Skip to main content
SpringerLink
Log in

Function preservation and optimal outcomes—definitive chemoradiotherapy with multi-phase treatment planning for locally advanced sinonasal cancer

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objectives

The aim of this study is to review radiotherapy (RT) techniques and outcomes for definitive RT or chemoradiotherapy (CRT) for very locally advanced or unresectable sinonasal cancer (SNC) at a single institution.

Methods

Between 1998 and 2010, there were 11 patients with very locally advanced or unresectable SNCs treated with definitive CRT (8) and RT alone (3) at the University of Utah. CRT was given to stage IVA (5) and stage IVB (3) patients; RT alone was given to stage III (1) and stage IVA (2) patients. All patients were treated with intensity-modulated radiation therapy (IMRT). The median dose was 70.2 Gy (70–72.4 Gy). Most patients underwent two treatment planning phases in order to prevent critical structures from receiving a high dose due to tumor regression and weight loss. The most common chemotherapy was cisplatin 40 mg/m2 given on a weekly basis for 6–7 cycles. A flexible nasal endoscopy with a biopsy was performed 3 months posttreatment to evaluate tumor response.

Results

With a median follow-up of 41 months (2–114), overall local control was seen in 8 out of 11 (72.7 %) patients. There was 1 (9.1 %) regional recurrence and 2 (18.2 %) distant metastasis. The definitive CRT or RT was well tolerated with only 2 patients experiencing a grade 3 late toxicity.

Conclusion

Definitive CRT or RT is feasible for very locally advanced or unresectable SNC. Local control is encouraging with acceptable treatment-related complications when treating with the described two-phase IMRT treatment technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Society, A.C. (2014) What are the key statistics about nasal cavity and paranasal sinus cancer? http://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/detailedguide/nasal-cavity-and-paranasal-sinuses-cancer-key-statistics. Accessed 17 July 2015.

  2. Dulguerov P, Jacobsen MS, Allal AS, et al. (2001) Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 92(12):3012–3029

    Article  CAS  PubMed  Google Scholar 

  3. Wong RJ, Kraus DK (2001). Cancer of the nasal cavity and paranasal sinues. In: American Cancer Society Atlas of Clinical Oncology: Cancer of the head and neck. Shah JP, ed. Hamilton, Ontario: BC Decker pp. 204–224.

  4. Edge SB, Byrd DR, Compton CC, et al. (eds) (2010) AJCC cancer staging manual (7th edition). Springer, New York, NY

    Google Scholar 

  5. Katz TS, Mendenhall WM, Morris CG, et al. (2002) Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck 24(9):821–829

    Article  PubMed  Google Scholar 

  6. Dirix P, Nuyts S, Geussens Y, et al. (2007) Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 69(4):1042–1050

    Article  PubMed  Google Scholar 

  7. Madani I, Bonte K, Vakaet L, et al. (2009) Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys 73(2):424–432

    Article  PubMed  Google Scholar 

  8. Jansen EP, Keus RB, Hilgers FJ, et al. (2000) Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys 48(1):27–35

    Article  CAS  PubMed  Google Scholar 

  9. Jang NY, Wu HG, Park CI, et al. (2010) Definitive radiotherapy with or without chemotherapy for T3-4N0 squamous cell carcinoma of the maxillary sinus and nasal cavity. Jpn J Clin Oncol 40(6):542–548

    Article  PubMed  Google Scholar 

  10. Roa WH, Hazuka MB, Sandler HM, et al. (1994) Results of primary and adjuvant CT-based 3-dimensional radiotherapy for malignant tumors of the paranasal sinuses. Int J Radiat Oncol Biol Phys 28(4):857–865

    Article  CAS  PubMed  Google Scholar 

  11. Waldron JN, O'Sullivan B, Warde P, et al. (1998) Ethmoid sinus cancer: twenty-nine cases managed with primary radiation therapy. Int J Radiat Oncol Biol Phys 41(2):361–369

    Article  CAS  PubMed  Google Scholar 

  12. Jiang GL, Morrison WH, Garden AS, et al. (1998) Ethmoid sinus carcinomas: natural history and treatment results. Radiother Oncol 49(1):21–27

    Article  CAS  PubMed  Google Scholar 

  13. Paulino AC, Marks JE, Bricker P, et al. (1998) Results of treatment of patients with maxillary sinus carcinoma. Cancer 83(3):457–465

    Article  CAS  PubMed  Google Scholar 

  14. Blanco AI, Chao KS, Ozyigit G (2004) Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy. Int J Radiat Oncol Biol Phys 59(1):51–58

    Article  PubMed  Google Scholar 

  15. Chen AM, Daly ME, Bucci MK, et al. (2007) 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 69(1):141–147

    Article  PubMed  Google Scholar 

  16. Hoppe BS, Nelson CJ, Gomez DR, et al. (2008) Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys 72(3):763–769

    Article  PubMed  Google Scholar 

  17. Mendenhall WM, Amdur RJ, Morris CG, et al. (2009) Carcinoma of the nasal cavity and paranasal sinuses. Laryngoscope 119(5):899–906

    Article  PubMed  Google Scholar 

  18. Le QT, Fu KK, Kaplan M, et al. (1999) Treatment of maxillary sinus carcinoma: a comparison of the 1997 and 1977 American Joint Committee on cancer staging systems. Cancer 86(9):1700–1711

    Article  CAS  PubMed  Google Scholar 

  19. Dirix P, Vanstraelen B, Jorissen M, et al. (2010) Intensity-modulated radiotherapy for sinonasal cancer: improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys 78(4):998–1004

    Article  PubMed  Google Scholar 

  20. Daly ME, Chen AM, Bucci MK, et al. (2007) Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys 67(1):151–157

    Article  PubMed  Google Scholar 

  21. Wiegner EA, Daly ME, Murphy JD, et al. (2012) Intensity-modulated radiotherapy for tumors of the nasal cavity and paranasal sinuses: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 83(1):243–251

    Article  PubMed  Google Scholar 

  22. Al-Mamgani A, Monserez D, Rooij P, et al. (2012) Highly-conformal intensity-modulated radiotherapy reduced toxicity without jeopardizing outcome in patients with paranasal sinus cancer treated by surgery and radiotherapy or (chemo)radiation. Oral Oncol 48(9):905–911

    Article  PubMed  Google Scholar 

  23. Giri SP, Reddy EK, Gemer LS, et al. (1992) Management of advanced squamous cell carcinomas of the maxillary sinus. Cancer 69(3):657–661

    Article  CAS  PubMed  Google Scholar 

  24. Claus F, Boterberg T, Ost P, et al. (2002) Short term toxicity profile for 32 sinonasal cancer patients treated with IMRT. Can we avoid dry eye syndrome? Radiother Oncol 64(2):205–208

    Article  PubMed  Google Scholar 

  25. Hoppe BS, Stegman LD, Zelefsky MJ, et al. (2007) Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting—the MSKCC experience. Int J Radiat Oncol Biol Phys 67(3):691–702

    Article  PubMed  Google Scholar 

  26. Duthoy W, Boterberg T, Claus F, et al. (2005) Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: clinical results in 39 patients. Cancer 104(1):71–82

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Room 1570, Salt Lake City, UT, 84112, USA

    Ying J. Hitchcock

  2. Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA

    Richard R. Orlandi, Jason P. Hunt, Luke O. Buchmann & Marcus M. Monroe

  3. Division of Oncology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Kenneth F. Grossman

Authors
  1. Lindsay M. Burt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard R. Orlandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jason P. Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luke O. Buchmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenneth F. Grossman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcus M. Monroe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dennis C. Shrieve
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ying J. Hitchcock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ying J. Hitchcock.

Ethics declarations

Conflict of interest

Dr. Lindsay M. Burt declares that she has no conflict of interest. Dr. Richard R. Orlandi is a consultant for Medtronic ENT and Intersect. Dr. Jason P. Hunt declares that he has no conflict of interest. Dr. Luke O. Buchmann declares that he has no conflict of interest. Dr. Kenneth Grossman serves in an advisory role for Genentech. Dr. Marcus M. Monroe declares that he has no conflict of interest. Dr. Dennis C. Shrieve declares that he has no conflict of interest. Dr. Ying J. Hitchcock declares that she has no conflict of interest.

Statement of ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Funding information

No funding was provided for this study.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burt, L.M., Orlandi, R.R., Hunt, J.P. et al. Function preservation and optimal outcomes—definitive chemoradiotherapy with multi-phase treatment planning for locally advanced sinonasal cancer. J Radiat Oncol 5, 47–54 (2016). https://doi.org/10.1007/s13566-015-0226-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-015-0226-3

Keywords

Search

Navigation