Nasal Cavity Cancer Research Articles

Are Intraoral Stents Effective for Reducing the Severity of Oral Mucositis During Radiotherapy for Maxillary and Nasal Cavity Cancer?

The intraoral stent (IOS) is an individualized mouth opening device that can be used during radiotherapy (RT) for head and neck cancer to prevent unnecessary irradiation to normal tissues. The purpose of the present study was to compare the severity of oral mucositis (OM) between patients using and not using an IOS during RT for maxillary and nasal cavity cancer. We designed and implemented a retrospective cohort study. The study sample included patients with maxillary and nasal cavity cancer who had undergone RT. The primary predictor variable was IOS application, and the outcome variable was the grade of OM. The IOS group included 18 patients with an IOS and the control group, 16 patients without an IOS. The parameters of the dose-volume histogram included the median dosage covering 1mL (D1mL) for the tongue and the mean dosage. The D1mL (36.2 vs 65.4Gy) and mean dosage (4.9Gy vs 25.9Gy) were both significantly lower in the IOS group than in the control group (P<.005). The incidence of OM using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were significantly different between the oral stomatitis grade and the use of an IOS (P=.028). A significant difference was found in opioid use between the IOS and control groups (P=.009). The use of an IOS decreased the radiation dosage to the tongue, the grade of OM, and opioid usage during RT.

Construction and clinical evaluation of a new customized bite block used in radiotherapy of head and neck cancer

PurposeIn the present study we constructed a new customized bite block and evaluated its effect on dosimetric and clinical features in radiotherapy. Materials and methodsThe key point of this method is using the oral stent and silicon rubber through a procedure of making fine intraoral impressions. For type I customized bite block, only the upper and lower alveoli of the oral stent are coated with silicone rubber and impressions of the teeth can be obtained. For type II customized bite block, all parts of the oral stent are coated with silicone rubber to make sure impressions of the teeth, tongue and other intraoral tissues can be obtained. Sixty patients undergoing radiotherapy of nasal cavity, paranasal sinuses and oromaxillofacial area were evaluated. For each patient, intensity-modulated radiotherapy plans created with and without customized bite block were compared and data were collected on radiation-induced complications. ResultsThe total fabricating time was approximately 20minutes, and the cost was approximately 10 US dollars. Type I customized bite block is applicable to cancer of sinuses and nasal cavity. Type II customized bite block is applicable to cancer of the oral cavity, salivary glands, especially tongue cancer. The use of the customized bite block showed promising results in decreasing the radiation dose to organs at risk during intensity-modulated radiotherapy. No patients had oral mucositis (grade 3 or above), taste dysfunction, or xerostomia during and post radiotherapy. ConclusionA customized bite block is easy-made and worthy of clinical use.

Primary surgical treatment of nasal vestibule cancer - therapeutic outcome and reconstructive strategies.

The treatment strategy of squamous cell carcinoma of the nasal vestibule (SCCNV) is controversial. The objective of this study is to investigate the role of surgery, which is the preferred treatment option at our institution. This was a monocentric prospective study of patients that were diagnosed with SCCNV between 2005 and 2013. Twenty-six patients were included. Tumors were staged using the UICC (7th edition) TNM classification of nasal cavity cancer and the classification proposed by Wang. The primary treatment was surgery in all patients. Survival data were statistically analyzed using the Kaplan-Meier method. The median follow-up time was 6 years. Using the UICC classification, 9/26 tumors were staged as pT1 (35%), 7/26 as pT2 (27%), and 10/26 as pT4a (39%). Using the classification by Wang, 9/26 tumors were staged as pT1 (35%), 15/26 as pT2 (58%), and 2/26 as pT3 (8%). Reconstruction was performed using an implant-retained prosthesis in 50% of patients and by plastic surgery in the remaining 50%. Only 2/26 patients (8%) needed adjuvant radiation therapy. The five-year recurrence-free survival (RFS) was 86.7%, disease-specific survival was 96.2% and overall survival was 91.8% after five years. Surgery in SCCNV gives an excellent prognosis and minimized the need for radiotherapy.

Cancer Risks of Hexavalent Chromium in the Respiratory Tract.

Hexavalent chromium (Cr(VI)) compounds are recognized as carcinogens in the respiratory tract, giving rise to cancers of the lung, nose and nasal sinuses, especially in certain occupational environments. Inhalation exposure of Cr(VI)-containing particles, dusts and fumes commonly occurs in chromium-related occupational environments, such as chromium production, plating, welding of chromium-containing metals and alloys, electroplating, chromium-containing pigments and paints. Epidemiological surveys of chromium compounds have shown strong associations between exposure to Cr(VI) and mortality due to lung cancer, as well as positive associations with cancers of the nose and nasal cavity. Nasal symptoms, such as nasal irritation, ulceration and perforation of the nasal septum, nasal turbinate engorgement and hypertrophy, are important signs for the early diagnosis of lung cancer and cancers of the nose and nasal cavity in those with an occupational history of Cr(VI) exposure. Cr(VI) exposure in the workplace remains a serious problem as a cause of lung cancer and cancers of nose and nasal cavity, especially in relatively small enterprises that use chromium compounds. Appropriate protection for workers should be considered in occupations that involve exposure to chromium compounds.

EP-1136: Interaction of chemotherapy with radiation and surgery in nasal cavity and nasal sinus cancer

EP-1136: Interaction of chemotherapy with radiation and surgery in nasal cavity and nasal sinus cancer

Results of preoperative chemoradiotherapy for patients with advanced cancer of the nasal cavity and paranasal sinuses

Objectives: Curative treatment of nasal cavity and paranasal sinus cancer is challenging due to the proximity to critical anatomical structures. The purpose of this study was to analyze the impact of trimodality therapy with preoperative chemotherapy and reduced-dose radiotherapy followed by organ-preserving surgery for treating patients with nasal cavity and paranasal sinus cancer.Methods: This retrospective study included all 156 patients diagnosed with sinonasal cancer in western Sweden between 1986 and 2009. We determined the treatment selection pattern and treatment outcomes for 79 patients treated with preoperative chemoradiotherapy.Results: Squamous cell carcinoma was the most common histology. The five-year overall survival was 54%, and 85% of these patients had T3 or T4 tumors. The five-year cumulative incidence rate of local recurrence was 32%. The five-year overall survival in patients with squamous cell carcinoma and adenocarcinoma was 45% and 76%, respectively. The median preoperative radiation dose was 48 Gy. Orbital exenteration was performed in 7% of patients.Conclusions: Preoperative chemoradiotherapy may be beneficial for patients with advanced sinonasal cancer when primary radical surgery is challenging. Survival outcomes were comparable to outcomes reported in the literature despite conservative surgery and relatively low radiation doses in patients with locally advanced tumors.

Current Aspects in Reconstructive Surgery for Nasal Cavity and Paranasal Sinus Cancer

Tumors of the nasal cavity and paranasal sinuses present a challenge to treat them. A combination of surgery and radiation therapy can improve treatment outcomes in 49-56% of patients with locally advanced nasal cavity and paranasal sinus cancer. The midface reconstruction poses a formidable challenge to the reconstructive surgeon due to the region’s complex skeletal and soft-tissue anatomy. The rehabilitation program including the reconstruction of the resected orbital walls using the porous and mesh implants from titanium nickelid (TiNi) was developed at the Cancer Research institute jointly with the Research Institute of Medical Materials. The technique was proven effective, allowing the natural position of the eye and visual function to be preserved in 90% of patients. A long period of reparative processes and risk of developing inflammation in the implant area, as well as the need to decrease length of surgery, contributed to the development of a novel approach to repairing the midface bone structures using the implant based on the microporous wire and TiNi mesh. Eighteen patients with nasal cavity and paranasal sinus cancer were treated using the combined thin implants. The novel technique allowed the time of the implant installation to be reduced to 5-10 minutes. The structure of the implant contributed to prevention of inflammatory processes in 97% of cases. Thus, the natural position of the eyeball and visual function were preserved in 100% of patients. The use of the TiNi implants in reconstructive surgery for patients with nasal cavity and paranasal sinus cancer led to reduced time of surgery and rehabilitation, increased level of social adaptation of patients and improved cosmetic and functional results.

Endoscopic Endonasal Approach for the Tumor Removal in Children with Nasal Cavity and Paranasal Sinuses Cancer with Skull Base Metastases

Background. Diversity of opinions on the possibility and feasibility of using endoscopic endonasal approaches for the removal of tumors located in the nasal cavity, paranasal sinuses, and the base of the skull in pediatric practice, age-related anatomical features of pediatric patients, as well as little conducted research make it difficult to elaborate an optimal therapeutic-diagnostic algorithm for the application of the endoscopic endonasal approach (EEA) in the surgical practice of a pediatric oncologist. Objective . The study is aimed at the development of an optimal algorithm for endoscopic endonasal methods for diagnosis and surgery of tumors located in the nasal cavity and paranasal sinuses with skull base metastases in pediatric patients. Methods . During the period from 2012 to 2017 at the NMRC of pediatric oncology, 54 endoscopic endonasal surgeries were performed in 43 patients aged from 1 month to 16 years. The mean age of patients at surgery was 8.1 years. The ratio of boys (n=23) and girls (n=20) in the study group was 1.15:1, or 53.5% and 46.5% respectively. About 10 (18.5%) operative interventions in the biopsy volume were performed regarding the suspicion of a malignant tumor. Removal of a malignant tumor before the beginning of a special treatment was performed in 2 (4.7%) patients. The first group included 22 (51.1%) patients diagnosed with morphologically confirmed malignant tumor. In 50% of cases, malignant tumors were detected in children aged 10–14 years. One of the morphological variants of sarcoma was verified in 15 (68.2%) patients, esthesioneuroblastoma (ENB) — in 6 (27.3%), and Burkitt’s lymphoma — in 1 (4.5%). Surgery as a part of complex treatment was performed in 6 (27.3%) patients with rhabdomyosarcoma (RMS) and at the final stage of treatment the removal of residual tumor was performed in 5 (22.7%) cases. 7 endoscopic endonasal surgeries were performed in 6 patients with ENB. One of them underwent repeated surgery in 4.1 years due to the relapse of the disease. In 3 patients in the stage A according to the Kadish–Morita classification, only operative treatment was performed. In one case, endoscopic endonasal resection of recurrent osteosarcoma of the maxillary sinus and the inferior orbit wall was performed in the first stage of treatment. In one patient enrolled in the study, the diagnosis of hemangiopericytoma was morphologically confirmed after the biopsy. Surgery using EEA was performed after neoadjuvant chemotherapy. The second group included patients (n=21) who had a suspicion of a malignant tumor according to the results of comprehensive examination; girls predominated — 13 (61.9%). The majority of patients were under 10 years old — 13 (61.9%), the mean age — 7.6 years. In all cases, after the removal of the tumor, a histological study was performed, confirming the benign nature of the neoplasm. Results. In patients who underwent endoscopic endonasal surgery (n=39), we did not register any case of systemic or local infections, orbital complications or bleeding associated with unrecognized vascular trauma. Cerebrospinal fluid leakage in the postoperative period was observed in 2 patients on the 2nd–4th day. In 22 patients with malignant tumors, 17 (77.3%) patients are alive without signs of progression and recurrence of the disease, the follow-up period is from 1 month to 5.1 years. Relapses were registered in 5 (22.7%) patients in the period from 1 month to 4.1 years. Lethal outcome occurred in 4 (18.2%) patients, 3 of them (13.6%) — due to the tumor progression, 1 (4.5%) — due to reasons not associated with tumor progression or toxicity of treatment. In the group of patients with benign tumors (n=21), all were alive during the observation period (1 month to 1.6 years). Relapses were registered in 3 (14.3%) patients. In 2 (9.5%) cases, relapses occurred in patients with fibrous dysplasia in 7–9 months. In 1 (4.8%) case, the development of recurrent angiofibroma of the nasopharynx was observed. Patients underwent re-operation. The observation period after the repeated surgery lasted for 1–11 months. Conclusion . The endoscopic endonasal approach for tumor removal in children with the nasal cavity and paranasal sinuses cancer with scull base metastases was developed basing on the data of modern medical research and personal clinical experience.

A Case of Nasal Septum Cancer Treated by a Combination of the Midfacial Degloving and Rhinoplasty using an Iliac Graft

Malignant tumor originating from the nasal septum accounts for a relatively small number of cases of head and neck cancer. In the early stages, as in cases of other head and neck squamous cancer, resection of the tumor by nasal surgery is the treatment of choice, although some cases with early carcinoma of the nasal septum have been treated by endoscopic surgery. We encountered a case of nasal septum cancer, in which we conducted nasal surgery and reconstructed the nasal bone using a graft from the ilium. The patient was a 63-year-old man who visited our hospital with the chief compliant of recurrent nosebleeds. Examination revealed a tumor of the nasal septum in the left nasal cavity. Contrast-enhanced CT and MRI revealed a mass measuring about 30 mm in diameter showing heterogeneous contrast enhancement. The lesion was found to have invaded the nasal septum cartilage. However, there was no spread to the mucosa lining on the opposite side of the nasal septum. The head side of the lesion was very close to the nasal bone. Therefore, we could not rule out invasion of the nasal bone. On biopsy, the lesion was diagnosed as a squamous cell carcinoma. There was no swelling of the cervical lymph nodes. PET-CT revealed accumulation only in the nasal cavity. There was no evidence of cervical lymph node metastasis or distant metastasis. We scheduled surgery under the diagnosis of nasal cavity cancer, cT2N0M0. By using a nasal endoscope, it was disconnected nostril side and the nasal cavity the bottom side of the tumor. The nasal cavity was accesed by the midfacial degloving method. We excised a part of the nasal bone, the outer nose cartilage and a part of the nasal septal mucousa with a sufficient safety margin. We reconstructed the nasal bone and the outer nose cartilage with a graft obtained from the ilium. The patient has shown no evidence of postoperative recurrence. We selected surgical therapy without radiation therapy/chemotherapy. As a result, we were able to avoid disabling systemic chemotherapy and radiation, and reserve these treatments for any recurrences.

ACR appropriateness criteria® nasal cavity and paranasal sinus cancers.

The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Here, we present the Appropriateness Criteria for cancers arising in the nasal cavity and paranasal sinuses (maxillary, sphenoid, and ethmoid sinuses). This includes clinical presentation, prognostic factors, principles of management, and treatment outcomes. Controversies regarding management of cervical lymph nodes are discussed. Rare and unusual nasal cavity cancers, such as esthesioneuroblastoma and sinonasal undifferentiated carcinomas, are included. © 2016 American College of Radiology. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 39: 407-418, 2017.

Prognostic value of tumoral heterogeneity and volumetric parameters as measured by F18-FDG PET/CT in sinonasal cancer.

The objective of this study was to investigate the value of parameters assessed with F18-FDG PET/CT in predicting recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with cancer of nasal cavity and paranasal sinus. Thirty-eight patients with cancer of nasal cavity (n=14) and paranasal sinus (n=24) who underwent PET/CT prior to curative treatment were enrolled. A volume of interest was placed on PET/CT images covering the entire tumor volume, and the maximum SUV (SUVmax), the mean SUV (SUVmean), and volumetric parameters of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured using thresholds of 40% of SUVmax. The heterogeneity factor (HF) defined as the derivative of volume-threshold function from 40 to 80% of SUV thresholds. RFS and DSS were defined as the time from the diagnosis to recurrence and death. Median values of SUVmax, SUVmean, MTV, TLG, and HF were 14.81, 9.16, 25.84, 150.74, and -0.496. SUVmax was higher in patients with advanced stage and nodal metastasis. High MTV and low HF group showed shorter RFS. Cox proportional hazards regression analysis revealed low HF was the only significant predictive factor on RFS. Furthermore, high TLG was associated with shorter DSS. High TLG was potent predictor of DSS by Cox proportional hazards regression analysis. In conclusion, the tumoral heterogeneity and volumetric parameters as measured by F18-FDG PET/CT could be significant prognostic surrogate markers in patients with sinonasal cancer.

Radiothérapie des cancers des cavités nasosinusiennes

The nasal cavity and parasinusal cancer are rare (10% of tumors of the head and neck) and are mainly represented by squamous cell carcinoma of the nasal cavity or the maxillary sinus and adenocarcinoma of the ethmoid sinus (occupational disease, wood dust). The most common clinical sign is nasal obstruction, but tumors can also manifest as rhinorrhea and/or epistaxis (usually unilateral signs). A magnetic resonance imaging of the facial structure is systematic for staging before treatment. The treatment consists of a first surgery if the patient is operable with a resectable tumor. If it is not the case, the treatment consists of radiotherapy (RT) associated with chemotherapy (CT) according to the initial data (T3/T4 or N+). After first surgery, RT is indicated (except T1N0 with complete resection) associated with a CT based on postoperative data (capsular effraction or incomplete resection). Lymph node irradiation is considered case by case, but is indicated in any nodal involvement. RT must be an intensity modulated RT (IMRT), static or dynamic, and must be imagery guided (IGRT). According to ICRU 83, doses to organs at risk and target volumes must be carried. Finally, after a post-treatment baseline imaging between 2 and 4 months, monitoring will be alternated with the ENT surgeon every 2 or 3 months for 2 years, then every 4 to 6 months for 5 years.

Germline TP53 Mutation and Clinical Characteristics of Korean Patients With Li-Fraumeni Syndrome.

BackgroundLittle is known of the mutation and tumor spectrum of Korean patients with Li-Fraumeni syndrome (LFS). Owing to the rarity of LFS, few cases have been reported in Korea thus far. This study aimed to retrospectively review the mutations and clinical characteristics of Korean patients with LFS.MethodsTP53 mutation was screened in 89 unrelated individuals at the Samsung Medical Center in Korea, from 2004 to 2015. Six additional mutation carriers were obtained from the literature.ResultsWe identified nine different mutations in 14 Korean patients (male to female ratio=0.3:1). Two such frameshift mutations (p.Pro98Leufs*25, p.Pro27Leufs*17) were novel. The recurrent mutations were located at codons 31 (n=2; p.Val31Ile), 175 (n=3; p.Arg175His), and 273 (n=4; p.Arg273His and p.Arg273Cys). The median age at the first tumor onset was 25 yr. Ten patients (71%) developed multiple primary tumors. A diverse spectrum of tumors was observed, including breast (n=6), osteosarcoma (n=4), brain (n=4), leukemia (n=2), stomach (n=2), thyroid (n=2), lung (n=2), skin (n=2), bladder (n=1), nasal cavity cancer (n=1), and adrenocortical carcinoma (n=1).ConclusionsThere was considerable heterogeneity in the TP53 mutations and tumor spectrum in Korean patients with LFS. Our results suggest shared and different LFS characteristics between Caucasian and Korean patients. This is the first report on the mutation spectrum and clinical characteristics from the largest series of Korean LFS patients.

The Evaluation of Formaldehyde Exposure in the Anatomy Laboratories and the Preventive Measures

Objective : Our aim is to evaluate the studies about formaldehyde exposure in anatomy laboratories at faculties of medicine all over the world reported from 2000 to 2013. Materials and Methods: In this research, formaldehyde exposure of medical students and researchers in the anatomy laboratories of faculties of medicine studies, which were reported in Pubmed database from 2000 to 2013, were reviewed and classified clinical symptoms, environmental monitoring and preventive measures. Results: There are 27 studies on formaldehyde exposure from anatomy laboratories of various faculties of medicine 15 (55.6%) of which are clinical symptom studies whereas 12 (44.4%) are environmental monitoring of formaldehyde exposure. Conclusion: Considering the fact that lower levels of exposure to formaldehyde is associated with cytogenetic changes in epithelial cells of the nasal region, long-term exposure to formaldehyde in the anatomy laboratories poses risks of nasopharynx and nasal cavity cancers. Medical students and instructors working in anatomy laboratories should take concrete measures to reduce exposure to formaldehyde

外鼻再建術を施行した超高齢鼻腔癌例

外鼻再建術を施行した超高齢鼻腔癌例

EPIGENETIC REGULATION OF GENE EXPRESSION IN HEAD AND NECK SQUAMOUS CELL CARCINOMA: THERAPEUTIC PERSPECTIVES

Head and neck tumors (HNT) include cancers of nasal cavity, oral cavity, larynx, pharynx, cervical esophagus, paranasal sinuses, and salivary glands; in most of the cases HNT are presented by squamous cell carcinoma. Despite the fact that tumors of head and neck are generally available for visual inspection, about 60–70 % of the patients are diagnosed with it at advanced (III or IV) stages of the disease. Unfortunately, optimization of diagnostic algorithms and wide implementation of instrumental diagnostics (ultrasound examination, computed tomography, fiber endoscopy) do not improve the situation. Current trends in HNT incidence and mortality in Russia (increasing of both absolute and relative figures of incidence and mortality over the last 10–12 years) clearly demonstrate its social importance. Available epidemiological data suggests the obvious need for fundamental studies devoted to HNT pathogenesis as well as for development of novel meth ods of pathogenetic therapy. Along with the importance of investigation of typical for HNT genetic abnormalities, we should also stress studying of epigenetic regulation disorders in tumor cells because of its particular practical value. This review is aimed to analyze the relationship between different mechanisms of epigenetic regulation of gene expression, and to evaluate this relationship in squamous cell HNT. In terms of new therapy methods development it is important to understand the complex nature of epigenetic control of gene expression as soon as it allows to create and implement optimal methods of chemotherapy. For instance, the antitumor effect of butyric acid could be theoretically modified or enhanced by the inhibitors of miR-17-92a or miR-31 mimics. In this case one of the drugs can be administrated locally, and the other one – systemically, this possibility can help to reach maximum therapeutic effect in the tumor tissue. The main aim of this review was to present mechanisms, development prospects and application possibilities of HNT epigenetic therapy, which can be soon offered to clinicians.

Estimation of the planning organ at risk volume for the lenses during radiation therapy for nasal cavity and paranasal sinus cancer.

To establish the optimal planning risk volume (PRV) of the lenses for patients who are receiving radiotherapy to the nasal cavity and paranasal sinus (NCPSC). Geometrical uncertainties of the lenses were evaluated for a prospective group of patients (G1). Differences between planned and delivered maximum doses to the lenses were evaluated for every fraction. The relationship between dose differences and geometrical uncertainties were analysed to establish an optimal PRV for the lenses. Obtained results were verified in the second group (G2) of patients for whom calculated PRV was applied. Data of 426 observations for 15 patients from G1 were investigated. The systematic and random errors equalled, respectively, 0.6 mm and 2.3 mm in the medio-lateral direction; 0.8 mm and 1.6 mm in the cranio-caudal direction; and 0.4 mm and 1.5 mm in the anterio-posterior direction. The clinical PRV for the lenses was established at 2 mm. Applied margin was evaluated for 10 patients from G2. The dose distribution in the planning target volume (PTV) for G1 and for G2 was comparable (P = 0.122), whereas the differences between planned and delivered doses in the lenses were significantly smaller for G2 (P = 0.013). The study showed that for radiotherapy of NCPSC, the PRV for the lenses could be defined as 2 mm. This margin does not affect the dose distribution in the PTV and effectively reduces the differences between planned and delivered doses in the lenses.

Sinonasal malignancies: A population-based analysis of site-specific incidence and survival.

Sinonasal malignancies vary in behavior according to histology and anatomical location. Incidence, survival, and optimal treatment for these lesions are thus uncertain in various cases. Our objective was to utilize a national population-based registry to identify the most common sinonasal histopathologies by anatomical site, and subsequently analyze the data by incidence trends, survival rates, patient demographics, and treatment modalities. Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. The SEER database was examined for patients diagnosed with sinonasal malignancies between 1973 and 2011. Data were stratified according to anatomical site, incidence, survival, histology, staging, and patient demographics. Therapy-based outcomes were analyzed for cases from 1983 to 2011. A total of 13,295 patients were identified, with an incidence of 0.83 per 100,000 people. Males comprised 58.6% of cases. Whites represented 81.5% of cases, while blacks comprised 8.7%. Squamous cell carcinoma was the most common histology (41.9%) across all sites of the sinonasal tract. The most common anatomical site of malignancy was the nasal cavity (45.7%), and least common was the frontal sinus (1.2%). For single sites, 5-year disease-specific survival (DSS) was highest for nasal cavity tumors (67.1%) and lowest for overlapping sinus malignancies (37.6%). The overall 5-year DSS for all sinonasal malignancies was 53.7%. Sinonasal malignancies are rare entities with poor overall prognosis. By anatomical site, prognosis is best for nasal cavity cancers and worst for overlapping lesions. 4.

Combined Modality Treatment Including Neutron Therapy for Tumors of the Nasal Cavity and Paranasal Sinuses

The study group comprised 91 patients with nasal cavity cancer and paranasal sinuses cancer who received the combined modality treatment with the use of 6.3 MeV fast neutrons generated within U-120 cyclotron. The method of combined modality treatment for locally advanced malignant tumors of the nasal cavity and paranasal sinuses was found to be more effective compared to the conventional treatment in terms of the 5-year overall and disease-free survival rates.

Dose distribution resulting from changes in aeration of nasal cavity or paranasal sinus cancer in the proton therapy

Background and purposeAeration in the nasal cavity and paranasal sinus (NCPS) was investigated during the course of proton therapy (PT), and the influence of aeration on the dose distribution was determined. Material and methodsTwenty patients with NCPS cancer (10 nasal cavity, 10 paranasal sinus) were analyzed. All the patients received a total proton beam irradiation dose of 38–78.4 Gray equivalents (GyE). Two to five CT examinations were performed during the course of treatment. The aeration ratio inside the cavity/sinus was calculated for each CT observation. Moreover, a simulation study supposing that the first treatment plan had been continued until the end of treatment was performed using the subsequent CT findings. ResultsThe aeration ratio was increased in 18 patients. The largest increase was from 15% to 82%. Three patients had a simulated maximum cumulative dose in the brainstem of beyond 60GyE, while 10 patients had a simulated maximum cumulative dose in the optic chiasm of beyond 50GyE. The shortest simulated time period to reach the dose limitation was 21days. ConclusionsAeration in the NCPS is altered during the course of PT treatment and can greatly alter the dose distribution in the brainstem and optic chiasm.