Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO
Sinonasal cancers (SNCs) are rare and heterogeneous in histology and biological behavior. The prognosis is generally unfavorable, especially in inoperable cases. In recent years, for some histologies, such as undifferentiated sinonasal carcinoma (SNUC), multimodal treatment with a combination of ind...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/7/2624 |
| _version_ | 1797607641238732800 |
|---|---|
| author | Barbara Vischioni Rossana Ingargiola Maria Bonora Sara Ronchi Anna Maria Camarda Stefania Russo Eleonora Rossi Giuseppe Magro Alfredo Mirandola Ester Orlandi |
| author_facet | Barbara Vischioni Rossana Ingargiola Maria Bonora Sara Ronchi Anna Maria Camarda Stefania Russo Eleonora Rossi Giuseppe Magro Alfredo Mirandola Ester Orlandi |
| author_sort | Barbara Vischioni |
| collection | DOAJ |
| description | Sinonasal cancers (SNCs) are rare and heterogeneous in histology and biological behavior. The prognosis is generally unfavorable, especially in inoperable cases. In recent years, for some histologies, such as undifferentiated sinonasal carcinoma (SNUC), multimodal treatment with a combination of induction chemotherapy, surgery, and chemo/radiotherapy (RT) has improved the prognosis. Nevertheless, still about half of the patients treated incur a recurrence, in most of the cases at the local site. Surgery with and without RT is usually the treatment choice in cases of recurrence after previous RT in combination with systemic therapy or RT in a histology-driven fashion. In the case of inoperable disease or contraindications to surgery, RT is still a valid treatment option. In this context, hadron therapy with protons (PT) or carbon ions (CIRT) is often preferred due to the physical and biological characteristics of charged particles, allowing the administration of high doses to the tumor target while sparing the surrounding healthy tissues and potentially limiting the side effects due to the high cumulative dose. In the absence of a standard of care for the recurrent setting, we aimed to investigate the role of re-RT with PT or CIRT. We retrospectively analysed 15 patients with recurrent, previously irradiated, SNCs treated at our institution between 2013 and 2020. Local control (LC) and overall survival (OS) were estimated by the Kaplan–Meier method. Acute and late toxicities were scored according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events CTCAE version 5.0. A total of 13 patients received CIRT and 2 patients received PT. The median re-RT dose was 54 GyRBE (range 45–64 GyRBE) delivered in 3 or 4 GyRBE/fr (fraction) for the CIRT, and 2 Gy RBE/fr for the PT schedule. LC was 44% at the 1-year follow-up and 35.2% at the 3-year follow-up. OS at 1 and 3 years were 92.9% and 38.2%, respectively. Fourteen patients developed G1–G2 acute toxicity (dermatitis and mucositis), and no patients developed G3–G5. Regarding late toxicity, 10 patients encountered at maximum G1–2 events, and 4 did not experience any toxicity. Only for one patient G3 late toxicity was reported (dysphagia requiring a percutaneous endoscopic gastrostomy). |
| first_indexed | 2024-03-11T05:32:44Z |
| format | Article |
| id | doaj.art-57443c5bb3ae4af08e409ead49e980fa |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T05:32:44Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-57443c5bb3ae4af08e409ead49e980fa2023-11-17T16:59:46ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01127262410.3390/jcm12072624Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAOBarbara Vischioni0Rossana Ingargiola1Maria Bonora2Sara Ronchi3Anna Maria Camarda4Stefania Russo5Eleonora Rossi6Giuseppe Magro7Alfredo Mirandola8Ester Orlandi9Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyMedical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyMedical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyMedical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyMedical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalySinonasal cancers (SNCs) are rare and heterogeneous in histology and biological behavior. The prognosis is generally unfavorable, especially in inoperable cases. In recent years, for some histologies, such as undifferentiated sinonasal carcinoma (SNUC), multimodal treatment with a combination of induction chemotherapy, surgery, and chemo/radiotherapy (RT) has improved the prognosis. Nevertheless, still about half of the patients treated incur a recurrence, in most of the cases at the local site. Surgery with and without RT is usually the treatment choice in cases of recurrence after previous RT in combination with systemic therapy or RT in a histology-driven fashion. In the case of inoperable disease or contraindications to surgery, RT is still a valid treatment option. In this context, hadron therapy with protons (PT) or carbon ions (CIRT) is often preferred due to the physical and biological characteristics of charged particles, allowing the administration of high doses to the tumor target while sparing the surrounding healthy tissues and potentially limiting the side effects due to the high cumulative dose. In the absence of a standard of care for the recurrent setting, we aimed to investigate the role of re-RT with PT or CIRT. We retrospectively analysed 15 patients with recurrent, previously irradiated, SNCs treated at our institution between 2013 and 2020. Local control (LC) and overall survival (OS) were estimated by the Kaplan–Meier method. Acute and late toxicities were scored according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events CTCAE version 5.0. A total of 13 patients received CIRT and 2 patients received PT. The median re-RT dose was 54 GyRBE (range 45–64 GyRBE) delivered in 3 or 4 GyRBE/fr (fraction) for the CIRT, and 2 Gy RBE/fr for the PT schedule. LC was 44% at the 1-year follow-up and 35.2% at the 3-year follow-up. OS at 1 and 3 years were 92.9% and 38.2%, respectively. Fourteen patients developed G1–G2 acute toxicity (dermatitis and mucositis), and no patients developed G3–G5. Regarding late toxicity, 10 patients encountered at maximum G1–2 events, and 4 did not experience any toxicity. Only for one patient G3 late toxicity was reported (dysphagia requiring a percutaneous endoscopic gastrostomy).https://www.mdpi.com/2077-0383/12/7/2624sinonasal cancerreirradiationparticle therapycarbon ionproton therapyhead and neck |
| spellingShingle | Barbara Vischioni Rossana Ingargiola Maria Bonora Sara Ronchi Anna Maria Camarda Stefania Russo Eleonora Rossi Giuseppe Magro Alfredo Mirandola Ester Orlandi Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO Journal of Clinical Medicine sinonasal cancer reirradiation particle therapy carbon ion proton therapy head and neck |
| title | Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO |
| title_full | Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO |
| title_fullStr | Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO |
| title_full_unstemmed | Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO |
| title_short | Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO |
| title_sort | particle reirradiation of malignant epithelial and neuroectodermal sinonasal tumors a case series from cnao |
| topic | sinonasal cancer reirradiation particle therapy carbon ion proton therapy head and neck |
| url | https://www.mdpi.com/2077-0383/12/7/2624 |
| work_keys_str_mv | AT barbaravischioni particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT rossanaingargiola particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT mariabonora particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT sararonchi particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT annamariacamarda particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT stefaniarusso particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT eleonorarossi particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT giuseppemagro particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT alfredomirandola particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao AT esterorlandi particlereirradiationofmalignantepithelialandneuroectodermalsinonasaltumorsacaseseriesfromcnao |