International Journal of Head and Neck Surgery

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VOLUME 4 , ISSUE 1 ( January-April, 2013 ) > List of Articles

RESEARCH ARTICLE

Early Clinical Outcomes in Midline Sinonasal Cancers treated with Helical Tomotherapy-based Image-guided Intensity-modulated Radiation Therapy

Deepa Nair, Vedang Murthy, Ashwini Budrukkar, Jaiprakash Agarwal, Gupta Tejpal, Sarbani Ghosh-Laskar, Prathamesh Pai, Tabassum Wadasadawala, Reena Phurailatpam, Siji Nojin Paul

Citation Information : Nair D, Murthy V, Budrukkar A, Agarwal J, Tejpal G, Ghosh-Laskar S, Pai P, Wadasadawala T, Phurailatpam R, Paul SN. Early Clinical Outcomes in Midline Sinonasal Cancers treated with Helical Tomotherapy-based Image-guided Intensity-modulated Radiation Therapy. Int J Head Neck Surg 2013; 4 (1):6-12.

DOI: 10.5005/jp-journals-10001-1128

Published Online: 01-08-2014

Copyright Statement:  Copyright © 2013; The Author(s).


Abstract

Introduction

Sinonasal cancers have variable biological behavior and outcomes. The physical proximity of several critical structures renders radiotherapy challenging for these cancers.

Purpose

To report our early experience of helical tomotherapy (HT)-based image-guided intensity-modulated radiation therapy (IMRT) in midline sinonasal cancers.

Materials and methods

Patients with midline sinonasal cancers were accrued on a prospective generic protocol of HT-based IMRT. HT plans were evaluated using standardized indices. All patients were followed up clinicoradiologically. Local control was defined as absence of failure (recurrence/ progression) in the tumor bed, whereas distant disease control was defined as absence of distant metastases. All time-to-event data was analyzed using Kaplan-Meier methods.

Results

Ten patients with a median age of 42 years (range: 29-62 years) were included. HT was able to achieve excellent target volume coverage, good high-dose conformality with exquisite sparing of organs at risk. The acute toxicity of HT was generally mild and self-limiting. Seven patients experienced acute grade I-II ocular toxicity that responded to topical steroids, while one patient developed grade III conjunctivitis. The same patient later developed bilateral cataract necessitating extraction (late grade III ocular toxicity). No patient experienced dry-eye syndrome, corneal opacity or blindness. With a median follow-up of 27 months (interquartile range: 13-35 months), the 3-year Kaplan-Meier estimate of local progression-free survival, distant metastases-free survival, disease-free survival and overall survival was 59.3, 90, 53.3 and 90% respectively.

Conclusion

HT-based image-guided IMRT for midline sinonasal cancers achieves good high-dose conformality and is associated with mild, self-limiting acute ocular toxicity, minimal late morbidity with acceptable disease control.

How to cite this article

Gupta T, Wadasadawala T, Phurailatpam R, Paul SN, Murthy V, Budrukkar A, Ghosh-Laskar S, Nair D, Pai P, Chaturvedi P, Agarwal JP. Early Clinical Outcomes in Midline Sinonasal Cancers treated with Helical Tomotherapy-based Image-guided Intensity-modulated Radiation Therapy. Int J Head and Neck Surg 2013;4(1): 6-12.


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  1. Incidence and survival in patients with sinonasal cancer: A historical analysis of population-based data. Head Neck 2012 Jun;34(6):877-85.
  2. Analysis of the clinical and pathological characteristics of sinonasal neoplasms (article in Chinese). J Clin Otolaryngol Head Neck Surg 2011;25: 1071-75.
  3. Endoscopic resection of sinonasal malignancies. Curr Oncol Rep 2011;13:138-44.
  4. Endoscopic resection of sinonasal cancers with and without craniotomy: Oncologic results. Arch Otolaryngol Head Neck Surg 2009;135:1219-24.
  5. Carniofacial resection for malignant paranasal sinus tumors: Report of an International Collaborative Study. Head Neck 2005;27:575-84.
  6. Retinal and optic nerve complications in a high dose irradiation technique of ethmoid sinus and nasal cavity. Radiology 1972;104:629-34.
  7. Dose-volume complication analysis for visual pathway structures of patients with advanced paranasal sinus tumors. Int J Radiat Oncol Biol Phys 1997;38: 273-84.
  8. Malignancies of the nasal cavity and paranasal sinuses: Long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2007;69:1042-50.
  9. Radiation oncology: A century of achievements. Nat Rev Cancer 2004;4:737-47.
  10. Tomotherapy: A new concept for the delivery of dynamic conformal radiotherapy. Med Phys 1993;20: 1709-19.
  11. Olfactory neuroblastoma: A clinical analysis of 17 cases. Cancer 1976;3:71571-76.
  12. New York: Springer 2009.
  13. A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 2000;93(Suppl 3):219-22.
  14. Radiation-induced injury to the visual pathway. Radiother Oncol 1994;30:17-25.
  15. Radiation optic neuropathy after megavoltage external-beam irradiation: Analysis of time-dose factors. Int J Radiat Oncol Biol Phys 1994;30:755-63.
  16. Ethmoid and upper nasal cavity carcinoma: treatment, results and complications. Radiother Oncol 1990;19:109-20.
  17. An implementation strategy for IMRT of ethmoid sinus cancer with bilateral sparing of the optic pathways. Int J Radiat Oncol Biol Phys 2001;51:318-31.
  18. Carcinomas of the paranasal sinuses and nasal cavity treated with radiotherapy at a single institution over five decades: Are we making improvement? Int J Radiat Oncol Biol Phys 2007;69:141-47.
  19. Short term toxicity profile for 32 sinonasal cancer patients treated with IMRT. Can we avoid dry eye syndrome? Radiother Oncol 2002;64:205-08.
  20. Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: Clinical results in 39 patients. Cancer 2005;104:71-82.
  21. Intensity modulated radiotherapy (IMRT) in patients with carcinomas of the paranasal sinuses: Clinical benefit for complex shaped target volumes. Radiat Oncol 2006;1:23.
  22. Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys 2007;67:151-57.
  23. Post-operative intensity-modulated radiotherapy for malignancies of the nasal cavity and paranasal sinuses. Radiother Oncol 2007;85:385-91.
  24. Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys 2009;73:424-32.
  25. Intensity-modulated radiotherapy for sinonasal cancer: Improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys 2010;78:998-1004.
  26. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys 2012 May 1;83(1):252-59.
  27. Potential of helical tomotherapy to reduce dose to the ocular structures for patients treated for unresectable sinonasal cancer. Am J Clin Oncol 2010;33:595-98.
  28. A dosimetric comparison of non-coplanar IMRT versus helical tomotherapy for nasal cavity and paranasal sinus cancer. Radiother Oncol 2007;82:174-78.
  29. Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence. Acta Oncol 2011;50:763-71.
  30. Carbon ion therapy for advanced sinonasal malignancies: Feasibility and acute toxicity. Radiat Oncol 2011;6:30.
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