Abstract
Background and purposePrimary radiotherapy is often preferred for early-stage cancer of the nasal vestibule (CNV), combining high disease control with preservation of nasal anatomy. However, due to practice variation and an absence of comparative trials, no consensus exists on preference for brachytherapy (BT) or external beam radiotherapy (EBRT). We compared these modalities in terms of disease control, nose preservation rates and toxicity. Materials and methodsMedical records of 225 patients with T1-T2 squamous cell carcinoma of the nasal vestibule treated with 3D image-guided primary radiotherapy between Jan 2010 and Dec 2016 in 6 Dutch institutions were reviewed retrospectively. Results153 of 225 patients were treated with BT, 65 with EBRT and 7 with other modalities. Median follow-up was 46 months. Overall 3-year local control (LC) and regional control (RC) were 87% and 89%. Five-year disease-specific survival (DSS) and overall survival (OS) were 94% and 82%. Three-year survival with preserved nose (SPN) was 76%.BT provided higher 3-year LC (95% vs 71%, p < 0.01) and SPN compared with EBRT (82% vs 61%, p < 0.01). Multivariable and propensity-score-matched cohort analyses confirmed better outcomes after BT. No difference was seen in DSS or OS. Five-year incidence of CTCAE 5.0 grade ≥2 toxicity was higher after BT (20% vs 3%, p = 0.03) and consisted mostly of radiation ulcers. 50% of all late toxicity recovered. ConclusionIn this largest-to-date multicenter analysis of T1-T2 CNV, BT achieved superior LC and SPN compared with EBRT. Grade 1–2 radiation ulcers occurred more frequently after brachytherapy, but were transient in half the cases. Considering these results, BT can be recommended as first-line treatment for T1-T2 CNV.
Highlights
Background and purposePrimary radiotherapy is often preferred for early-stage cancer of the nasal vestibule (CNV), combining high disease control with preservation of nasal anatomy
Materials and methods: Medical records of 225 patients with T1-T2 squamous cell carcinoma of the nasal vestibule treated with 3D image-guided primary radiotherapy between Jan 2010 and Dec 2016 in 6 Dutch institutions were reviewed retrospectively
BT provided higher 3-year local control (LC) (95% vs 71%, p < 0.01) and survival with preserved nose (SPN) compared with external beam radiotherapy (EBRT) (82% vs 61%, p < 0.01)
Summary
A pilot questionnaire was distributed to radiation oncologists in all head and neck oncology centers in the Netherlands. For propensity-score matching, multivariable logistic regression analysis was performed, predicting treatment by radiotherapy modality (BT vs EBRT) adjusted for baseline prognostic factors (T-stage, age, sex and smoking status). In multivariable risk factor analysis, treatment with EBRT was the sole significant risk factor for local recurrence (Table 2). Nificant difference in 3-year RC was observed between BT and EBRT (Fig. 1B) In univariable analysis, both tumor diameter !1.5 cm and T2 stage were found to be significant risk factors for regional recurrence (table 2), with 3-year RC rates of 83% and 81% respectively. EBRT remained a significant risk factor for lower SPN in multivariable risk analysis (Table 2) and after adjustment for all possible confounders. Multivariable risk factor analysis in the propensity-scorematched cohort showed that treatment by EBRT was a significant risk factor for local recurrence and decreased survival with preserved nose (Table 3B). According to CTCAE 5.0 scores [15], late toxicity was grade 1 for 23 patients, grade 2
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