弧形調控放射治療應用於嗅神經母細胞瘤：案例報告

嗅神經母細胞（esthesioneuroblastoma, ENB）是在1924年首先由Berger等人描述的嗅粘膜的一種罕見的侵襲性腫瘤。傳統上ENB可以透過根治性手術，放射治療和化療來治療。然而，這種罕見的腫瘤具有高復發和死亡率，根據研究顯示，與單一形式治療相比，手術後合併放射治療可提供更長的總生存期。因此本篇案例報告提出使用弧形調控放射治療技術（volumetric modulated arc therapy, VMAT）RapidArc成功治療ENB的案例。一名72歲的男性患者主訴，在10年期間鼻腔偶爾會有一些黃紅色的分泌物。最近1個月，有咳嗽、鼻塞、嗅覺喪失和膿性鼻漏的症狀。2013年3月4日MRI顯示，於右顱前窩發現有一48 x 40 x 44 mm硬膜外腫瘤並侵犯到右篩竇，頸部淋巴結無顯著腫大。病人被診斷為Kadish分期C，Hyams分級Ⅲ的ENB。使用RapidArc治療7000 cGy的累積劑量後，追蹤39個月患者仍無病存活。

關鍵字

嗅神經母細胞；弧形調控放射治療

並列摘要

Esthesioneuroblastoma (ENB) is a rare aggressive tumor of the olfactory mucosa which was first described by Berger et al. in 1924. ENB has been traditionally treated with radical surgery, radiotherapy and/or chemotherapy. Nevertheless, these rare tumors are still associated with high rates of tumor recurrence and mortality. Studies have shown that surgery with postoperative radiotherapy offers a longer overall survival when compared with single modality treatment. We present an advanced case of ENB who was successfully treated with RapidArc (VMAT) technique. A 72 year-old male Taiwanese farmer was seen at the ENT outpatient clinic complaining of productive cough, nasal obstruction, loss of smell sensation and purulent rhinorrhea for 1 month, the patient also complained of yellow to reddish nasal discharge for 10 years. MRI on 2013/03/04 revealed a strongly enhanced right anterior cranial fossa epidural mass (48 x 40 x 44 mm) with a cystic component invading the right ethmoid sinus. No significant neck lymphadenopathy was noted. The patient was diagnosed as Kadish stage C, Hyams grade III ENB. Treatment consisted of giving a cumulative dose of 7000 cGy using the RapidArc technique concurrently with cisplatin and etoposide. The patient is still disease-free 39 months after CCRT.

並列關鍵字

Esthesioneuroblastoma ； Volumetric modulated arc therapy (VMAT)

國際替代計量

弧形調控放射治療應用於嗅神經母細胞瘤：案例報告

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