Abstract

e16003 Background: The curative rate of radiotherapy for unresectable malignancies of the nasal cavity and paranasal sinuses was only 10-15%. Proton beams are characterized by their rapid fall-off at the distal end of the Bragg peak and sharp lateral penumbra, depending on energy, depth, and delivery. These physical characteristics give proton beam therapy (PBT) better dose distribution than X-ray irradiation. Therefore PBT may improve treatment outcome of diseases which are located in proximity to risk organs. We retrospectively analyzed the clinical profile of PBT for unresectable malignancies of the nasal cavity and paranasal sinuses. Methods: We reviewed 40 patients in our database fulfilling the following criteria: unresectable malignant tumors of the nasal cavity, paranasal sinuses and/or the skull base; and recieved definitive PBT (>60GyE) from January 1999 to December 2006. Acute and late toxicities were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTCAE ver. 3.0). Results: Patient characteristics were as follows: median age; 57 years (range, 22 to 84), male/female; 22/18, tumor type SCC/ACC/Olfactory neuroblastoma/ melanoma/others; 11/6/9/6/8, Induction chemotherapy yes/no; 10/30, PBT alone/PBT with concurrent CDDP; 39/1. With a median active follow- up of 45.6 months, 3-year progression-free and overall survival was 50.5% and 60.4%, respectively. The most common acute toxicities were mild dermatitis (grade 2: 32.5%), but no severe toxicity was observed (grade 3: 0%). Five patients (10%) experienced grade 3-4 late toxicities, namely cerebrospinal fluid (CSF) leakage, cataract, decreased visual acuity, central nerve-VI disorder, and bone necrosis in one patient each. One treatment-related death was reported, caused by CSF leakage grade 4 (2.5%). Conclusions: The clinical profile of PBT for unresectable malignancies of the nasal/paranasal sinuses is much better than those of radiotherapy in previous reports and seems to be sufficient to establish it as a promising treatment option for these patients. No significant financial relationships to disclose.

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