Ethmoid Sinus Cancer Research Articles

Establishment and characterization of patient-derived xenografts as paraclinical models for head and neck cancer

BackgroundWe investigated whether head and neck squamous cell carcinoma (HNSCC) patient-derived xenografts (PDXs) reaffirm patient responses to anti-cancer therapeutics.MethodsTumors from HNSCC patients were transplanted into immunodeficient mice and propagated via subsequent implantation. We evaluated established PDXs by histology, genomic profiling, and in vivo anti-cancer efficacy testing to confirm them as the authentic in vivo platform.ResultsFrom 62 HNSCCs, 15 (24%) PDXs were established. The primary cancer types were tongue (8), oropharynx (3), hypopharynx (1), ethmoid sinus cancer (1), supraglottic cancer (1), and parotid gland (1); six PDXs (40%) were established from biopsy specimens from advanced HNSCC. PDXs mostly retained donor characteristics and remained stable across passages. PIK3CA (H1047R), HRAS (G12D), and TP53 mutations (H193R, I195T, R248W, R273H, E298X) and EGFR, CCND1, MYC, and PIK3CA amplifications were identified. Using the acquisition method, biopsy showed a significantly higher engraftment rate when compared with that of surgical resection (100% [6/6] vs. 16.1% [9/56], P < 0.001). Specimens obtained from metastatic sites showed a significantly higher engraftment rate than did those from primary sites (100% [9/9] vs. 11.3% [6/53], P < 0.001). Three PDX models from HPV-positive tumors were established, as compared to 12 from HPV-negative (15.8% [3/19] and 27.9% [12/43] respectively, P = 0.311), suggesting that HPV positivity tends to show a low engraftment rate. Drug responses in PDX recapitulated the clinical responses of the matching patients with pan-HER inhibitors and pan-PI3K inhibitor.ConclusionsGenetically and clinically annotated HNSCC PDXs could be useful preclinical tools for evaluating biomarkers, therapeutic targets, and new drug discovery.

Case report: persistent corneal epithelial defect after glaucoma device implantation for radiation glacoma

AbstractPurposeWe report a case with persistent epithelial defect after Barvert glaucoma implant for radiation glaucoma.Methods and Results62‐year‐old man had a total of 70 Gray radiation exposure for 2 months for left ethmoid sinus cancer In December 2015. In February 2016, the patient visited eye clinic for left eye pain. Only SPK was found and artificial tear drop was prescribed and followed‐up in the clinic. In January 2017, left intraocular pressure was elevated and angle neovascularization was found. Photocoagulation was started on diagnosis of radiation glaucoma. Although the treatment could not be completed due to progression of cataract, intraocular pressure had been within normal range under glaucoma drops treatment. He was referred to our hospital in August 2018 for the treatment of cataract surgery in his left eye. At the first visit, his left best corrected visual acuity was 0.01 and left Intraocular pressure was 20 mmHg. Mild Superficial punctate keratitis was found in his left eye but tear fluid meniscus was normal. We planned to add PC after cataract surgery at first. But in consideration of the possibility of deterioration of Neovasucular Glaucoma after surgery, we performed not only cataract surgery but also vitrectomy with Barvert glaucoma implantation and photocoagulation in September of the same year. Postoperative inflammation was transient, the intraocular pressure was good, and small corneal erosion was found immediately after the operation. However, after surgery, there was an extreme decrease in lacrimal secretion, and corneal erosions were enlarged, resulting in persistent epithelial defects. Treatment with a punctum plug, a therapeutic soft contact lens, eye drops etc. was poorly improved, and a corneal infiltration suspected of fungal keratitis was found during the course.ConclusionsImplantation or vitreous surgery for radiation retinopathy or radiation glaucoma may cause persistent corneal epithelial defects. It is necessary to carefully check the preoperative evaluation of tears and corneal condition and to carry out minimally invasive treatment.

Ethmoid Sinus Cancer: Experience and Oncological Outcomes at Memorial Sloan-Kettering Cancer Center (MSKCC): Non-Squamous Cell Malignancies of the Head and Neck (thyroid, skin cancers, salivary gland and sinus cancers)

Ethmoid Sinus Cancer: Experience and Oncological Outcomes at Memorial Sloan-Kettering Cancer Center (MSKCC): Non-Squamous Cell Malignancies of the Head and Neck (thyroid, skin cancers, salivary gland and sinus cancers)

Postradiation Sarcoma From a Free Flap

Postradiation sarcomas constitute approximately 0.5% to 5.5% of all sarcomas. They develop locally approximately 3 to 20 years after the administration of radiotherapy (RT). They are generally high-grade tumors. Osteosarcomas, fibrosarcomas, malignant fibrous histiocytoma, angiosarcomas, and leiomyosarcomas are the most frequently observed. It is rare for these tumors to originate from free flaps, and this patient report is one of the first in the literature. A 59-year-old man was operated on because of ethmoid sinus cancer in 2004, and the reconstruction was performed with a rectus abdominis free muscle flap. He received postoperative RT and subsequently presented to our clinic with a medially protruding mass on his upper jaw. A biopsy was performed. Its pathologic diagnosis was reported as malignant mesenchymal tumor. Computed tomography and magnetic resonance imaging were performed, demonstrating that the mass originated from the free muscle flap (m. rectus abdominis) at the front wall of the sphenoid sinus. A total excision of the free muscle flap and near-total maxillectomy were performed. The pathologic finding was reported as leiomyosarcoma with bone invasion. With the advancement of medical and pharmaceutical technologies, our patient's life expectancy is increasing. In long-living patients who have received RT, tumors can develop 20 years after the RT. The close follow-up of patients receiving RT is of utmost importance because treatment survival is linked to early diagnosis and resection with negative surgical margins. We must not forget that, even if years have passed since receiving RT, these patients may present with such tumors.

Practical application of whole genome and transcriptome tumour analysis to guide chemotherapy decision-making for patients with advanced cancers.

e22020 Background: We propose that applying personal genomic information prospectively, in a clinically realistic timeframe can aid chemotherapy decision-making and result in more effective cancer treatment. We are investigating this approach in a variety of cancers to examine timeliness, deliverability, and rate of actionable targets identified. Methods: Eligible subjects with incurable cancer and limited chemo options have a tumour biopsy and “normal” blood taken for analysis. Archival specimens are concurrently analyzed to look for changes with time and treatment. Samples are subject to both an Ampliseq amplicon panel and in-depth whole genome DNA and RNA sequencing (WGS). Bioinformatics approaches identity genes with somatic and copy number variations, and expression changes. Variants are integrated into a pathway analysis to identify tumour specific processes that may drive the tumour, these are then matched to drug databases, with manual literature reviews, to indentify drugs that may be useful or even contra-indicated. Results: Between July 2012 -Jan 2013, 9 subjects (of 30 planned) are enrolled: 2 cases each of: colorectal and breast and 1 each of: squamous skin, squamous ethmoid sinus, nasopharyngeal, lung, and CLL-peripheral mantle cell cancer. 5 have completed analyses. Cancer panel results correlated well with WGS; although the panel is more rapid, it provides less comprehensive information and has not been as informative for identifying candidate druggable drivers. Extensive pathway mapping uncovered potential drug targets in each case that would not have necessarily been considered without this analyses. To date, 4 subjects have started chemo based on the analyses and 1 patient has had his diagnosis radically changed. There are significant genomic differences between archival and fresh tumour samples. Conclusions: This approach is feasible and yields actionable targets that can inform real-time chemotherapy decision-making. Archival samples do not appear to adequately represent post-treatment cancers. The impact of WGS vs. panel sequencing will require more subjects but it appears a panel may be insufficient for detailed treatment guidance.

Abstract LB-173: Genome analysis informs chemotherapy decision-making in patients with advanced malignancies.

Abstract Background: Tumor heterogeneity poses a significant challenge to the success of treatment; tumors with similar histological features may have substantially different underlying biological drivers. Applying personal genomic information prospectively to assist in chemotherapy decision-making could result in more effective and efficient cancer treatment. Methods: Eligible subjects with incurable cancers for whom there are limited or no standard chemotherapy options, have a tumor biopsy and when possible a tissue matched normal sample plus “normal” blood samples taken specifically for genomic analysis. Archival specimens are concurrently analyzed to look for changes over time and with chemo and/or radiation. Samples are subject to both an Ampliseq amplicon cancer panel analysis and whole genome DNA and RNA sequencing. State-of-the-art bioinformatics approaches are used to identity genes with somatic variants, copy number variants, and expression changes. All variants are integrated into a pathway analysis to identify tumor specific biological processes that may be driving the tumor. These pathways are matched to the known drug databases and to manual literature reviews to identify drugs that may be useful or drugs that may be counter-indicated and a report is generated and discussed. Results: Between July 2012 and January 2013, 10 subjects (of 30 planned) have been enrolled; 3 cases of colorectal and 2 of breast, 1 each of squamous skin, squamous ethmoid sinus cancer, nasopharynx, lung, and one CLL-peripheral mantle cell cancer. The Ampliseq panel results have generally correlated well with whole genome and RNA sequencing results, although the panel, providing less comprehensive information albeit more rapidly, has not been as informative a modality for identifying candidate druggable driver events. And the case of ethmoid cancer was discovered to be a rare pediatric tumor, this was not identified by the panel. Each case had extensive pathway mapping and uncovered potential drug targets that would not have necessarily been considered without this analyses. To date, 3 subjects have initiated treatment based on the reports generated; the analyses are in process for the remaining cases. We also note that we observe significant genomic differences between the archival and fresh tumor materials. Conclusions: Initial results suggest that the information garnered from detailed genomic analysis can inform chemotherapy decision-making. The panel is adept at profiling the common abnormalities that are the target of many of the current generation of molecular targeted drugs; however the whole genome approach provides a comprehensive view of the genomic landscape providing more information on particular aberrant pathways affected and ideas for drug repositioning. For now we have elected to employ whole genome and transcriptome analysis in addition to an “oncogene panel” to both compare the relative utility of these two approaches and provide as comprehensive a view of candidate druggable driver events across patients to inform on the next generation of rapid panel designs. Citation Format: Janessa J. Laskin, Karen Gelmon, Howard Lim, Daniel Renouf, Stephen Yip, David Huntsman, Anna Tinker, Cheryl Ho, Erin D. Pleasance, Yvonne Li, Yaoqing Shen, Katayoon Kasaian, Richard Corbett, Karen Mungall, Yongjun Zhao, Andy Mungall, Jacquie Schein, Robyn Roscoe, Steven Jones, Marco Marra. Genome analysis informs chemotherapy decision-making in patients with advanced malignancies. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-173. doi:10.1158/1538-7445.AM2013-LB-173

EP-1219: Planning study of locally advanced ethmoid sinus cancer patient.

EP-1219: Planning study of locally advanced ethmoid sinus cancer patient.

An endoscopic approach to reconstruction of skull base defects using a vascular pedicled nasoseptal mucoperiosteal flap

To introduce a method and the clinical effects of repairing skull base defects and dural defects using vascular pedicled nasoseptal mucoperiosteal flaps through an endoscopic endonasal approach. The clinical and follow-up data for 8 patients who underwent endoscopic endonasal reconstruction of skull base defects and cerebrospinal fluid rhinorrhea with a vascular pedicled nasoseptal mucoperiosteal flap between July 2008 and March 2010 were retrospectively reviewed. All patients were male. The age of these patients ranged from 28 to 60 years (average 41 years). The diagnosis for these patients included one hemangiopericytoma of the anterior skull base one olfactory neuroblastoma (type of Kadish C), one ethmoid sinus cancer, three local recurrent cancers of the nasopharynx after radiotherapy, one carcinoid of skull base and one traumatic cerebrospinal fluid rhinorrhea with recurrent intracranial infection. There were six anterior skull base defects and two middle cranial fossa defects. An endoscopic endonasal surgical approach was used for the repair. A pedicled flap using the nasal septal mucoperiosteum based on the posterior nasal artery was harvested from the ipsilateral side. The tissue flap was used to cover the dural defects. The margin was covered with gelatin sponge and fixed with fibrin glue. The nasal cavity was packed with iodoform gauze, a Foley catheter balloon and Merocel in this sequence to secure the flap in place. Nasal packing was removed 5 to 7 days postoperatively. Partial septal flap necrosis was found in one case, but the flaps in the other 7 cases survived. A postoperative cerebrospinal fluid leak occurred in one case 7 days after surgery. This was re-explored and successfully repaired with abdominal fat. All cases healed well, with no delayed cerebrospinal fluid leaks or intracranial infections during the 6 to 24 months follow-up period. The vascular pedicled nasoseptal mucoperiosteal flap is a reliable choice for endoscopic endonasal skull base reconstruction.

Dosimetric comparison between coplanar and non coplanar field radiotherapy for ethmoid sinus cancer

BackgroundTo compare non coplanar field (NCF) with coplanar field (CF) -intensity-modulated radiotherapy (IMRT) planning for ethmoid cancer.MethodsSeven patients treated with NCF IMRT for ethmoid cancer were studied. A CF IMRT optimization was prepared with the same constraints as for the NCF treatment. The maximum point doses (D max) obtained for the different optic pathway structures (OPS) should differ no more than 3% from those achieved with the NCF IMRT plan. The distribution of the dose in the target volume and in the critical structures was compared between the two techniques, as well as the Conformity (CI) and the Homogeneity Indexes (HI) in the target volume.ResultsWe noted no difference between the two techniques in the OPS for the D1, D2, and D5%, in the inner ear and controlateral lens for the average Dmax, in the temporo-mandibular joints for the average mean dose, in the cord and brainstem for the average D1%. The dose-volume histograms were slightly better with the NCF treatment plan for the planning target volume (PTV) with a marginally better HI but no impact on CI. We found a great improvement in the PTV coverage with the CF treatment plan for two patients with T4 tumors.ConclusionIMRT is one of the treatment options for ethmoid cancer. The PTV coverage is optimal without compromising the protection of the OPS. The impact of non coplanar versus coplanar set up is very slight.

Management of the orbit in malignant sinonasal tumors

Malignant ethmoid and maxillary sinus tumors frequently involve the orbit. Orbital involvement is an important prognostic predictor of recurrence-free, disease-specific, and overall survival. Most authors agree that orbital preservation as opposed to orbital exenteration or clearance does not result in significant differences in local recurrence or actuarial survival. The eye can be safely preserved in most patients with ethmoid or maxillary sinus cancer invading the orbital wall, including malignancies that invade the orbital soft tissues with penetration through the periorbita provided that they can be completely dissected away from the orbital fat. Malposition of the globe and nonfunctional eyes frequently result when patients have not had adequate rigid reconstruction of the orbital floor, particularly if they have received postoperative radiotherapy. This underscores the importance of such reconstruction. Isolated defects following orbital exenteration may be reconstructed with a temporalis muscle flap. Microvascular free-tissue transfer is the best option for repair of defects following orbital exenteration and total maxillectomy, although an obturator still has a role in selected patients.

The influence of air cavities within the PTV on Monte Carlo-based IMRT optimization

Integrating Monte Carlo calculated dose distributions into an iterative aperture-based IMRT optimization process can improve the final treatment plan. However, the influence of large air cavities in the planning target volume (PTV) on the outcome of the optimization process should not be underestimated. To study this influence, the treatment plan of an ethmoid sinus cancer patient, which has large air cavities included in the PTV, is iteratively optimized in two different situations, namely when the large air cavities are included in the PTV and when these air cavities are excluded from the PTV. Two optimization methods were applied to integrate the Monte Carlo calculated dose distributions into the optimization process, namely the 'Correction–method' and the 'Per Segment–method'. The 'Correction–method' takes the Monte Carlo calculated global dose distribution into account in the optimization process by means of a correction matrix, which is in fact a dose distribution that is equal to the difference between the Monte Carlo calculated global dose distribution and the global dose distribution calculated by a conventional dose calculation algorithm. The 'Per Segment–method' uses directly the Monte Carlo calculated dose distributions of the individual segments in the optimization process. Both methods tend to converge whether or not large air cavities are excluded from the PTV during the optimization process. However, the 'Per Segment–method' performs better than the 'Correction–method' in both situations and the 'Per Segment–method' in the case where the large air cavities are excluded from the PTV leads to a better treatment plan then when these air cavities are included. Therefore we advise to exclude large air cavities and to apply the 'Per Segment–method' to integrate the Monte Carlo dose calculations into an iterative aperture-based optimization process. Nevertheless, the 'Correction–method' provides a good alternative in the case when the external dose engine is not able to generate individual dose distributions for the individual segments.

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.

Comparison of dose–volume histograms of IMRT treatment plans for ethmoid sinus cancer computed by advanced treatment planning systems including Monte Carlo

Background and purpose To recompute clinical intensity-modulated treatment plans for ethmoid sinus cancer and to compare quantitatively the dose–volume histograms (DVHs) of the planning target volume (PTV) and the optic organs at risk. Material and methods Ten step-and-shoot intensity-modulated treatment plans were enrolled in this study. Large natural and surgical air cavities challenged the calculation systems. Each optimized treatment plan was recalculated by two superposition convolution (TMS and Pinnacle) and a Monte Carlo system (MCDE). To compare the resulting DVHs, a one-way ANOVA for repeated measurements was performed and multiple pairwise comparisons were made. Results The tails of the PTV-DVHs were significantly higher for the Monte Carlo system. The DVHs of the critical organs displayed some statistically but not always clinically significant differences. For the individual patients, the three planning systems sometimes reproduced clinically discrepant DVHs that were not significantly different when averaged over all patients. Conclusions Dose to air cavities contains computational uncertainty. As this dose is clinically irrelevant and optimizing it is meaningless, we recommended extracting the air from the PTV when constructing the PTV-DVH. The planning systems considered reproduce DVHs that are significantly different, especially in the tail region of PTV-DVHs.

Subtotal Nasal Reconstruction for Ethmoid Sinus Cancer Defect Using a Fibula Osteocutaneous Free Flap

Subtotal Nasal Reconstruction for Ethmoid Sinus Cancer Defect Using a Fibula Osteocutaneous Free Flap

225 IMRT dose distributions for ethmoid sinus cancer calculated by five different treatment planning systems

225 IMRT dose distributions for ethmoid sinus cancer calculated by five different treatment planning systems

Ethmoid sinus cancer: Results of treatment with surgery and combined therapy

Objective—Ethmoid sinus cancer is a rare paranasal sinus malignancy. Its characteristics include a low incidence rate, a great variety of histopathological types and multiple treatment modalities. Currently, there remains no definite consensus regarding its optimal management. The aim of this study was to examine the outcome of a population of Asian patients with advanced ethmoid sinus cancers that had been treated with surgery plus combined therapy.Material and Methods—Between January 1989 and December 2002 inclusive, 19 newly diagnosed patients with ethmoid sinus cancers who had undergone surgical intervention were enrolled, T4 being the principal carcinoma stage (68.4%). All participating cases proved to be node-negative and no evidence of any distant metastasis was detected at the time of diagnosis. The major treatment modality was surgery plus postoperative radiotherapy. All but 2 of the 13 patients with T4 cancer underwent craniofacial resection with pericranial flap reconstruction.Results—The estimated overall and disease-free survival rates 3 years post-treatment were 49.4% and 26.3%, respectively. Local tumor recurrence was more common than regional recurrence and/or distant metastasis. A total of 5/15 T3–T4 patients (33%) developed a neck metastasis, 3 of whom also suffered a distant metastasis. There was no postoperative mortality for the cases treated with craniofacial resection.Conclusions—Ethmoid sinus cancer typically demonstrates a propensity for late diagnosis and poor prognosis. This study confirms that craniofacial resection plus combined associated therapy is the optimal approach for the effective management of extensive ethmoid sinus tumors and is associated with an acceptable morbidity rate. More aggressive disease management featuring prophylactic concurrent chemoradiotherapy including neck or elective neck dissection plus chemotherapy should be considered for T3–T4 patients as opposed to T1–T2 patients.

770 poster Results of an intensity modulated radiation therapy (IMRT) planning comparison for an ethmoid sinus cancer case

770 poster Results of an intensity modulated radiation therapy (IMRT) planning comparison for an ethmoid sinus cancer case

Postoperative radiotherapy for adenocarcinoma of the ethmoid sinuses: treatment results for 47 patients

Purpose : Ethmoid sinus cancer is a rare malignancy. Treatment results are mostly reported together with other sinonasal tumors, grouping a wide range of different histologies and treatment approaches. This study reports on the treatment outcome of 47 patients diagnosed with adenocarcinoma of the ethmoid sinuses and treated with surgery and high-dose postoperative radiation therapy. Methods and Materials : Between September 1985 and October 2001, 51 patients with adenocarcinoma of the ethmoid sinuses were referred to the Ghent University Hospital. Four patients were treated with low-dose palliative radiation because of very extended inoperable disease or distant metastasis at the time of diagnosis. They were not included in this analysis. The other 47 patients, all staged as N0M0, were treated with surgery and postoperative high-dose radiation therapy. The median follow-up was 32 months. The T-stages were T1 for 2, T2 for 17, T3 for 11, and T4 for 17 patients. All 47 patients were staged as N0M0. Results : The 3-year, 5-year, and 7-year overall survival are respectively 71%, 60%, and 38%. The 3-year and 5-year disease-free survival are respectively 62% and 36%. The 3-year and 5-year disease-free survival for T1–T2 stages are respectively 87% and 55%, for T3 stages 57% and 28%, and for T4 stages 41% and 25%. The locoregional tumor control was 70% and 59% at respectively 3 and 5 years. Patients presenting with intracranial tumor invasion at the time of diagnosis relapsed within 7 months after the end of radiotherapy. Radiation-induced severe dry eye syndrome and optic neuropathy was observed in respectively 7 and 2 of the 47 cases. Conclusion : Postoperative radiotherapy for adenocarcinoma of the ethmoid sinuses is associated with good local control rates. Crucial for a favorable prognosis is the absence of intracranial invasion. The rarity of these tumors makes it difficult to evaluate new therapeutic advances.

Factors Predicting Survival for Cancer of the Ethmoid Sinus

The aim of this study was to determine survival and prognostic factors for ethmoid sinus cancer. From the Surveillance, Epidemiology, and End Results database for the time period 1988-1998, all cases of ethmoid sinus malignancy were extracted. Demographic, staging, treatment, and survival data were computed. Survival analysis was conducted with the Kaplan-Meier method. Clinical factors influencing survival were determined with the Cox proportional hazards model. After excluding patients with metastatic disease on presentation (8.9%) and patients with missing data for T stage, a total of 180 cases were identified. Average age was 60.2 years. Squamous cell carcinoma was the most common tumor (27.8%), followed by adenocarcinoma (12.8%). Overall mean survival was 57 months (median, 38 months) with a 5-year survival of 40.3%. The percentage of patients presenting with T4 lesions was 45.6%, which had a notably lower mean survival of 38 months (median, 18 months). Only 2.3% of patients had positive nodal disease. Increasing age, T stage, and absence of radiation therapy predicted poorer survival in the multivariate model Adenocarcinoma, adenoid cystic carcinoma, esthesioneuroblastoma, and melanoma showed more favorable survival than other tumor types. T stage and tumor histology are the most important prognostic factors in ethmoid sinus carcinoma. Survival for T4 lesions is markedly worse than survivalfor T1-T3 lesions. Radiation therapy offers a survival benefit in ethmoid sinus malignancy.

Intensity Modulation Technique Using The Complementary Boost-Fields for Ethmoid Sinus Cancer

Purpose: To explore a static intensity-modulated radiation therapy (IMRT) technique of a more homogeneous isodose distribution to an irregular-shaped tumour of the ethmoid sinus, with concomitantly sparing the adjacent critical normal organs including the orbit.Methods and Materials: We conducted a static IMRT technique adding 2 or smaller complementary boost-fields to the underdosed volume in the PTV, which resulted from complete blocking of the orbits in all coplanar or non-coplanar main ports of the standard 3-D CRT. The standard 3-D CRT plans (Plan A) and IMRT plans adding complementary boost fields (Plan B) were established for 10 patients with ethmoid sinus cancer. Two sets of different plans for each patient were compared using isodose distribution, dose statistics, and dose volume histogram (DVH) of the planning target volume (PTV) and also using dose statistics and DVH of the adjacent critical structures.Results: The IMRT plans adding 2 or more complementary boost-fields (Plan B) for each patient demonstrated better coverage and improved dose homogeneity of the PTV compared to the standard 3-D CRT plan (Plan A). Moreover, the radiation doses to adjacent normal tissue organs, such as the orbits, optic nerves, brain stem and optic chiasm were similarly spared in both plans.Conclusion: With concomitantly sparing the surrounding visual pathway structures, our IMRT technique using the complementary boost-fields was quantitatively better than current standard 3-D CRT technique with respect to the dose homogeneity within the PTV. Therefore, we believe that our technique, though still not ideal, is thorough enough to be used routinely in treatment of ethmoid sinus tumour.