鼻咽癌的挽救手术：揭示经鼻内窥镜鼻咽切除术对晚期复发肿瘤的疗效。

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2024-10-02 DOI:10.1016/j.oraloncology.2024.107048

Gulpembe Bozkurt , Mario Turri Zanoni , Marco Ferrari , Alessandro Ioppi , Sinem Kara Peker , Hasan Elhassan , Melis Ece Arkan Anarat , Yetkin Zeki Yilmaz , Stefano Taboni , Alessandra Ruaro , Vittorio Rampinelli , Davide Mattavelli , Alberto Schreiber , Alessandro Vinciguerra , Benjamin Verillaud , Paolo Battaglia , Cesare Piazza , Philippe Herman , Paolo Castelnuovo , Piero Nicolai , Alperen Vural

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引用次数: 0

摘要

目的：本系统性综述评估了经鼻内窥镜鼻咽切除术作为晚期复发性鼻咽癌（rNPC）挽救治疗方法的疗效和发病率：按照 PRISMA 指南，我们在 Medline、Scopus 和 PubMed 上进行了系统检索，确定了经鼻内窥镜鼻咽切除术治疗复发性鼻咽癌的相关研究。纳入标准包括既往接受过放疗或化疗的组织学确诊的 rT3 和 rT4 鼻咽癌患者。对总生存期（OS）、无病生存期（DFS）和并发症的数据进行了提取和分析：结果：9项研究符合纳入标准，共纳入429名患者。5项研究报告了2年总生存率（OS），从34.6%到88.7%不等。三项研究报告的 3 年 OS 率介于 50% 到 63.5% 之间。三项研究的 5 年长期生存率差别很大，从 0% 到 100%。一项研究详细列出的 1 年无病生存率（DFS）和 OS 分别为 93% 和 98%。汇总分析包括429名患者，中位随访时间为26.1个月。并发症主要是轻微的一过性并发症。主要并发症包括坏死、出血、颅神经麻痹和死亡。先进的手术技术和颈内动脉栓塞等治疗前措施改善了切除效果，降低了并发症发生率：结论：经鼻内窥镜鼻咽切除术是治疗晚期鼻咽癌的可行挽救方案，可提供良好的生存效果和可控的并发症情况。未来的研究应侧重于完善手术技术和改进患者选择标准，以进一步提高治疗效果。

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Salvage surgery in nasopharyngeal Cancer: Unraveling the efficacy of transnasal endoscopic nasopharyngectomy for advanced stage recurrent tumors

Objective

This systematic review evaluates the efficacy and morbidity of transnasal endoscopic nasopharyngectomy as a salvage treatment for advanced-stage recurrent nasopharyngeal carcinoma (rNPC).

Methods

Following PRISMA guidelines, we conducted a systematic search in Medline, Scopus, and PubMed, identifying studies on transnasal endoscopic nasopharyngectomy for rNPC. Inclusion criteria encompassed histologically confirmed rT3 and rT4 NPC patients previously treated with radiotherapy or chemoradiotherapy. Data on overall survival (OS), disease-free survival (DFS), and complications were extracted and analyzed.

Results

Nine studies, including a total of 429 patients, met the inclusion criteria. Five studies reported 2-year overall survival (OS) rates ranging from 34.6 % to 88.7 %. Three studies reported 3-year OS rates between 50 % and 63.5 %. Long-term 5-year survival varied widely from 0 % to 100 % across three studies. One study detailed 1-year disease-free survival (DFS) and OS at 93 % and 98 %, respectively. The pooled analysis included 429 patients with a median follow-up of 26.1 months. Complications were predominantly minor and transient. Major complications included necrosis, hemorrhage, cranial nerve palsy, and death. Advanced surgical techniques and pre-treatment measures, such as internal carotid artery embolization, improved resection outcomes and reduced complication rates.

Conclusion

Transnasal endoscopic nasopharyngectomy emerges as a viable salvage option for advanced rNPC, offering favorable survival outcomes and manageable complication profiles. Future research should focus on refining surgical techniques and improving patient selection criteria to further enhance treatment efficacy.

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.