侵及眼眶鼻腔鼻窦腺样囊性癌的放疗策略分析

Analysis of radiotherapeutic strategy on adenoid cystic carcinoma in nasal cavity and sinuses with orbital invasion

目的探讨伴有不同眼眶侵犯程度的鼻腔鼻窦腺样囊性癌(ACC)患者放疗后的临床预后,为今后对该疾病的放疗策略选择提供一定参考。方法回顾分析2005—2019年间复旦大学附属眼耳鼻喉科医院放疗科收治的伴有眼眶侵犯的鼻腔鼻窦ACC患者62例资料,比较不同眼眶侵犯程度患者放疗后的总生存、无进展生存情况(Kaplan-Meier法分析)及视力保存情况。结果62例患者中37例患者接受三维适形放疗(3D-CRT),25例患者接受调强放疗(IMRT)。放疗后患者总生存和无进展生存率及视力保存程度与放疗方式(3D-CRT及IMRT)、放疗顺序(术前放疗、术后放疗)无关(均P>0.05),与肿瘤本身的Iannetti分级有关(P<0.05)。放疗+手术+化疗的综合治疗模式的临床预后优于其他综合治疗模式(均P<0.05)。结论在实施精确放疗的前提下,不同程度眼眶侵犯的鼻腔鼻窦ACC患者均得到较好的预后,放疗+手术+化疗的综合治疗模式对视力损伤程度最小,有利于提高患者疗后生存质量。

Objective To provide a reference in the selection of radiotherapy strategy for adenoid cystic carcinoma(ACC)in nasal and sinuses with varying degrees of orbital invasion by retrospectively analyzing its clinical prognosis.Methods A total of 62 patients diagnosed as ACC in nasal and sinuses with orbital invasion treated by radiotherapy from March 2005 to December 2019 were enrolled in this study.The overall survival(OS)and progression-free survival(PFS)by Kaplan-Meier method and log-rank test,and visual impairment degrees among patients with different degrees of orbital invasion after radiotherapy were compared.Results Among 62 patients,37 patients received three-dimensional conformal radiotherapy(3D-CRT)and the other 25 patients underwent intensity-modulated radiotherapy(IMRT).The difference of OS,PFS and visual impairment of patients after radiotherapy between 3D-CRT group and IMRT group(different mode of radiotherapy),preoperation radiotherapy and postoperation radiotherapy(order of treatment)were not statistically significant(all P>0.05),however,there were statistically significant among different degrees of orbital invasion based on Iannetti classification(P<0.05).The clinical prognosis of radiotherapy+surgery+chemotherapy was better than that of other comprehensive treatment regimen(all P<0.05).Conclusions Based on precise radiotherapy,sinonasal ACC with varied degrees of orbital invasion has relatively good clinical prognosis.The comprehensive treatment regimen of radiotherapy+surgery+chemotherapy has the least damage to vision and is conducive to improving the survival quality of patients after treatment.