鼻窦癌和鼻咽癌放疗后眼前节并发症：接受RADPLAT治疗的上颌窦癌中发生频率高

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中文摘要

目的： 描述鼻窦癌和鼻咽癌放疗后眼前节表现的发生频率和时间模式，特别关注眼前节新生血管形成及其与超选择性动脉内顺铂灌注联合同步放疗（RADPLAT）的关联。方法：我们回顾性分析了2019年至2022年间接受调强放疗的113例患者。以整个队列作为分母，并在因眼部症状转诊的患者中评估眼前节表现。采用Aalen-Johansen估计量，以死亡作为竞争风险估计累积发生率，并使用Gray检验进行比较。结果：中位随访时间为1666天。47例患者（41.6%）转诊至眼科。眼前节表现发生于16/60例（26.7%）鼻腔癌患者和13/31例（41.9%）上颌窦癌患者（p = 0.16）；5年累积发生率分别为27.7%和46.1%（p = 0.018）。眼前节新生血管形成发生于7/113例患者（6.2%），包括接受RADPLAT治疗的6/21例（28.6%）和未接受RADPLAT治疗的1/92例（1.1%）（p < 0.001）；5年累积发生率分别为31.4%和1.4%（p < 0.001）。在上颌窦癌患者中，新生血管形成发生于5/19例接受RADPLAT治疗的患者和0/12例未接受RADPLAT治疗的患者（p = 0.13）；然而，非RADPLAT组的中位随访时间显著较短（385天 vs. 1784天）。新生血管形成发生较晚（中位时间975天），4例受影响患者的最终最佳矫正视力低于0.05。结论：放疗后眼前节表现显示出不同的时间模式。晚期、威胁视力的新生血管形成与RADPLAT密切相关，但由于治疗选择受到肿瘤部位、疾病范围、眶侵犯和放疗特征的混杂影响，无法确定因果关系。这些发现将眼前节新生血管形成确定为重要的安全性信号，值得进行前瞻性评估。需要标准化的基线眼科评估、长期监测和患者水平的眼部剂量测定，以阐明机制并确定适当的随访策略。

英文摘要

Objectives: To characterize the frequency and temporal patterns of anterior segment findings after radiotherapy for sinonasal and nasopharyngeal cancer, with particular focus on anterior segment neovascularization and its association with superselective intra-arterial cisplatin infusion with concurrent radiotherapy (RADPLAT). Methods: We retrospectively reviewed 113 patients treated with intensity-modulated radiotherapy between 2019 and 2022. Anterior segment findings were evaluated using the whole cohort as the denominator and among patients referred for ocular symptoms. Cumulative incidence was estimated with death as a competing risk using the Aalen-Johansen estimator and compared using Gray's test. Results: Median follow-up was 1666 days. Forty-seven patients (41.6%) were referred to ophthalmology. Anterior segment findings occurred in 16/60 patients (26.7%) with nasal cavity cancer and 13/31 (41.9%) with maxillary sinus cancer (p = 0.16); 5-year cumulative incidences were 27.7% and 46.1%, respectively (p = 0.018). Anterior segment neovascularization occurred in 7/113 patients (6.2%), including 6/21 (28.6%) treated with RADPLAT and 1/92 (1.1%) without RADPLAT (p < 0.001); 5-year cumulative incidences were 31.4% and 1.4%, respectively (p < 0.001). Among patients with maxillary sinus cancer, neovascularization occurred in 5/19 RADPLAT-treated patients and 0/12 non-RADPLAT patients (p = 0.13); however, median follow-up was substantially shorter in the non-RADPLAT group (385 vs. 1784 days). Neovascularization developed late (median, 975 days), and four affected patients had final best-corrected visual acuity below 0.05. Conclusions: Anterior segment findings showed distinct temporal patterns after radiotherapy. Late, vision-threatening neovascularization was strongly associated with RADPLAT, although causality cannot be established because treatment selection was confounded by tumor site, disease extent, orbital invasion, and radiotherapy characteristics. These findings identify anterior segment neovascularization as an important safety signal warranting prospective evaluation. Standardized baseline ophthalmological assessment, long-term surveillance, and patient-level ocular dosimetry are needed to clarify mechanisms and define appropriate follow-up strategies.