gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Long-term Outcome of Proton Beam Therapy for Advanced Sinonasal Malignancies

Meeting Abstract

  • M. Cianchetti - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • J. A. Adams - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • P. Pommier - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • J. J. Wang - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • N. J. Liebsch - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • J. F. McIntyre - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA
  • A. Chan - Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, USA

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog042

DOI: 10.3205/09ptcog042, URN: urn:nbn:de:0183-09ptcog0426

Published: September 24, 2009

© 2009 Cianchetti et al.
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Outline

Text

Background: Due to the anatomical location of sinonasal malignancies, conventional radiation therapy results in very poor local control rate and is associated with significant treatment-related toxicity. Proton radiation therapy with its superior dose distribution properties allows the delivery of higher doses to the tumor and lower doses to the surrounding normal tissues. The purpose of this study is to determine the long-term treatment outcome and prognostic factors in patients with locally advanced sinonasal malignancy treated with proton radiation therapy.

Material and methods: Between 1991 and 2003, 99 patients with newly diagnosed sinonasal malignancy were treated with proton beam radiation therapy at the Massachusetts General Hospital. The histological subtypes were squamous cell carcinoma in 32 patients, esthesioneuroblastoma/neuroendocrine tumors in 30, adenoid cystic carcinoma in 20, sarcoma in 11, and adenocarcinoma in 6. Sixty-five percent of the patients had T4b disease. Two patients had positive neck nodes at diagnosis. Sixty-seven percent of the patients had surgery before radiation. Only 2% of the patients had concurrent chemotherapy. Elective nodal irradiation was delivered in 79% of the patients. The median total dose to the primary tumor was 72.8 GyE (range 59.4–79.4). The median percentage of protons was 57% (range 22%–84%). Eight-two percent of patients received twice-daily radiation.

Results: With a median follow-up of 92.6 months for all surviving patients, the local control rates at 5 and 8 years were 87% and 83%, respectively. There was no statistically significant difference in local control rate per histological subtype, T stage, and surgery vs. biopsy. Distant metastasis was the predominant pattern of relapse; 56% of all relapses were distant. The distant-metastasis-free survival rate at 5 and 8 years was 69%. In multivariate analysis, only T4b was significantly associated with decreased distantmetastasis- free survival rate (p=0.024). The overall survival rates at 5 and 8 years were 57% and 46%, respectively. In multivariate analysis, T4b disease (p=0.001), squamous cell carcinoma (p=0.002), and KPS = 80 (p=0.005) were associated with decreased overall survival rates. The rate of freedom from grade 3 or higher late toxicity at 5 years was 78%. The rates of grade 3 or higher late toxicity in 5 years were 29% and 7% in patients with and without surgery before radiation, respectively (p=0.07). Soft tissue toxicity was the most common with 9% of all patients developing grade 3 or higher soft tissue toxicity at 5 years.

Conclusion: Proton beam therapy results in encouraging outcome in patients with locally advanced 2 sinonasal malignancies. Prospective multi-institutional studies are necessary to further study the use of proton beam therapy in the treatment of this rare and aggressive malignancy.