Outcomes and toxicities of definitive radiotherapy and reirradiation using 3-dimensional conformal or intensity-modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies Journal Article


Authors: Fan, M.; Kang, J. J.; Lee, A.; Fan, D.; Wang, H.; Kitpanit, S.; Fox, P.; Sine, K.; Mah, D.; McBride, S. M.; Tsai, C. J.; Riaz, N.; Dunn, L. A.; Sherman, E. J.; Michel, L.; Singh, B.; Ganly, I.; Wong, R. J.; Boyle, J. O.; Cohen, M. A.; Lee, N. Y.
Article Title: Outcomes and toxicities of definitive radiotherapy and reirradiation using 3-dimensional conformal or intensity-modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies
Abstract: Background: Proton therapy (PT) improves outcomes in patients with nasal cavity (NC) and paranasal sinus (PNS) cancers. Herein, the authors have reported to their knowledge the largest series to date using intensity-modulated proton therapy (IMPT) in the treatment of these patients. Methods: Between 2013 and 2018, a total of 86 consecutive patients (68 of whom were radiation-naive and 18 of whom were reirradiated) received PT to median doses of 70 grays and 67 grays relative biological effectiveness, respectively. Approximately 53% received IMPT. Results: The median follow-up was 23.4 months (range, 1.7-69.3 months) for all patients and 28.1 months (range, 2.3-69.3 months) for surviving patients. The 2-year local control (LC), distant control, disease-free survival, and overall survival rates were 83%, 84%, 74%, and 81%, respectively, for radiation-naive patients and 77%, 80%, 54%, and 66%, respectively for reirradiated patients. Among radiation-naive patients, when compared with 3-dimensional conformal proton technique, IMPT significantly improved LC (91% vs 72%; P <.01) and independently predicted LC (hazard ratio, 0.14; P =.01). Sixteen radiation-naive patients (24%) experienced acute grade 3 toxicities; 4 (6%) experienced late grade 3 toxicities (osteoradionecrosis, vision loss, soft-tissue necrosis, and soft tissue fibrosis) (grading was performed according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 5.0]). Slightly inferior LC was noted for patients undergoing reirradiation with higher complications: 11% experienced late grade 3 toxicities (facial pain and brain necrosis). Patients treated with reirradiation had more grade 1 to 2 radionecrosis than radiation-naive patients (brain: 33% vs 7% and osteoradionecrosis: 17% vs 3%). Conclusions: PT achieved remarkable LC for patients with nasal cavity and paranasal sinus cancers with lower grade 3 toxicities relative to historical reports. IMPT has the potential to improve the therapeutic ratio in these malignancies and is worthy of further investigation. © 2020 American Cancer Society
Keywords: adult; treatment outcome; aged; middle aged; survival rate; major clinical study; overall survival; intensity modulated radiation therapy; disease free survival; radiation dose; follow up; radiotherapy; cohort analysis; radiation injury; retrospective study; prediction; fibrosis; cancer control; toxicity; relative biologic effectiveness; brain necrosis; paranasal sinus cancer; visual impairment; bone necrosis; radiation necrosis; paranasal sinus; soft tissue disease; nasal cavity; conformal radiotherapy; reirradiation; face pain; re-irradiation; nose cavity cancer; human; male; female; priority journal; article; pencil beam proton therapy; pencil beam algorithm
Journal Title: Cancer
Volume: 126
Issue: 9
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2020-05-01
Start Page: 1905
End Page: 1916
Language: English
DOI: 10.1002/cncr.32776
PUBMED: 32097507
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Jay O Boyle
    103 Boyle
  2. Bhuvanesh Singh
    217 Singh
  3. Loren Michel
    23 Michel
  4. Eric J Sherman
    191 Sherman
  5. Nadeem Riaz
    259 Riaz
  6. Nancy Y. Lee
    617 Lee
  7. Richard J Wong
    252 Wong
  8. Ian Ganly
    280 Ganly
  9. Sean Matthew McBride
    158 McBride
  10. Lara   Dunn
    53 Dunn
  11. Chiaojung Jillian   Tsai
    124 Tsai
  12. Marc A Cohen
    35 Cohen
  13. Anna Lee
    16 Lee
  14. Dan Fan
    8 Fan
  15. Jung Yun Kang
    13 Kang
  16. Ming Fan
    2 Fan
  17. Huili Wang
    2 Wang