Long-term Outcomes from Proton Therapy for Sinonasal Cancers
Purpose: To report long-term disease control, survival, and toxicity after proton therapy for sinonasal cancer. Patients and Methods: We reviewed 143 cases of adults with nonmetastatic sinonasal cancers treated with primary (18%; n = 26) or adjuvant (82%; n = 117) proton therapy. The most common his...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Particle Therapy Co-operative Group
2021-06-01
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| Series: | International Journal of Particle Therapy |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-20-00068.1 |
| _version_ | 1797203428841095168 |
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| author | Roi Dagan, MD, MS Haruka Uezono, MD Curtis Bryant, MD Adam L. Holtzman, MD Christopher G. Morris, MS William M. Mendenhall, MD |
| author_facet | Roi Dagan, MD, MS Haruka Uezono, MD Curtis Bryant, MD Adam L. Holtzman, MD Christopher G. Morris, MS William M. Mendenhall, MD |
| author_sort | Roi Dagan, MD, MS |
| collection | DOAJ |
| description | Purpose: To report long-term disease control, survival, and toxicity after proton therapy for sinonasal cancer.
Patients and Methods: We reviewed 143 cases of adults with nonmetastatic sinonasal cancers treated with primary (18%; n = 26) or adjuvant (82%; n = 117) proton therapy. The most common histologies were squamous cell carcinoma (29%; n = 42), olfactory neuroblastoma (23%; n = 33), and adenoid cystic carcinoma (16%; n = 23). Patients had predominantly advanced-stage disease (T3, 24%, n = 35; T4, 66%, n = 94) and high-grade histology (52%; n = 74). Surgery included endoscopic resection alone (50%) with craniotomy (10%) or open resection (40%), and 31% had gross disease present at radiotherapy. Most (91%) received high-dose (median, 73.6 Gy radiobiological equivalent [GyRBE]; 84% > 70 GyRBE) passive-scatter proton therapy using accelerated hyperfractionation (1.2 GyRBE twice daily) and concurrent chemotherapy (70%). Univariate and multivariate models assessed prognostic factors. Grade 3+ toxicities were recorded per Common Terminology Criteria, version 4. Median follow-up was 3.4 years (range, 0.1–12.5 years) overall and 4.9 years (range, 0.9–12.5 years) for living patients.
Results: The 5-year outcomes were as follows: local control (LC), 80%; neck control, 96%; local-regional control, 78%; freedom from distant metastases, 71%; and disease-free survival, 62%; cause-specific survival, 64%; and overall survival, 59%. Surgery improved LC, but only with gross total resection (5-year LC 87% versus subtotal resection 62.9%, and biopsy alone 55% (P < 0.001). Gross residual disease was the only significant prognostic factor for local-regional control on multivariate analysis. High-grade, T4, and local recurrence were associated with decreased overall survival. Late (G3+) toxicity occurred in 22% (32 of 143), including central nervous system necrosis and vision loss in 6% (9 of 143) and 3.5% (5 of 143), respectively.
Conclusion: Proton therapy after gross-total resection provides excellent long-term LC in patients with locally advanced, high-grade sinonasal cancer. Moreover, LC remains strongly associated with long-term survival. With gross disease, about 60% of patients had long-term LC with proton therapy and induction or concurrent chemotherapy. |
| first_indexed | 2024-04-24T08:19:11Z |
| format | Article |
| id | doaj.art-59928fbefea54bc899689b2377dcc556 |
| institution | Directory Open Access Journal |
| issn | 2331-5180 |
| language | English |
| last_indexed | 2024-04-24T08:19:11Z |
| publishDate | 2021-06-01 |
| publisher | Particle Therapy Co-operative Group |
| record_format | Article |
| series | International Journal of Particle Therapy |
| spelling | doaj.art-59928fbefea54bc899689b2377dcc5562024-04-17T02:25:11ZengParticle Therapy Co-operative GroupInternational Journal of Particle Therapy2331-51802021-06-018120021210.14338/IJPT-20-00068.1i2331-5180-8-1-200Long-term Outcomes from Proton Therapy for Sinonasal CancersRoi Dagan, MD, MSHaruka Uezono, MDCurtis Bryant, MDAdam L. Holtzman, MDChristopher G. Morris, MSWilliam M. Mendenhall, MDPurpose: To report long-term disease control, survival, and toxicity after proton therapy for sinonasal cancer. Patients and Methods: We reviewed 143 cases of adults with nonmetastatic sinonasal cancers treated with primary (18%; n = 26) or adjuvant (82%; n = 117) proton therapy. The most common histologies were squamous cell carcinoma (29%; n = 42), olfactory neuroblastoma (23%; n = 33), and adenoid cystic carcinoma (16%; n = 23). Patients had predominantly advanced-stage disease (T3, 24%, n = 35; T4, 66%, n = 94) and high-grade histology (52%; n = 74). Surgery included endoscopic resection alone (50%) with craniotomy (10%) or open resection (40%), and 31% had gross disease present at radiotherapy. Most (91%) received high-dose (median, 73.6 Gy radiobiological equivalent [GyRBE]; 84% > 70 GyRBE) passive-scatter proton therapy using accelerated hyperfractionation (1.2 GyRBE twice daily) and concurrent chemotherapy (70%). Univariate and multivariate models assessed prognostic factors. Grade 3+ toxicities were recorded per Common Terminology Criteria, version 4. Median follow-up was 3.4 years (range, 0.1–12.5 years) overall and 4.9 years (range, 0.9–12.5 years) for living patients. Results: The 5-year outcomes were as follows: local control (LC), 80%; neck control, 96%; local-regional control, 78%; freedom from distant metastases, 71%; and disease-free survival, 62%; cause-specific survival, 64%; and overall survival, 59%. Surgery improved LC, but only with gross total resection (5-year LC 87% versus subtotal resection 62.9%, and biopsy alone 55% (P < 0.001). Gross residual disease was the only significant prognostic factor for local-regional control on multivariate analysis. High-grade, T4, and local recurrence were associated with decreased overall survival. Late (G3+) toxicity occurred in 22% (32 of 143), including central nervous system necrosis and vision loss in 6% (9 of 143) and 3.5% (5 of 143), respectively. Conclusion: Proton therapy after gross-total resection provides excellent long-term LC in patients with locally advanced, high-grade sinonasal cancer. Moreover, LC remains strongly associated with long-term survival. With gross disease, about 60% of patients had long-term LC with proton therapy and induction or concurrent chemotherapy.https://theijpt.org/doi/pdf/10.14338/IJPT-20-00068.1proton therapyparticle therapyhead and neckoutcomessinonasal tumors |
| spellingShingle | Roi Dagan, MD, MS Haruka Uezono, MD Curtis Bryant, MD Adam L. Holtzman, MD Christopher G. Morris, MS William M. Mendenhall, MD Long-term Outcomes from Proton Therapy for Sinonasal Cancers International Journal of Particle Therapy proton therapy particle therapy head and neck outcomes sinonasal tumors |
| title | Long-term Outcomes from Proton Therapy for Sinonasal Cancers |
| title_full | Long-term Outcomes from Proton Therapy for Sinonasal Cancers |
| title_fullStr | Long-term Outcomes from Proton Therapy for Sinonasal Cancers |
| title_full_unstemmed | Long-term Outcomes from Proton Therapy for Sinonasal Cancers |
| title_short | Long-term Outcomes from Proton Therapy for Sinonasal Cancers |
| title_sort | long term outcomes from proton therapy for sinonasal cancers |
| topic | proton therapy particle therapy head and neck outcomes sinonasal tumors |
| url | https://theijpt.org/doi/pdf/10.14338/IJPT-20-00068.1 |
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