Abstract：
OBJECTIVE: Mucosal melanoma of the nasal cavity and paranasal sinuses (NPMM) is a highly aggressive disease. The role of postoperative adjuvant radiation therapy is controversial.
METHODS: A total of 300 patients with NPMM treated between March 2009 and January 2020 were divided into surgery alone (SA; 158 patients) and surgery plus radiation therapy (SR; 142 patients) groups. Postoperative radiation therapy was recommended, with a total dose of 65 to 70 Gy/30 to 35 fractions to the gross tumor volume and 60 Gy/30 fractions to the clinical target volume. The primary endpoint was relapse-free survival. Secondary endpoints included local recurrence-free survival, distant metastasis-free survival, and overall survival.
RESULTS: At a median follow-up of 50.0 months, relapse-free survival in the SA and SR groups was 9.8 and 15.2 months (hazard ratio [HR], 0.714; 95% CI, 0.546-0.933; P = .014). Distant metastasis-free survival in the SA and SR groups was 23.8 and 21.3 months (HR, 0.896; 95% CI, 15.7-31.9 vs 13.3-29.3; P = .457). Overall survival in the SA and SR groups was 31.0 and 35.1 months (HR, 0.816; 95% CI, 25.7-36.3 vs 27.1-43.2; P = .178). For patients with stage IVA NPMM, radiation therapy reduced the incidence of relapse by 0.43-fold.
CONCLUSIONS: Postoperative radiation therapy played a crucial role in the local control of resected NPMM, especially in patients with stage T4a or IVA disease.
METHODS: A total of 300 patients with NPMM treated between March 2009 and January 2020 were divided into surgery alone (SA; 158 patients) and surgery plus radiation therapy (SR; 142 patients) groups. Postoperative radiation therapy was recommended, with a total dose of 65 to 70 Gy/30 to 35 fractions to the gross tumor volume and 60 Gy/30 fractions to the clinical target volume. The primary endpoint was relapse-free survival. Secondary endpoints included local recurrence-free survival, distant metastasis-free survival, and overall survival.
RESULTS: At a median follow-up of 50.0 months, relapse-free survival in the SA and SR groups was 9.8 and 15.2 months (hazard ratio [HR], 0.714; 95% CI, 0.546-0.933; P = .014). Distant metastasis-free survival in the SA and SR groups was 23.8 and 21.3 months (HR, 0.896; 95% CI, 15.7-31.9 vs 13.3-29.3; P = .457). Overall survival in the SA and SR groups was 31.0 and 35.1 months (HR, 0.816; 95% CI, 25.7-36.3 vs 27.1-43.2; P = .178). For patients with stage IVA NPMM, radiation therapy reduced the incidence of relapse by 0.43-fold.
CONCLUSIONS: Postoperative radiation therapy played a crucial role in the local control of resected NPMM, especially in patients with stage T4a or IVA disease.
摘要：
背景：鼻腔和鼻旁窦的粘膜黑色素瘤（NPMM）是一种高度侵袭性的疾病。术后辅助放疗的作用存在争议。
方法：2009年3月至2020年1月期间，共300例NPMM患者被分为SA（单纯手术，158名患者）和SR（手术加放疗，142名患者)组。建议术后放疗，GTV的总剂量为65-70Gy/30-35fx（总肿瘤体积），CTV的总剂量为60Gy/30分（临床目标体积）。主要终点是无复发生存期（RFS）。次要终点包括无局部复发生存期，无远处转移生存期（DMFS），总生存率（OS）。
结果：中位随访时间为50.0个月，SA和SR组的RFS分别为9.8和15.2个月（HR：0.714，95％CI：0.546-0.933，P=0.014）。SA和SR组的DMFS分别为23.8和21.3个月（HR：0.896，95％CI：15.7-31.9vs.13.3-29.3，P=0.457）。SA和SR组的OS分别为31.0和35.1个月（HR：0.816，95％CI：25.7-36.3vs.27.1-43.2，P=0.178）。对于IVANPMM阶段的患者，放疗使复发率降低了0.43倍.
结论：术后放疗在切除的NPMM的局部控制中起着至关重要的作用。特别是在T4a或IVA疾病的患者中。
方法：2009年3月至2020年1月期间，共300例NPMM患者被分为SA（单纯手术，158名患者）和SR（手术加放疗，142名患者)组。建议术后放疗，GTV的总剂量为65-70Gy/30-35fx（总肿瘤体积），CTV的总剂量为60Gy/30分（临床目标体积）。主要终点是无复发生存期（RFS）。次要终点包括无局部复发生存期，无远处转移生存期（DMFS），总生存率（OS）。
结果：中位随访时间为50.0个月，SA和SR组的RFS分别为9.8和15.2个月（HR：0.714，95％CI：0.546-0.933，P=0.014）。SA和SR组的DMFS分别为23.8和21.3个月（HR：0.896，95％CI：15.7-31.9vs.13.3-29.3，P=0.457）。SA和SR组的OS分别为31.0和35.1个月（HR：0.816，95％CI：25.7-36.3vs.27.1-43.2，P=0.178）。对于IVANPMM阶段的患者，放疗使复发率降低了0.43倍.
结论：术后放疗在切除的NPMM的局部控制中起着至关重要的作用。特别是在T4a或IVA疾病的患者中。
