Nasal Cavity Cancer Research Articles

A Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT) and Non-Coplanar Intensity Modulated Radiation Therapy (IMRT) for Nasal Cavity and Paranasal Sinus Cancer

Background To compare dosimetric parameters of volumetric modulated arc therapy (VMAT) and non-coplanar intensity modulated radiotherapy (IMRT) for nasal cavity and paranasal sinus cancer with regard to the coverage of planning target volume (PTV) and the sparing of organs at risk (OAR).

Role of Chronic Polypous Rhinosinusitis in Contraction of Cancer of Nasal Cavity and Paranasal Sinuses

There is a growing number of with malignant tumors of nasal cavity and paranasal sinuses. Majority of with this pathology are hospitalized with III-IV cancer stages. There is no tendency to decrease the advanced stage of cancer. The efficiency of patients treatment can be increased by early diagnostics. The main reason of delayed diagnostics is insufficient oncologic alarm in primary health care. While the background prodromic cancer processes are morphologically detected in 56.7 % of patients, the issues of treatment policy during cavity and paranasal sinuses premalignancy are still unsettled. Chronic polypous rhinosinusitis is one of the most frequent background process of cancer of nasal cavity and paranasal sinuses. Rhinosinusitis morbidity is high; the growth of its incidence is 2-4 % per year in the last decade. There are few works, considering polypous rhinosinusitis as premalignant condition.

第11回頭頸部癌化学療法研究会]鼻副鼻腔癌に対する超選択的動注療法+照射の同時併用療法

第11回頭頸部癌化学療法研究会]鼻副鼻腔癌に対する超選択的動注療法+照射の同時併用療法

Solitary Splenic Metastasis from Head and Neck Cancer: A Case Report

Solitary splenic metastases from head and neck cancer are rare. We report a 35-year-old male with nasal cavity cancer with metastasis to the cervical lymph nodes. The patient underwent three cycles of induction chemotherapy, followed by left medial maxillectomy with modified radical neck dissection and concurrent chemoradiotherapy with weekly cisplatin. After 7 months of a disease-free interval, positron-emission tomography showed a high uptake in the spleen, and a biopsy confirmed metastatic carcinoma. After four cycles of systemic chemotherapy with docetaxel and cisplatin, laparoscopic splenectomy was performed. This case highlights that solitary splenic metastasis, although rare, may occur with a locoregionally controlled head and neck cancer and could be treated with local and systemic treatment. (Korean J Med 2013;85:324-328)

Upper Aerodigestive Tract Cancer in Patients With Chronic Lymphocytic Leukemia

To compare incidence, stage, and survival of upper aerodigestive tract (UADT) cancers in patients with and without chronic lymphocytic leukemia (CLL). Inception cohort. National database. Individuals with CLL and UADT cancers included in the Surveillance, Epidemiology, and End Results (SEER) database. Incidence was compared by computing standardized incidence ratio (SIR), the ratio of observed UADT cancers in patients with CLL, and the number of UADT cancers expected based on the characteristics of patients with CLL and population incidence of UADT cancers. The association between CLL and UADT cancer stage was measured using odds ratio (OR) calculations. Survival of patients with UADT cancer with and without CLL was compared. For the SIR calculation, 36 985 patients with CLL contributed a mean 6.36 years of follow-up each, for a total of 235 314 person-years of follow-up. The SIR was 1.18 (95% CI, 0.97-1.41) for UADT cancers; 1.52 (95% CI, 1.18-1.93) for laryngeal cancer; and 1.92 (95% CI, 1.05-3.23) for cancers of the nasal cavity and paranasal sinuses. In the stage and survival analyses, 253 patients with CLL followed by a UADT cancer were compared with 133 840 patients with 1 UADT cancer only. Cancers of the UADT in patients with CLL were more likely localized (OR, 0.50; 95% CI, 0.37-0.68). Relative survival was worse in patients with CLL. In multivariate analysis, CLL was independently associated with poorer observed survival (hazard ratio, 1.45; 95% CI, 1.24-1.70). Larynx and nasal cavity cancers were more common in patients with CLL. Overall incidence of UADT cancers was not significantly elevated. Cancers of the UADT in patients with CLL were more likely to be localized at diagnosis than those in patients without CLL. Finally, CLL was associated with poorer survival outcomes.

Outcomes of Nasal Cavity and Paranasal Sinus Cancers Treated With Proton Therapy

Sixty-eight patients with cancers of the nasal cavity and paranasal sinuses have completed treatment with proton therapy since January of 2007. The disease characteristics, treatment planning and delivery techniques, and follow-up results of 49 patients who have completed treatment more than 1 year ago are presented. Of 49 patients, 43 had prior surgery, 23 with close/positive margins. Six patients had biopsy only. Skull-base invasion was noted in 34 of 49 patients, (69%). Ages ranged from 16 to 82 years with a median of 58 years. Histology included sino-nasal undifferentiated carcinoma, adenoid cystic carcinoma, esthesioneuroblastoma, mucosal melanoma, spindle-cell carcinoma and osteogenic sarcoma. Prescribed doses ranged from 64.8 GyE to 69.6 GyE for post-op negative margins, to 74.4 GyE for presence of positive margins or presence of gross unresectable tumor at 1.2 GyE twice-a-day. Proton treatments were delivered with orthogonal kV x-ray imaging guidance to achieve 1 mm setup accuracy for each fraction. All patients completed their prescribed treatment. Follow-ups ranged from 0.4 to 4.1 years (median 2 years). Brisk skin reactions developed in all patients, and resolved within 4 weeks after completion. Medial retinopathy occurred within the treated volume in 1 patient at 11 months after completion without negative impact on vision. Complete local disease control was noted in 43 of 49 patients (88%). In-field recurrence was noted in 2 post-operative patients at 9 and 12 months; one of them is free of disease after surgical salvage. Progressive meningeal seeding was identified in 1 patient within 2 months after radiation and was salvaged by additional therapy. Six patients who at initial diagnosis were inoperable and received 74.4 GyE had varying local response, succumbed to disease progression in 6 months to 20 months. Five patients who received post-operative proton radiation died of distant metastasis between 12 and 15 months without any evidence of local recurrence. The overall survival at 1- and 2-years was 94% and 73% respectively. Patients with cancers involving the nasal cavity and paranasal sinuses with skull base invasion will benefit from high-dose conformal proton therapy.

A Treatment Planning Comparison of Passive-Scattering and Intensity-Modulated Proton Therapy for Typical Tumor Sites

Intensity-modulated proton therapy (IMPT) is expected to improve treatment results with fewer side effects than other proton therapies. The purpose of this study was to evaluate the tumor sites for which IMPT was effective under the same beam calculation conditions by planning IMPT for typical cases treated with passive scattering proton therapy (PSPT). We selected 16 cases of nasal cavity, lung, liver or prostate cancers as typical tumor sites receiving PSPT. The dose distributions and dose volume histograms optimized by the IMPT were compared with those optimized by the PSPT. We took particular note of the doses to the skin and organs at risk (OAR) when PSPT was replaced by IMPT. Furthermore, an improvement of the beam angles was also performed to obtain better dose distributions in the IMPT. The IMPT with the same beam angles resulted in near-maximum doses to the skin of average 78%, 64%, 84% and 99% of the PSPT doses for nasal cavity, lung, liver, and prostate cancers, respectively. However, it was difficult to improve the dose homogeneity of the target volume. The change of the IMPT beam angles could reduce the doses to OARs and skin in the case of the nasal cavity, while it had limited effect in the other cases. We concluded that IMPT was effective for reducing the doses to some OARs when treating nasal cavity, lung, liver and prostate cancers. The selection of beam angles was important in the IMPT optimization, especially for nasal cavity cancers.

Temporalis Myofascial Flap for Maxillofacial and Oral Defect

Objective: Temporalis myofascial flap is a good option for the reconstruction of maxillofacial, oral cavity, and parotid defect. Method: A total of 28 patients with postoperative defects located in the lower two thirds of the face and oral cavity in Chiang Mai University Hospital were included in this study. Results: Sixteen patients had nasal cavity and maxillary sinus cancer, 6 patients had oral cavity and oropharyngeal cancer, 3 patients had parotid cancer, 1 patient had cementifying fibroma, 1 patient had facial palsy, and 1 patient had osteoradionecrosis of the mandible. Temporalis muscle flap provided profuse well-vascularized tissue for the obliteration of orbital exenteration and totalor partial maxillectomy cavities and coverage of the surface of sinonasal and oropharyngeal defects. Conclusion: Oral and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically simple flap can be preferred for the reconstruction of maxilla-facial defects after ablative tumor surgery, especially in older and debilitated patients.

Cancer statistics of Şırnak city

The aim of this study is to investigate the cancer incidence and distribution in the province of Şırnak by examining the two years data of two pathology laboratories in Şırnak and Cizre State Hospital. One hundred fifty two cases of cancer diagnosed between January 2009 and December 2010 were reviewed retrospectively from the archive. Types of cancer, age and gender profile of the patients with the pathology reports were obtained. Sixty-two patients (40.78%) were male and 90 (59.22%) were female. The male to female ratio was 0.68. The youngest patient was 14, the oldest patient was 96 years old, and the mean age was 54.81. Fifty-nine patients (38.81%) were under the age of 50 and 93 (61.19%) were aged 50 and over. In order of frequency, the most common cancer was skin cancer (43.42%), followed by thyroid cancer (14.47%), colorectal cancers (9.86%), breast cancer (21.9%), gastric cancer (5.26%), esophageal cancer (3.28%), soft tissue, bladder and appendix cancers (1.97%), lung and cervical cancers (31.1%) and nasal cavity, gall bladder, testicular, liver, ovary, endometrium, prostate, kidney and lymph node cancer (0.65%). The five most common cancers were skin, colorectal, stomach, thyroid, esophagus cancer in men and skin, thyroid, breast, colorectal, esophagus cancer in women. Basal cell carcinoma was the most common skin cancer. Skin cancers and thyroid and colorectal cancers are common in our region. Skin cancers are the most common cancers in both genders.

Definitive Radiotherapy With or Without Chemotherapy for T3-4N0 Squamous Cell Carcinoma of the Maxillary Sinus and Nasal Cavity

To evaluate the efficacy and toxicity of definitive radiotherapy with or without chemotherapy for T3-4 squamous cell carcinoma of maxillary sinus and nasal cavity. Forty-two patients with T3-4N0 squamous cell carcinoma of maxillary sinus (n = 30) and nasal cavity (n = 12) received definitive radiotherapy. Chemotherapy was used in 34 patients and elective neck irradiation was not used. The 5-year overall survival/local control rates were 34%/29% for maxillary sinus cancer and 50%/52% for nasal cavity cancer. For maxillary sinus cancers, a performance status of Eastern Cooperative Oncology Group >or=2 (P = 0.012), biologically equivalent dose <68 Gy (P = 0.011) and no use of chemotherapy (P = 0.037) were significant worse predictors for overall survival on log-rank analysis. Biologically equivalent dose <68 Gy was independently associated with poor local control (hazard ratio, 3.32; 95% confidence interval, 1.38-7.97; P = 0.007) and overall survival (hazard ratio, 2.94; 95% confidence interval, 1.23-7.01; P = 0.015). Regional recurrence occurred in only 1 of 30 patients with maxillary sinus cancer and 4 of 12 patients with nasal cavity. Two radiation necrosis in brain, one osteoradionecrosis, and one retinopathy and optic neuropathy occurred. The treatment outcome was poor and local control was a major problem. High radiation dose, effective chemotherapy and elective neck irradiation for advanced nasal cavity cancers may improve disease control.

8539 Induction chemotherapy with docetaxel, cisplatin and S-1 (TPS) followed by proton therapy concurrent with cisplatin in the patients with T4 nasal cavity cancer

8539 Induction chemotherapy with docetaxel, cisplatin and S-1 (TPS) followed by proton therapy concurrent with cisplatin in the patients with T4 nasal cavity cancer

O147. Reconstruction of mid-facial defect with free tissue transfer after surgery of nasal cavity and maxillary sinus cancer

O147. Reconstruction of mid-facial defect with free tissue transfer after surgery of nasal cavity and maxillary sinus cancer

Consistency Check of Planned Adaptive® Option on Helical Tomotherapy

This study aims to evaluate a new Planned Adaptive software (TomoTherapy Inc., Madison, WI) of the helical tomotherapy system by retrospective verification and adaptive re-planning of radiation treatment. Four patients with different disease sites (brain, nasal cavity, lungs, prostate) were planned in duplicate using the diagnostic planning kVCT data set and MVCT studies of the first treatment fraction with the same optimization parameters for both plan types. The dosimetric characteristics of minimum, maximum, and mean dose to the targets as well as to organs at risk were compared. Both sets of plans were used for calculation of dose distributions in a water-equivalent phantom. Corresponding measurements of these plans in phantom were carried out with the use of radiographic film and ion chamber. In the case of the lung and prostate cancer patients, changes in dosimetric parameters compared to data generated with the kVCT study alone were less than 2%. Certain changes for the nasal cavity and brain cancer patients were greater than 2%, but they were explained in part by anatomy changes that occurred during the time between kVCT and MVCT studies. The Planned Adaptive software allows for adaptive radiotherapy planning using the MVCT studies obtained by the helical tomotherapy imaging system.

SU-GG-T-75: IMRT for Cancers of Paranasal Sinuses and Nasal Cavity: A Planning Study

Purpose: to compare intensity-modulated radiotherapy (IMRT) plans generated by segmental multileaf collimator (SMLC, 1-cm leaf width) and helical Tomotherapy (HT) techniques for patients with cancers of paranasal sinuses and nasal cavity. Method and Materials: Five patients with locally advanced cancers of the paranasal sinuses and nasal cavity previously treated using HT technique were selected for this study. Treatment goals included a prescribed dose of 70 Gy to at least 95% of the PTV over 35 treatments while respecting dose-volume constraints to OARs. Each patient was planned using Tomotherapy HI-ART system with 2.5 cm jaw, 0.3 pitch, and 2.5 initial modulation parameters. All five patients were subsequently planned on Pinnacle TPS using the same goals for PTV and OARs for a 9-field SMLC technique on an Elekta Synergy™ LINAC equipped with 1 cm MLC. Dose volume histograms were generated and compared from both planning systems. Results: HT planning results (average ± one standard deviation (SD)) for PTV70 are: V77 (percentage of PTV70 receiving 77 Gy): 8.0% ± 17.7%; V70: 94.9% ± 0.2%; V65.1: 98.3% ± 1.2%. In comparison, SMLC planning results are: V77: 37.4% ± 43.8%; V70: 95.3% ± 0.7%; V65.1: 98.5% ± 1.3%. Maximum point doses for HT technique are: to optic chiasm (40.0 ± 21.9 Gy), ipsi optic nerve (ON) (39.0 ± 26.7 Gy) and contralateral ON (37.1 ± 22.9 Gy). For SMLC technique: to optic chiasm (41.8 ± 30.4 Gy), ipsi ON (45.2 ± 30.2 Gy) and contralateral ON (39.9 ± 30.1 Gy). Summary: Results are consistent with those of others evaluating HT-IMRT for cancers of the head and neck, i.e. HT technique achieved a more homogeneous PTV dose coverage while delivering less dose to OARs compared to 9-field SMLC technique used. Investigations using Synergy-S™ SMLC, 4-mm leaf width are underway and will also be presented.

Postoperative intensity‐modulated radiation therapy for cancers of the paranasal sinuses, nasal cavity, and lacrimal glands: Technique, early outcomes, and toxicity

Our aim was to review Memorial Sloan-Kettering Cancer Center's experience with postoperative intensity-modulated radiotherapy (IMRT) for paranasal sinus, nasal cavity, and lacrimal gland cancer and report dosimetric measures, toxicity, and outcomes. Between September 2000 and June 2006, 37 patients with paranasal sinus, nasal cavity, or lacrimal gland cancer underwent postoperative IMRT. Median values were as follows: prescription dose, 60 Gy (range, 50-70); PTV(D95), 99% (range, 79-101%); optic nerve Dmax, 53 Gy (range, 2-54); optic chiasm Dmax, 51Gy (range, 2-55). Acute and late toxicities were scored by Radiation Therapy Oncology Group morbidity criteria. Median follow-up was 28 months. Two-year local progression-free and overall survivals were 75% and 80%. No early- or late-grade 3/4 radiation-induced ophthalmologic toxicity occurred. Preliminary results show that adjuvant IMRT in these patients is feasible, allowed for excellent planning target volume (PTV) coverage, and minimized dose delivered to optic structures. Longer follow-up is warranted to assess the extent of late effects and outcomes.

Long-Term Radiotherapy Outcomes for Nasal Cavity and Septal Cancers

Carcinoma of the nasal cavity and septum has historically been associated with a poor prognosis. This report updates the long-term outcomes for radiotherapy (RT) of this disease site at the University of Texas M.D. Anderson Cancer Center. A retrospective analysis was performed on the data from 68 patients diagnosed with histologically proven carcinoma of the nasal cavity or septum treated with RT for curative intent between 1969 and 2000. The disease histologic type was as follows: 45 (66%) had squamous cell carcinoma, 12 (18%) had adenoid cystic carcinoma, 8 (12%) had adenocarcinoma, and 3 (4%) had poorly/undifferentiated carcinoma. Of the 68 patients, 32 (47%) had received definitive RT. Of these, 23 had received external beam RT and 9 brachytherapy. Of the remaining 36 patients, 3 (4%) underwent preoperative external beam RT and 33 (49%) postoperative external beam RT. Of the 68 patients, 13 (19%) received neck RT. The median dose for patients receiving definitive and postoperative RT was 65 and 58.2 Gy, respectively. The median follow-up for the entire cohort was 11 years (range, 2.4-30.1 years). Of the 68 patients, 19 (28%) developed a locoregional relapse, 14 (21%) locally and 5 (7%) regionally. The local control rate at 5 and 10 years was 86% and 76%, respectively. The disease-specific survival rate was 86% and 78%, and the overall survival rate was 82% and 62% at 5 and 10 years, respectively. This extended follow-up of our institutional experience has demonstrated that RT can provide durable long-term locoregional control and survival outcomes for patients with carcinoma of the nasal cavity and septum.

Regional Recurrence of Squamous Cell Carcinoma of the Nasal Cavity

To demonstrate whether the regional recurrence (RR) of squamous cell carcinoma (SCC) of the nasal cavity is higher than previously suspected. Original articles, including a previously published series from our institution, were identified from systematic searches of the MEDLINE database. Studies that analyzed tumors other than SCC or tumors from sites other than the nasal cavity were excluded. Studies that did not report an RR were also excluded. Studies identified by the literature search were reviewed by a single reviewer (W.C.S.), and studies not excluded were reviewed for data extraction by 2 reviewers (W.C.S. and M.Y.C.). From the 23 studies reviewed, the average weighted percentage RR for SCC of the nasal cavity was 18.1% (95% confidence interval, 13.4%-22.8%). Currently, few authors advocate elective treatment of the neck in patients with high-risk SCC of the nasal cavity. The results of this systematic review and meta-analysis demonstrate that the RR of this entity may be higher than previously suspected. Because many studies included other histopathologies or analyzed recurrence data from tumors of multiple subsites, a true RR for SCC of the nasal cavity has not been firmly established. Now that a uniform staging system exists for nasal cavity cancers, better prospective analysis of these tumors will be available. The authors suggest that the risk of RR of certain high-risk SCCs of the nasal cavity to the lymph nodes, including the perifacial and upper cervical lymphatics, may approach the frequently cited 20% risk suggestive of consideration for elective regional therapy.

A dosimetric comparison of non-coplanar IMRT versus Helical Tomotherapy for nasal cavity and paranasal sinus cancer

Purposes To determine if there are clinically significant differences between the dosimetry of sinus tumors delivered by non-coplanar LINAC-based IMRT techniques and Helical Tomotherapy (HT). HT is capable of delivering highly conformal and uniform target dosimetry. However, HT lacks non-coplanar capability, which is commonly used for linear accelerator-based IMRT for nasal cavity and paranasal sinus tumors. Methods and materials We selected 10 patients with representative early and advanced nasal cavity and paranasal sinus malignancies treated with a preoperative dose of 50 Gy/25 fractions without coverage of the cervical lymphatics for dosimetric comparison. Each plan was independently optimized using either Corvus inverse treatment planning system, commissioned for a Varian 2300 CD linear accelerator with 1 cm multileaf collimator (MLC) leaves, or the HT inverse treatment planning system. A non-coplanar seven field technique was used in all Corvus plans with five mid-sagittal fields and two anterior oblique fields as described by Claus et al. [F. Claus, W. De Gersem, C. De Wagter, et al., An implementation strategy for IMRT of ethmoid sinus cancer and bilateral sparing of the optic pathways, Int J Radiat Oncol Biol Phys 51 (2001) 318–331], whereas only coplanar beamlets were used in HT planning. Dose plans were compared using DVHs, the minimum PTV dose to 1 cm 3 of the PTV, a uniformity index of planned treatment volume (PTV), and a comprehensive quality index (CQI) based on the maximum dose to optical structures, parotids and the brainstem which were deemed as the most critical adjacent structures. Results Both planning systems showed comparable PTV dose coverage, but HT had significantly higher uniformity ( p < 0.01) inside the PTV. The CQI for all organs at risk were equivalent except ipsilateral lenses and eyes, which received statistically lower dose from HT plans ( p < 0.01). Conclusions Overall HT provided equivalent or slightly better normal structure avoidance with a more uniform PTV dose for nasal cavity and paranasal sinus cancer treatment than non-coplanar LINAC-based IMRT. The disadvantage of coplanar geometry in HT is apparently counterbalanced by the larger number of fields.

Ａｕｒｉｃｕｌａｒ Ｈｅｌｉｘ Ｆｒｅｅ Ｆｌａｐによる外鼻再建例

Surgical treatment of nasal cavity cancers usually results in defects of the nasal tip, ala and collumela, which causes a significant deterioration of QOL for the patients. We used an auricular helix free flap to reconstruct the nasal defects after successful resection of nasal cavity cancer. Donor vessels of the flap, the superficial temporal artery and vein, were anastomosed to the superior thyroid artery and external juglar vein respectively using vascular grafts. The flap successfully became established and the patient has satisfactorily accepted its appearance. We suggest that auricular helix free flap is one of appropriate surgical reconstruction methods for nasal defects with the advantage of resemblance in the color and contour of nose.

Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting—the MSKCC experience

To perform a retrospective analysis of patients with paranasal sinus (PNS) cancer treated with postoperative radiotherapy (RT) at Memorial Sloan-Kettering Cancer Center. Between January 1987 and July 2005, 85 patients with PNS and nasal cavity cancer underwent postoperative RT. Most patients had squamous cell carcinoma (49%; n = 42), T4 tumors (52%; n = 36), and the maxillary sinus (53%; n = 45) as the primary disease site. The median radiation dose was 63 Gy. Of the 85 patients, 76 underwent CT simulation and 53 were treated with either three-dimensional conformal RT (27%; n = 23) or intensity-modulated RT (35%; n = 30). Acute and late toxicities were scored according to the Radiation Therapy Oncology Group radiation morbidity scoring criteria. With a median follow-up for surviving patients of 60 months, the 5-year estimates of local progression-free, regional progression-free, distant metastasis-free, disease-free, and overall survival rates were 62%, 87%, 82%, 55%, and 67%, respectively. On multivariate analysis, squamous cell histology and cribriform plate involvement predicted for an increased likelihood of local recurrence, and squamous cell histologic features predicted for worse overall survival. None of the patients who underwent CT simulation and were treated with modern techniques developed a Grade 3-4 late complication of the eye. Complete surgical resection followed by adjuvant RT is an effective and safe approach in the treatment of PNS cancer. Emerging tools, such as three-dimensional conformal treatment and, in particular, intensity-modulated RT for PNS tumors, may minimize the occurrence of late complications associated with conventional RT techniques. Local recurrence remains a significant problem.