综合治疗保护T4b期鼻腔鼻窦鳞状细胞癌患者眼器官的临床分析

Clinical analysis of multimodal treatment for orbital organ preservation in T4b squamous cell carcinoma of nasal cavity and paranasal sinuses

目的 通过诱导化疗后同步螺旋断层放疗联合化疗保护鼻腔鼻窦鳞状细胞癌（简称鳞癌）侵犯的眼器官,避免眼球摘除,提高患者的生活质量.方法 回顾性分析2008年5月-2015年3月解放军总医院耳鼻咽喉头颈外科应用综合治疗方法保护的侵犯眼器官的26例T4b期鼻腔鼻窦鳞癌患者,评估疗效和治疗相关的不良反应.其中男17例,女9例,平均年龄54.7岁.全部患者接受1～2周期诱导化疗后同步放化疗,其中11例患者接受了表皮生长因子受体（EGFR）分子靶向药物治疗.放疗采用螺旋断层放疗,放疗总剂量为60～70 Gy.放化疗不良反应采用不良事件通用术语标准（common terminology criteria for adverse events,CTCAE）第4版评估.总生存率、局部控制率采用Kaplan-Meier方法计算,眼功能保护率以实际保护率计算.结果 全部患者完成了计划的化疗,25例（96.2％）患者完成计划的放疗周期.经过综合治疗后,患者3年的总生存率、局部控制率、实际眼功能保留率分别为56.7％、79.5％、80.0％.患者能够承受治疗中的不良反应,治疗过程中最常见的不良反应为≥2级的口咽腔黏膜炎、放射性皮肤炎和干眼症.结论 综合治疗方法保留了T4b期鼻腔鼻窦鳞癌患者的眼器官,获得了比较理想的眼器官保护率和生存率,提高了患者的生活质量,为患者提供了一种新的治疗选择.

Objective To investigate the efficacy of induction chemotherapy （ICT） followed by concurrent chemotherapy and helical tomotherapy （HT） in the patients with T4b squamous cell carcinoma of nasal cavity and paranasal sinus （SCCNP） for orbital organ preservation and high quality of life.Methods A total of 26 patients with the orbital involvement of T4b SCCNP between May 2008 and March 2013 were analyzed retrospectively.There were 17 males and 9 females;the average age was 54.7 years.The median follow-up time was 25 months （range 4-77 months）.The patients received 1-2 cycles ICT with TP （docetaxel 70 mg/m2 on day 1 and cisplatin 40 mg/m2 on day 1-2,every 3 weeks） or TPF （docetaxel 70 mg/m2 on day 1 and cisplatin 70 mg/m2 on day 1-2,5-fu 700 mg/m2 on day 1-5,every 3 weeks）,followed by concurrent HT （60-70 Gy） and chemotherapy with TP and/or epidermal growth factor receptor （EGFR） inhibitor.The Kaplan-Meier method was used to determine the 3-year overall survival rate and local control rate.Side-effects were evaluated with the established common terminology criteria for adverse events （CTCAE） version 4.0 criteria.Results All patients completed the planned chemotherapy and 96.2% （25/26）patients completed the planned radiotherapy.The 3-year overall survival rate,the local control rate and real orbital preservation rate were 56.7%,79.5% and 80.0% respectively.The most common acute side effects higher than grade 2 were oral mucositis,radiodermatitis and dry eye syndrome.Conclusion The strategy including ICT followed by CCRT and/or EGFR inhibitor is an effective treatment for T4b SCCNP patients,with minimal toxicities,higher 3-year OS rate and orbital preservation rate,and also provides a new treatment option for T4b SCCNP patients.