Image-guided brachytherapy for cancer of the nasal vestibule: achieving high local-regional control while preserving cosmesis
Menée à partir de données portant sur 102 patients atteints d'un carcinome épidermoïde du vestibule nasal de stade T1 à T2 (durée médiane de suivi : 42 mois), cette étude évalue, du point de vue du contrôle de la maladie, de la préservation de la fonction nasale et des résultats esthétiques, l'intérêt d'une curiethérapie guidée par l'imagerie
Objective : To evaluate the efficacy of modern image-guided brachytherapy for squamous cell carcinoma of the nasal vestibule and to explore tumor volume as prognostic factor for local and regional recurrence. Furthermore, to assess patient satisfaction with nasal function and appearance post-treatment. Methods : In a retrospective analysis, we reviewed the medical records of 102 patients with Wang T1-T2 nasal vestibule cancer treated with brachytherapy as the sole treatment at a single institution. Median follow-up time was 42 months (range 3-210 months). A patient satisfaction study using the validated Nasal Appearance and Function Evaluation Questionnaire was conducted among 42 patients >1 year after treatment. A statistically significant cutoff point for tumor volume as prognostic factor of local control was established using Youden’s index method. Results : 77 out of 102 patients were treated with interstitial implants and 25 by an intracavitary mould technique. The 5-year control rates were 95%, 91% and 83% for local, regional and local-regional control, respectively. Tumor volume ≥2.3 cm3 resulted in worse 3-year regional control compared to volume <2.3cm3 (62% vs 96%; p = .01). Ultimate regional control after salvage treatment was 96%, with no significant difference between subgroups by tumor volume (92% for ≥2.3 cm3 vs 96% for <2.3 cm3; p = .57). Three patients with regional failure developed distant metastases. 5-year disease-specific survival and overall survival were 94% and 74% respectively. Patient assessed cosmetic and functional satisfaction were both rated high (mean 3.7 and 4.0 out of 5, respectively). Conclusion : We report the largest cohort to date treated with brachytherapy as the sole treatment for nasal vestibule carcinoma. Brachytherapy offers excellent local control for Wang T1-T2 tumors with high patient satisfaction. Tumor volume is an adequate predictive factor for patients at risk of regional recurrence, but ultimate control rates after salvage treatment are high. Therefore, we do not recommend elective treatment of the neck.