Clinical analysis of multimodal treatment for orbital organ preservation in T4b squamous cell carcinoma of nasal cavity and paranasal sinuses

Abstract

To investigate the efficacy of induction chemotherapy (ICT) followed by concurrent chemotherapy and helical tomotherapy (HT) in the patients with T4b squamous cell carcinoma of nasal cavity and paranasal sinus (SCCNP) for orbital organ preservation and high quality of life. A total of 26 patients with the orbital involvement of T4b SCCNP between May 2008 and March 2013 were analyzed retrospectively. There were 17 males and 9 females; the average age was 54.7 years. The median follow-up time was 25 months (range 4-77 months). The patients received 1-2 cycles ICT with TP (docetaxel 70 mg/m(2) on day 1 and cisplatin 40 mg/m(2) on day 1-2, every 3 weeks) or TPF (docetaxel 70 mg/m(2) on day 1 and cisplatin 70 mg/m(2) on day 1-2, 5-fu 700 mg/m(2) on day 1-5, every 3 weeks), followed by concurrent HT (60-70 Gy) and chemotherapy with TP and/or epidermal growth factor receptor (EGFR) inhibitor. The Kaplan-Meier method was used to determine the 3-year overall survival rate and local control rate. Side-effects were evaluated with the established common terminology criteria for adverse events (CTCAE) version 4.0 criteria. All patients completed the planned chemotherapy and 96.2%(25/26)patients completed the planned radiotherapy. The 3-year overall survival rate, the local control rate and real orbital preservation rate were 56.7%, 79.5% and 80.0% respectively. The most common acute side effects higher than grade 2 were oral mucositis, radiodermatitis and dry eye syndrome. The strategy including ICT followed by CCRT and/or EGFR inhibitor is an effective treatment for T4b SCCNP patients, with minimal toxicities, higher 3-year OS rate and orbital preservation rate, and also provides a new treatment option for T4b SCCNP patients.