(P092) Definitive Chemoradiotherapy or Radiotherapy for Unresectable, Very Locally Advanced, or Medically Inoperable Paranasal Sinus and Nasal Cavity Cancer

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Definitive CRT or RT is feasible for unresectable, very locally advanced, or medically inoperable PNS/NC cancer with minimal late toxicity. Local disease control is encouraging, with acceptable treatment-related complications, when treating with the described two-phase IMRT treatment technique.

Lindsay M. Burt, Ying Hitchcock; Huntsman Cancer Institute, University of Utah

PURPOSE: To review radiotherapy (RT) technique and outcomes for definitive RT or chemoradiotherapy (CRT) for unresectable, very locally advanced, or medically inoperable paranasal sinus (PNS) or nasal cavity (NC) cancer at a single institution.

METHODS: Between 1998 and 2010, there were 11 patients with unresectable, very locally advanced, or medically inoperable PNS/NC cancers treated with definitive CRT (7) or RT alone (4) at the University of Utah. There were 10 males and 1 female, with a mean age of 57.3 years (range: 28–75 yr). CRT was given to stage IVA (5) and stage IVB (2) patients, and RT alone was given to stage II (1), stage III (1), and stage IVA (2) patients. One patient was treated with a three-dimensional (3D) conformal technique, and 10 were treated with intensity-modulated RT (IMRT). The median dose was 70.2 Gy (range: 70–72.4 Gy). In order to adapt to tumor shrinkage and prevent critical structures from receiving a high dose due to tumor regression and weight loss, most patients underwent two treatment planning phases, with a resimulation at a dose of 45–50 Gy. One patient received a boost of 11 Gy using stereotactic radiosurgery (SRS) following 70.2 Gy external beam RT (EBRT). The most common chemotherapy agent was cisplatin at 40 mg/m2, given on a weekly basis for 6–7 cycles. A flexible nasal endoscopy with a biopsy was performed 3 months posttreatment to evaluate tumor response.

RESULTS: There was a median follow-up of 39 months (range: 1–70 mo). Six patients underwent a debulking surgery. Overall, six (55%) patients remained disease-free, two (18%) developed local recurrences, one (9%) developed regional recurrence, and 2 (18%) developed distant metastasis. Local control was seen in 9 of 11 (81.8%) patients. The treatment was well tolerated, with only one patient experiencing a grade 3 late toxicity (trismus), two patients experiencing grade 2 late toxicities (cataract, retinal detachment, and trismus), and five patients experiencing grade 1 late toxicities (dysgeusia, dry mouth, fibrosis, skin telangiectasia, and nasal congestion). Three patients had no late toxicities.

CONCLUSION: Definitive CRT or RT is feasible for unresectable, very locally advanced, or medically inoperable PNS/NC cancer with minimal late toxicity. Local disease control is encouraging, with acceptable treatment-related complications, when treating with the described two-phase IMRT treatment technique.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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