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

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.

Oncology for the rhinologist

“…Esthesioneuroblastoma had higher 2-year PFS (91.7% vs. 57.0%), OS (91.7 vs. 64.5%) compared to SNEC. The authors’ previous studies reported a 75% rate or recurrence within 2 years [14,15].…”