Postoperative volumetric modulated arc therapy for sinonasal cancer: Improved survival compared with 3D conformal radiation therapy

Abstract

Background Prospective evaluation of the results of volumetric modulated arc therapy (VMAT) for sinonasal cancer compared to 3D conformal radiation therapy (3DCRT). Materials and Methods We prospectively evaluated 34 patients (pts) treated with postoperative VMAT with simultaneous integrated boost (SIB; RapidArc) from 2011 to 2015. These pts were retrospectively compared with 24 pts treated with 3DCRT from 2003 to 2011. The two sets were not significantly different on sex, mean age, tumor site, stage, histology. Efficacy and toxicity were evaluated. Results Median follow‐up was 45 months (range: 6‐143 months). Three‐year overall survival was 85.2% in VMAT‐SIB versus 65.2% in 3DCRT (P = .02). Three‐year local control was 81.2% in VMAT‐SIB versus 62.5% in 3DCRT (P = .04). There was a reduction of acute (<0.09) and late (0.03) ocular toxicity of grade ≥ 2 for pts with VMAT‐SIB. Conclusion VMAT significantly improved local control and overall survival in sinonasal cancer with lower rate of toxicity.

Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery

“…Similar or lower rate of acute toxicities not reaching significance have been observed with IMRT compared to 3D radiotherapy [38]. Fewer [6] (by about 20% compared with 3D radiotherapy) or less severe late toxicities have been reported [36,38]. Severe late radiationinduced toxicities have decreased in rate from about 50% of patients in the 1960s, 35-40% in the 1980s, and 15% in the 2000s and severe (grade 3+) to less debilitating (grade 2 or higher), yet bothersome symptoms.…”

“…Similar or lower rate of acute toxicities not reaching significance have been observed with IMRT compared to 3D radiotherapy [38]. Fewer [6] (by about 20% compared with 3D radiotherapy) or less severe late toxicities have been reported [36,38].…”

“…Most series are retrospective and consist of 50–200 patients. IMRT (including volumetric arc therapy) has consistently shown better 3-year locoregional recurrence-free survival rates by 20–30% compared with 3D conformal RT for carcinomas (89% vs. 60%; p = 0.035 [ 31 ], 85% vs. 65%, p = 0.02) [ 36 , 38 ]. For inoperable T4 paranasal sinus and skull-base tumors, the steep dose-gradient between tumor and normal tissue is even more advantageous, given the crucial need to maintain dose intensity to the tumor [ 39 ].…”

“…While early IMRT series may have underestimated toxicity rates [ 43 , 44 , 45 , 46 , 47 ], other series report grade ≥ 2 late toxicities in the order of 28% [ 36 ]. Grade 2+ visual deterioration is reported in about 12–20% of patients [ 36 , 38 , 48 , 49 , 50 ]; 63% impaired olfactory function [ 50 ]; ear loss in 8–46% [ 5 , 51 , 52 ]); hormonal deficiencies in 22–62% including hypopituitarism in 24% [ 50 , 53 ]; cognitive dysfunction in up to 77% affecting short-term memory and speech; and fatigue in 18% [ 54 , 55 ]. According to Hamilton et al, sinonasal neoplasms are associated with significant symptoms during RT including pain, mucositis and dysgeusia [ 56 ].…”

Toxicidade aguda em cavidade oral e glândulas salivares em pacientes submetidos à arcoterapia volumétrica modulada na região de cabeça e pescoço

“…Os resultados clínicos da VMAT para CCPs ainda são incertos, em função do baixo número de artigos científicos publicados que abordam detalhadamente as toxicidades agudas e tardias desta técnica (Osborn, 2017). Para os cânceres de sinonasais (Frederic-Moreau et al, 2019) e de nasofaringe (Fang et al, 2019), a…”