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  

Effect of surgery combined with high-dose radiotherapy in treating locally advanced

作　　者：高军茂[1] 许卫东[1] 陈点点[1] 张富利[1] 王雅棣[1] 

机构地区：[1]北京军区总医院放疗科,100700

出　　处：《中国医药》2016年第8期1244-1247,共4页China Medicine

摘　　要：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．O％和42．6％；中位生存期和无病生存期分别约为印、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KadishB、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。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 simuhaneous-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 radio-therapy 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 recurreuce 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.

关 键 词：嗅神经母细胞瘤 手术 调强放射治疗 

分 类 号：R739.62[医药卫生—肿瘤]