手术联合高剂量放疗治疗局部晚期嗅神经母细胞瘤的临床效果

摘要

Objective To explore the effect of surgery combined with high-dose irradiation in treatment of locally advanced esthesioneuroblastoma (ENB).Methods Eleven patients pathologically confirmed as ENB from March 2005 to December 2014 were retrospectively analyzed.All patients were treated with simultaneous-boost intensity modulated radiation therapy before or after surgery combined with or not with chemotherapy.After radiotherapy,Kaplan Meier method was used to calculate the cumulative survival rates and disease-free survival (DFS) rate for 5 years.Results Surgery was performed in 10 patients,among them,9 cases received surgery + postoperative radiotherapy and 1 cases received preoperative radiotherapy + surgery,6 cases received complete tumor excision and 4 cases received partial tumor resection.One case who received preoperative radiotherapy refused surgery and underwent radical cure of radiotherapy.Three patients received adjuvant chemotherapy during the first treatment.The median follow-up period was 52 months (5-86 months).The cumulative survival rate and DFS rate for 5 years were 45.0％ and 42.6％;the median overall survival time and DFS time were 60 months and 55 months.Local recurrence occurred in 1 patient,lymphatic metastasis occurred in 2 cases,distant metastasis occurred in 4 cases.No cervical nodal failure occurred in 9 patients receiving elective prophylactic irradiation of nodal.Conclusion Surgery combined with high-dose irradiation provides a high local control rate in treating ENB of Kadish stage B and C;elective prophylactic irradiation of nodal might prevent regional failure in locally advanced ENB.%目的 探讨手术联合高剂量放疗治疗局部晚期嗅神经母细胞瘤的临床效果.方法 回顾性选择2005年3月至2014年12月于北京军区总医院就诊的经病理证实为Kadish B、C期嗅神经母细胞瘤的患者11例,所有患者均术前或术后接受同期整合补量调强放射治疗和/或化疗治疗.放疗结束后随访,采用Kaplan-Meier法计算5年累积生存率和无病生存率并记录复发情况.结果 11例患者中,10例接受手术治疗(9例接受手术+术后放疗,1例接受术前放疗+手术;6例肿瘤完全切除,4例肿瘤部分切除),1例术前放疗后拒绝手术改行根治量放疗.初次治疗时3例接受辅助化疗.中位随访52个月(5～86个月),5年累积生存率和无病生存率分别约45.0％和42.6％;中位生存期和无病生存期分别约为60、55个月;局部复发1例,淋巴结转移2例,远地转移4例;9例行颈淋巴结区预防照射,均未出现淋巴结失败.结论 根治性手术+高剂量放疗治疗Kadish B、C期嗅神经母细胞瘤可获得较高的肿瘤局部控制率,选择性颈淋巴结区预防照射可能减少局部晚期患者颈淋巴结失败率.