Unresectable carcinoma of the paranasal sinuses: Outcomes and toxicities Journal Article

Authors: Hoppe, B. S.; Nelson, C. J.; Gomez, D. R.; Stegman, L. D.; Wu, A. J.; Wolden, S. L.; Pfister, D. G.; Zelefsky, M. J.; Shah, J. P.; Kraus, D. H.; Lee, N. Y.
Article Title: Unresectable carcinoma of the paranasal sinuses: Outcomes and toxicities
Abstract: 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 progression-free 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. © 2008 Elsevier Inc. All rights reserved.
Keywords: adult; cancer survival; clinical article; controlled study; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; young adult; overall survival; three dimensional; intensity modulated radiation therapy; cisplatin; fluorouracil; cancer combination chemotherapy; patient selection; cancer radiotherapy; radiation dose; combined modality therapy; chemotherapy; cancer staging; follow up; carboplatin; etoposide; mucosa inflammation; radiotherapy dosage; radiotherapy; radiation injury; biotechnology; cetuximab; distant metastasis; ifosfamide; vinblastine; survivors; docetaxel; intensity-modulated radiotherapy; radiotherapy, intensity-modulated; irradiation; long term care; cancer relapse; platinum; health; radiotherapy, conformal; platinum compounds; toxicity; mitomycin; computer assisted radiotherapy; paranasal sinus neoplasms; chemoradiation; mucositis; hearing impairment; eye protection; intensity-modulated radiation therapy; hearing loss; radiation necrosis; paranasal sinus; nose neoplasms; paranasal sinuses; ototoxicity; nasal cavity; platinum-based chemotherapy; progression-free survival; otitis media; three-dimensional conformal radiotherapy; equivalent dose; paranasal sinus carcinoma; unresectable; electrotherapeutics; optic nerves; radiotherapy alone; significant factor; with or without; external otitis; unilateral blindness
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 72
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2008-11-01
Start Page: 763
End Page: 769
Language: English
DOI: 10.1016/j.ijrobp.2008.01.038
PUBMED: 18395361
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 11" - "Export Date: 17 November 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    624 Zelefsky
  2. Dennis Kraus
    259 Kraus
  3. Suzanne L Wolden
    424 Wolden
  4. Daniel R Gomez
    21 Gomez
  5. Nancy Y. Lee
    550 Lee
  6. Bradford Scott Hoppe
    14 Hoppe
  7. David G Pfister
    251 Pfister
  8. Abraham Jing-Ching Wu
    202 Wu
  9. Jatin P Shah
    544 Shah
  10. Carl Nelson
    1 Nelson