Abstract
PurposeTo evaluate feasibility and toxicity of carbon ion therapy for treatment of sinonasal malignancies. First site of treatment failure in malignant tumours of the paranasal sinuses and nasal cavity is mostly in-field, local control hence calls for dose escalation which has so far been hampered by accompanying acute and late toxicity. Raster-scanned carbon ion therapy offers the advantage of sharp dose gradients promising increased dose application without increase of side-effects.MethodsTwenty-nine patients with various sinonasal malignancies were treated from 11/2009 to 08/2010. Accompanying toxicity was evaluated according to CTCAE v.4.0. Tumor response was assessed according to RECIST.ResultsSeventeen patients received treatment as definitive RT, 9 for local relapse, 2 for re-irradiation. All patients had T4 tumours (median CTV1 129.5 cc, CTV2 395.8 cc), mostly originating from the maxillary sinus. Median dose was 73 GyE mostly in mixed beam technique as IMRT plus carbon ion boost. Median follow- up was 5.1 months [range: 2.4 - 10.1 months]. There were 7 cases with grade 3 toxicity (mucositis, dysphagia) but no other higher grade acute reactions; 6 patients developed grade 2 conjunctivits, no case of early visual impairment. Apart from alterations of taste, all symptoms had resolved at 8 weeks post RT. Overall radiological response rate was 50% (CR and PR).ConclusionCarbon ion therapy is feasible; despite high doses, acute reactions were not increased and generally resolved within 8 weeks post radiotherapy. Treatment response is encouraging though follow-up is too short to estimate control rates or evaluate potential late effects. Controlled trials are warranted.
Highlights
Sinonasal malignancies include malignant tumours of various histologies in the nasal cavity and paranasal sinuses
Fifty-nine percent (17 pts) received treatment as definitive radiation therapy either due to surgical inoperability or R2-resections, 9 patients were treated for locally recurrent disease; 2 patients received carbon ion therapy as a second course of radiation
Despite high delivered dose, this therapy is feasible, acute reactions were not increased as compared to 3D and Intensity-modulated radiotherapy (IMRT) treatment techniques and generally resolved within 6-8 weeks post radiotherapy
Summary
Sinonasal malignancies include malignant tumours of various histologies in the nasal cavity and paranasal sinuses. Squamous cell carcinomas account for the majority of these tumours [1,2,3], various rare histologies such as adenoidcystic carcinoma, aesthesioneuroblastoma, and mucosal melanoma are found. Due to limited accessibility of these sites and late occurrence of symptoms, patients are mostly diagnosed with advanced disease [4,5,6]. Faced with predominantly advanced tumour stages surgical resection is limited by the proximity of various critical structures such as eye and optic pathways. Extensive surgery in advanced sinonasal tumours can be very mutilating; in view of patients’ quality of life, radicality of surgical resection can rarely be achieved. Mortality and complication rates are not insignificant [7] and substantially increasing with patient age [8]
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