandomized prospective study of a case series in a tertiary referral center.
Nine consecutive patients with newly diagnosed esthesioneuroblastoma or neuroendocrine carcinoma of the paranasal sinuses from June 1992 to October 1995 underwent this treatment protocol.
After histological diagnosis and detailed imaging, 2 cycles of cisplatin and etoposide chemotherapy were instituted. Chemotherapy responders were treated with combined photon and stereotaxic fractionated proton radiation therapy totaling approximately 68 Gy to the primary site, whereas poor responders were treated with surgical resection followed by postoperative radiation. In both cases, therapy was then concluded with 2 additional cycles of cisplatin and etoposide chemotherapy.
Response to therapy, survival, disease-free survival, and complications of therapy were examined.
Nine patients with a median Dulguerov T stage of T3 (range, T2 to T4) completed the treatment protocol, with mean follow-up after diagnosis of 20.5 months. Eight of 9 patients exhibited a dramatic response to therapy with remission of their tumor, and resection was not required. One patient failed to respond to induction chemotherapy and received surgical therapy to be followed by postoperative radiotherapy. There have been no recurrences (mean disease-free interval of 14.0 months). Complications were limited and generally transient.
The use of combined cisplatin and etoposide chemotherapy with proton radiation has demonstrated initial success in treatment of these tumors. Dramatic response from chemotherapy is possible even in bulky or unresectable disease. This protocol has an acceptable complication rate and conveys less morbidity than craniofacial resection and conventional radiotherapy. Further follow-up will be required to determine the long-term success rate of this therapeutic protocol.
研究一种新设计的治疗鼻窦嗅神经母细胞瘤和神经内分泌癌的策略的疗效。
在一家三级转诊中心对一系列病例进行的非随机前瞻性研究。
1992年6月至1995年10月期间，9例新诊断为鼻窦嗅神经母细胞瘤或神经内分泌癌的连续患者接受了该治疗方案。
在组织学诊断和详细影像学检查后，进行2个周期的顺铂和依托泊苷化疗。化疗有反应者接受光子和立体定向分割质子放射治疗联合方案，对原发部位总计给予约68 Gy的照射，而反应不佳者接受手术切除，术后再行放疗。在这两种情况下，治疗均以另外2个周期的顺铂和依托泊苷化疗结束。
检查治疗反应、生存率、无病生存率和治疗并发症。
9例患者的杜尔格罗夫T分期中位数为T3（范围为T2至T4），完成了治疗方案，诊断后的平均随访时间为20.5个月。9例患者中有8例对治疗表现出显著反应，肿瘤缓解，无需切除。1例患者对诱导化疗无反应，接受了手术治疗，术后进行放疗。无复发（平均无病间隔为14.0个月）。并发症有限，且一般为短暂性。
顺铂和依托泊苷联合化疗与质子放疗在这些肿瘤的治疗中已显示出初步成功。即使是体积较大或无法切除的疾病，化疗也可能产生显著反应。该方案的并发症发生率可接受，与颅面切除术和传统放疗相比，发病率更低。需要进一步随访以确定该治疗方案的长期成功率。
