背景:鼻窦粘膜黑色素瘤(SNMM)是一种罕见但侵袭性的疾病。有自由边缘的手术,在可行的情况下,是治疗的选择。在过去的三十年里,电化学疗法(ECT)已经成为一种局部消融程序,与诊所医生一起表演,用于不同组织学的皮肤和粘膜肿瘤。我们提供了通过新的内窥镜电极进行ECT治疗的病例报告,一名受原发性SNMM影响的老年患者。
方法:一名88岁的男性,诊断为SNMM(cT4aN0M0)-IV期,在我们机构展示的左鼻窝。症状为鼻出血和完全左鼻塞。他拒绝鼻窦扩大手术和放疗。他接受了肿瘤消积术,然后进行了专门用于症状控制的ECT,有姑息的意图。
结果:患者在全身麻醉下接受了SNMM减瘤,其次是肿瘤边缘的ECT。手术后,他已经5个月没有症状了,拥有良好的生活质量。通过新的局部切除和边缘的ECT手术控制了局部复发。患者在接下来的4个月内保持无症状。诊断后17个月,患者有轻微的鼻窦疾病症状。因此,他出现了全身性疾病进展。
结论:根据我们的经验,当延长手术没有治愈意图或不可行时,ECT可用作SNMM症状和局部控制的辅助工具。不出所料,ECT似乎对全身性疾病进展没有任何影响。
BACKGROUND: Sinonasal Mucosal Melanoma (SNMM) is a rare but aggressive disease. Surgery with free margins, when feasible, is the treatment of choice. In the last three decades, electrochemotherapy (ECT) has emerged as a local ablative procedure, performed with the Cliniporator, for cutaneous and mucosal tumours of different histology. We present a case report of an ECT treatment performed by means of a new endoscopic electrode, on an elderly patient affected by primary SNMM.
METHODS: An 88-year-old man with a diagnosis of SNMM (cT4aN0M0)-Stage IV, of the left nasal fossa presented at our institution. Symptoms were epistaxis and complete left nasal obstruction. He refused sinonasal extended surgery and radiotherapy. He underwent a tumor debulking followed by ECT exclusively for symptom control, with palliative intent.
RESULTS: The patient underwent SNMM debulking under general anaesthesia, followed by ECT on tumour margins. After the procedure, he had been free from symptoms for 5 months, with a good quality of life. Local recurrence was controlled with a new local debulking and ECT procedure on margins. The patient remained symptom free for the next 4 months. Seventeen months after diagnosis, the patient is mild symptomatic for sinonasal disease. Therefore, he developed a systemic disease progression.
CONCLUSIONS: In our experience, ECT can be used as an adjuvant tool for symptom and local control in SNMM when extended surgery is out of curative intent or unfeasible. As expected, ECT does not appear to have any effect on systemic disease progression.