Postoperative intensity-modulated radiation therapy for cancers of the paranasal sinuses, nasal cavity, and lacrimal glands: Technique, early outcomes, and toxicity (original) (raw)
International Journal of Radiation Oncology Biology Physics, 2003
Purpose: Intensity-modulated radiotherapy (IMRT) plans require decisions about priorities and tradeoffs among competing goals. This study evaluates the incorporation of various clinical decisions into the optimization system, using locally advanced paranasal sinus tumors as a model. Methods and Materials: Thirteen patients with locally advanced paranasal sinus tumors were retrospectively replanned using inverse planning. Two clinical decisions were assumed: (1) Spare both optic pathways (OP), or (2) Spare only the contralateral OP. In each case, adequate tumor coverage (treated to 70 Gy in 35 fractions) was required. Two beamlet IMRT plans were thus developed for each patient using a class solution cost function. By altering one key variable at a time, different levels of risk of OP toxicity and planning target volume (PTV) compromise were compared in a systematic manner. The resulting clinical tradeoffs were analyzed using dosimetric criteria, tumor control probability (TCP), equivalent uniform dose (EUD), and normal tissue complication probability. Results: Plan comparisons representing the two clinical decisions (sparing both OP and sparing only the contralateral OP), with respect to minimum dose, TCP, V 95 , and EUD, demonstrated small, yet statistically significant, differences. However, when individual cases were analyzed further, significant PTV underdosage (>5%) was present in most cases for plans sparing both OP. In 6/13 cases (46%), PTV underdosage was between 5% and 15%, and in 3 cases (23%) was greater than 15%. By comparison, adequate PTV coverage was present in 8/13 cases (62%) for plans sparing only the contralateral OP. Mean target EUD comparisons between the two plans (including 9 cases where a clinical tradeoff between PTV coverage and OP sparing was required) were similar: 68.6 Gy and 69.1 Gy, respectively (p ؍ 0.02). Mean TCP values for those 9 cases were 56.5 vs. 61.7, respectively (p ؍ 0.006). Conclusions: In IMRT plans for paranasal sinus tumors, tradeoff values between OP toxicity and PTV coverage can be compared for different clinical decisions. The information derived can then be used to individualize the parameters within the optimization system. This process of determining clinical tradeoffs associated with different clinical decisions may be a useful tool in other sites.
International Journal of Radiation Oncology*Biology*Physics, 2007
Purpose: To determine the effects of three changes in radiotherapy technique on the outcomes for patients irradiated postoperatively for maxillary sinus cancer. Methods and Materials: The data of 146 patients treated between 1969 and 2002 were reviewed. The patients were separated into two groups according to the date of treatment. Group 1 included 90 patients treated before 1991 and Group 2 included 56 patients treated after 1991, when the three changes were implemented. The outcomes were compared between the two groups. Results: No differences were found in the 5-year overall survival, recurrence-free survival, local control, nodal control, or distant metastasis rates between the two groups (51% vs. 62%, 51% vs. 57%, 76% vs. 70%, 82% vs. 83%, and 28% vs. 17% for Groups 1 and 2, respectively). The three changes were to increase the portals to cover the base of the skull in patients with perineural invasion, reducing their risk of local recurrence; the addition of elective neck irradiation in patients with squamous or undifferentiated histologic features, improving the nodal control, distant metastasis, and recurrence-free survival rates (64% vs. 93%, 20% vs. 3%, and 45% vs. 67%, respectively; p < 0.05 for all comparisons); and improving the dose distributions within the target volume, reducing the late Grade 3-4 complication rates (34% in Group 1 vs. 8% in Group 2, p ؍ 0.014). Multivariate analysis revealed advancing age, the need for enucleation, and positive margins as independent predictors of worse overall survival. The need for enucleation also predicted for worse local control. Conclusion: The three changes in radiotherapy technique improved the outcomes for select patients as predicted. Despite these changes, little demonstrable overall improvement occurred in local control or survival for these patients and additional work must be done.
Unresectable Carcinoma of the Paranasal Sinuses: Outcomes and Toxicities
International Journal of Radiation Oncology*Biology*Physics, 2008
Purpose: To evaluate long-term outcomes and toxicity in patients with unresectable paranasal sinus carcinoma treated with radiotherapy, with or without chemotherapy. Methods and Materials: Between January 1990 and December 2006, 39 patients with unresectable Stage IVB paranasal sinus carcinoma were treated definitively with chemotherapy plus radiotherapy (n = 35, 90%) or with radiotherapy alone (n = 4, 10%). Patients were treated with three-dimensional conformal radiotherapy (n = 18, 46%), intensity-modulated radiotherapy (n = 12, 31%), or conventional radiotherapy (n = 9, 23%) to a median treatment dose of 70 Gy. Most patients received concurrent platinum-based chemotherapy (n = 32, 82%) and/or concomitant boost radiotherapy (n = 29, 74%). Results: With a median follow-up of 90 months, the 5-year local progression-free survival, regional progressionfree survival, distant metastasis-free survival, disease-free survival, and overall survival were 21%, 61%, 51%, 14%, and 15%, respectively. Patients primarily experienced local relapse (n = 25, 64%), mostly within the irradiated field (n = 22). Nine patients developed neck relapses; however none of the 4 patients receiving elective neck irradiation had a nodal relapse. In 13 patients acute Grade 3 mucositis developed. Severe late toxicities occurred in 2 patients with radionecrosis and 1 patient with unilateral blindness 7 years after intensity-modulated radiation therapy (77 Gy to the optic nerve). The only significant factor for improved local progression-free survival and overall survival was a biologically equivalent dose of radiation $65 Gy. Conclusions: Treatment outcomes for unresectable paranasal sinus carcinoma are poor, and combined-modality treatment is needed that is both more effective and associated with less morbidity. The addition of elective neck irradiation may improve regional control. Ó
Radiotherapy and Oncology, 1999
Compare dose distributions of traditional versus conformal beam orientations in paranasal sinus malignancies. Maximum normal tissue doses, dose volume histograms (DVH), normal tissue complication probabilities (NTCP), and the percentage of each normal tissue receiving >80% of the average target dose (V80) were calculated. Conformal planning reduced the V80 to the optic nerves and chiasm as well as the normal tissue maximum doses to the ipsilateral and contralateral optic nerves and chiasm, and mean NTCPs.
International Journal of Radiation Oncology*Biology*Physics, 2007
Purpose: To compare clinical outcomes of patients with carcinomas of the paranasal sinuses and nasal cavity according to decade of radiation treatment. Methods and Materials: Between 1960 and 2005, 127 patients with sinonasal carcinoma underwent radiotherapy with planning and delivery techniques available at the time of treatment. Fifty-nine patients were treated by conventional radiotherapy; 45 patients by three-dimensional conformal radiotherapy; and 23 patients by intensity-modulated radiotherapy. Eighty-two patients (65%) were treated with radiotherapy after gross total tumor resection. Nineteen patients (15%) received chemotherapy. The most common histology was squamous cell carcinoma (83 patients). Results: The 5-year estimates of overall survival, local control, and disease-free survival for the entire patient population were 52%, 62%, and 54%, respectively. There were no significant differences in any of these endpoints with respect to decade of treatment or radiotherapy technique (p > 0.05, for all). The 5-year overall survival rate for patients treated in was 46%, 56%, 51%, 53%, and 49%, respectively (p ؍ 0.23). The observed incidence of severe (Grade 3 or 4) late toxicity was 53%, 45%, 39%, 28%, and 16% among patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s, respectively (p ؍ 0.01). Conclusion: Although we did not detect improvements in disease control or overall survival for patients treated over time, the incidence of complications has significantly declined, thereby resulting in an improved therapeutic ratio for patients with carcinomas of the paranasal sinuses and nasal cavity.
Simultaneous integrated prophylactic cranial irradiation in sino-nasal cancer
Clinical and translational radiation oncology, 2017
Therapy for small cell cancer and high grade neuroendocrine tumours of the paranasal sinuses is extrapolated from the treatment of small cell lung cancer and paranasal cancer of different histologies. Prophylactic cranial irradiation has proven survival benefit in small cell lung cancer. Two patients with aggressive cancer of the paranasal sinuses received radiotherapy with simultaneous integrated prophylactic brain irradiation, using two sequential plans. Chemotherapy was given before, during and after radiotherapy. None of the patients had intracranial recurrence. One patient experienced severe, but transient encephalitis-like symptoms that could only be attributed to radiotherapy. No long term side effects in the CNS were observed. The treatment was feasible, but with possible severe, but transient side effects. It should be considered in cases with head and neck cancer, with a high risk of intracerebral metastasis, as well as a significant overlap between the primary irradiated ...
Japanese Journal of Clinical Oncology, 2010
To evaluate the efficacy and toxicity of definitive radiotherapy with or without chemotherapy for T3-4 squamous cell carcinoma of maxillary sinus and nasal cavity. Methods: Forty-two patients with T3-4N0 squamous cell carcinoma of maxillary sinus (n ¼ 30) and nasal cavity (n ¼ 12) received definitive radiotherapy. Chemotherapy was used in 34 patients and elective neck irradiation was not used. Results: The 5-year overall survival/local control rates were 34%/29% for maxillary sinus cancer and 50%/52% for nasal cavity cancer. For maxillary sinus cancers, a performance status of Eastern Cooperative Oncology Group !2 (P ¼ 0.012), biologically equivalent dose ,68 Gy (P ¼ 0.011) and no use of chemotherapy (P ¼ 0.037) were significant worse predictors for overall survival on log-rank analysis. Biologically equivalent dose ,68 Gy was independently associated with poor local control (hazard ratio, 3.32; 95% confidence interval, 1.38-7.97; P ¼ 0.007) and overall survival (hazard ratio, 2.94; 95% confidence interval, 1.23-7.01; P ¼ 0.015). Regional recurrence occurred in only 1 of 30 patients with maxillary sinus cancer and 4 of 12 patients with nasal cavity. Two radiation necrosis in brain, one osteoradionecrosis, and one retinopathy and optic neuropathy occurred. Conclusions: The treatment outcome was poor and local control was a major problem. High radiation dose, effective chemotherapy and elective neck irradiation for advanced nasal cavity cancers may improve disease control.
Locally advanced paranasal sinus carcinoma: A study of 30�patients
Oncology Letters, 2017
Sinonasal carcinomas (SNcs) are rare neoplasms arising from the paranasal sinuses and nasal cavity. Although these tumours have a heterogeneous histology, they are commonly diagnosed as a locally advanced disease and are associated with a poor prognosis. The present retrospective study reviewed 30 patients with locally advanced SNc, who were treated with surgery followed by chemoradiotherapy or radiotherapy, or radiotherapy with or without concomitant chemotherapy between January 1999 and January 2013 at the Department of Radiation Therapy, University of Naples 'Federico II' (Naples, Italy). A total of 19 patients were treated with upfront surgery followed by adjuvant radio-or chemoradiotherapy (group A), while the remaining 11 patients received exclusive radiotherapy with or without concomitant chemotherapy (group B). Concurrent cisplatin-based chemotherapy (100 mg/m 2 , days 1, 22 and 43 for 3 cycles) was administered to 34% of patients in group A and 55% of patients in group B. At a median follow-up of 31 months, 33.3% of patients were alive. Cause-specific survival (CSS) and progression-free survival (PFS) times were 32 and 12 months, respectively. No difference in CSS rate was observed between the two treatment groups. Univariate analysis determined that disease stage was the only factor that significantly affected CSS (P=0.002) and PFS (P= 0.0001) rates. Acute and chronic toxicities were mild, with only 23.3% of patients reporting G1-2 side effects and no treatment-related blindness. The present study reported moderate activity and efficacy of surgery followed by adjuvant radio-or chemoradiotherapy, and exclusive radiotherapy with or without chemotherapy in this poor prognosis category of patients.
Radiotherapy and Oncology, 2019
Material and Methods We retrospectively reviewed the data from 70 patients with non-metastatic nasopharyngeal carcinoma who received IMRT-SIB from January 2007 to December 2015. High-risk PTV was treated with a daily dose of 2.12 Gy and a total dose of 69.96Gy. Low-risk PTV was treated with a daily dose of 1.64 Gy and a total dose of 54.12 Gy. Patients received concurrent chemotherapy during the course of the RT with intravenous administration of 100 mg/m 2 cisplatin every 3 weeks or 30-40 mg/m 2 weekly. The induction chemotherapy regimen was TPF (docetaxel/cisplatin/5-fluorouracil) or PF every 3 weeks for 2-3 cycles. Post-radiation adjuvant chemotherapy with PF (two-three cycles) also was used as option treatment. We analyzed the survival outcome and late toxicity outcome (scale CTCAE v4.03). Results 73% of all cases were men; median age was 51 years (range 15-79). Non-keratinizing carcinoma was the most common histological type (76.9%) and EBV was positive in 44 (62.9%). According to the AJCC 7 th Edition staging system 94.3% of cases were locally advanced disease, stage III-IVB. Only 7 patients (10%) were treated exclusively with RT, while the rest received chemotherapy, mainly concurrent (88.4%). 29 (41.5%) patients received induction chemotherapy. 25 (35.7%) patients received neoadyuvant and adjuvant chemotherapy. Response rate 8 weeks after ending radiotherapy were: complete response 65.7%, partial response 29.9%, stable disease 1.5% and progressive disease 2.9%. At a median follow-up of 62 months (range 4-136), 9 patients experienced local regional failure and distant metastasis occurred in 12 patients. 1-ys, 3-ys and 5-ys Disease Free Survival were 90%, 79% and 67%, respectively while 1-ys, 3-ys and 5-ys Overall Survival were 98%, 86% and 74% respectively. The most common late adverse effects were: xerostomia, dysphagia, and fibrosis. Grade 3 dental damage and xerostomia occurred in 1 case (16%) and 1 (2.1%) respectively. No case of grade IV toxicity was observed. Conclusion IMRT-SIB combined with concurrent chemotherapy or plus neoadjuvant or adyuvant chemotherapy resulted in promising rates of local regional control with acceptable rates of late side effects in patients with nasopharyngeal carcinoma.
Postoperative radiotherapy in the management of cancer of the maxillary sinus
International Journal of Radiation Oncology Biology Physics, 1989
This report comprises 149 patients with carcinoma of the maxillary sinus treated with radical surgery and postoperative radiotherapy (5500 to 6000 cGy in 6 weeks) between 1963 and 1980 at the Institute National de Enfermedades Neoplasicas of Lima. Permanent local control was observed in 67.1% of the cases with a 5-year actuarial survival of 36.2% and a corrected survival for death not due to cancer of 42.3%. The ultimate local and distant failures were 61%. Data were analyzed regarding stage of the disease, radiotherapeutic technique and its influence on local control, complications, and patterns of relapse. The data indicate that the stage of the tumor influences survival. Because of the natural history of this disease, local control is paramount. Maxillary sinus carcinoma, Postoperative irradiation, Local control, Survival. * Atomic Energy of Canada Ltd., Theratron 80. t Varian linear accelerator Clinac 4: Serial No. 10. Cancer of the maxillary sinus 0 M. ZAHARIA et al.