Stage III-IV Sinonasal and Nasal Cavity Carcinoma Treated with Three-Dimensional Conformal Radiotherapy

Gabriele, Anna Maria; Airoldi, Mario; Garzaro, Massimiliano; Zeverino, M.; Amerio, Simonetta; Condello, Cecilia; Trotti, Alessandro Boidi

doi:10.1177/030089160809400306

Cited by 22 publications

(21 citation statements)

References 23 publications

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“…This pattern of early locoregional failure is consistent with previous literature [9, 12, 22]. By reducing the bulk of the tumour, induction chemotherapy facilitates surgery and also reduces the area of high risk CTV (critical tumour volume) in radiation planning.…”

Section: Discussionsupporting

confidence: 91%

“…As seen in Table 3, the studies are mostly retrospective case series which have low numbers, patients treated over decades, and both early and late stage carcinoma maxilla and include patients with malignancy of other paranasal sinuses [4–7, 9, 12, 15–22]. The available data suggests that in locally advanced tumours, surgery followed by radiation leads to better outcomes than radical radiation alone [5–8, 12]. There have been some studies on concurrent chemoradiation too that have shown benefit [4].…”

Section: Discussionmentioning

confidence: 99%

“…These patients have traditionally been treated with radical radiotherapy, with or without concurrent chemotherapy. The 5-year overall survival in this subgroup of patients is dismal, around 9–25% [7, 9, 12]. Considering such results, there is an urgent need for a new treatment paradigm for patients with maxillary carcinomas, especially in patents with unresectable disease or those who will require morbid resections.…”

Section: Introductionmentioning

confidence: 99%

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Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus

Noronha

Patil

Joshi

et al. 2014

Chemotherapy Research and Practice

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Background. Locally advanced carcinoma of maxillary sinus has been historically reported to have poor prognosis. We evaluated the role of NACT in improving the outcome in these patients. Methods. 41 patients with locally advanced technically unresectable (stage IVa) or unresectable maxillary carcinoma (stage IVb) were treated with induction chemotherapy between 2008 and 2011. The demographic profile, response and toxicity of chemotherapy, definitive treatment received, progression free survival (PFS), and overall survival (OS) were analyzed. Univariate and multivariate analysis were performed to determine factors associated with PFS and OS. Results. The chemotherapy included two drugs (platinum and taxane) in 34 patients (82.9%) and three drugs (platinum, taxane, and 5 FU) in 7 (17.1%). There was no complete response seen in any of the patients, stable disease in 18 (43.9%), partial response in 16 (39%), and progression in 7 (17.1%) patients. After induction, the treatment planned included surgery in 12 (29.3%), CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%), and palliative chemotherapy in 3 (7.3%) patients. Overall, the median PFS was 10.0 months. The OS at 24 months and 36 months was 41% and 35%, respectively. Conclusion. In unresectable maxillary carcinoma, induction chemotherapy has clinically significant benefit with acceptable toxicity.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus

Noronha

Patil

Joshi

et al. 2014

Chemotherapy Research and Practice

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“…We believe that our approach might help improve outcomes especially in patients with cancers of the oral cavity, maxillary sinus and hypopharynnx. [18,[23][24][25][26][27][28][29][30][31][32][33][34] These sites have traditionally had poor outcomes with chemoradiation alone. Recent reports from major centers in India appear to show benefit with NACT.…”

Section: Discussionmentioning

confidence: 99%

Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center

Patil¹,

Noronha²,

Joshi³

et al. 2014

Indian J Cancer

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“…In the IMRT plan without water-filled balloons, a significant underdosage region in the ethmoid sinus was observed despite not employing stringent dosimetric constraints for ipsilateral vision (Figure 5). It was reported that patients with infrastructural involvement had significantly higher survival rates compared to patients with suprastructural involvement[16],[17]. According to the 2010 AJCC clinical staging system, only advanced stage tumors involve suprastructures of the maxillary sinus.…”

Section: Discussionmentioning

confidence: 99%

Water-filled balloon in the postoperative resection cavity improves dose distribution to target volumes in radiotherapy of maxillary sinus carcinoma

Zhang¹,

Lin²,

He³

et al. 2011

Chin J Cancer

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Postoperative radiotherapy is a major treatment for patients with maxillary sinus carcinoma. However, the irregular resection cavity poses a technical difficulty for this treatment, causing uneven dose distribution to target volumes. In this study, we evaluated the dose distribution to target volumes and normal tissues in postoperative intensity-modulated radiotherapy (IMRT) after placing a water-filled balloon into the resection cavity. Three postoperative patients with advanced maxillary sinus carcinoma were selected in this trial. Water-filled balloons and supporting dental stents were fabricated according to the size of the maxillary resection cavity. Simulation CT scans were performed with or without water-filled balloons, IMRT treatment plans were established, and dose distribution to target volumes and organs at risk were evaluated. Compared to those in the treatment plan without balloons, the dose (D98) delivered to 98% of the gross tumor volume (GTV) increased by 2.1 Gy (P = 0.009), homogeneity index (HI) improved by 2.3% (P = 0.001), and target volume conformity index (TCI) of 68 Gy increased by 18.5% (P = 0.011) in the plan with balloons. Dosimetry endpoints of normal tissues around target regions in both plans were not significantly different (P > 0.05) except for the optic chiasm. In the plan without balloons, 68 Gy high-dose regions did not entirely cover target volumes in the ethmoid sinus, posteromedial wall of the maxillary sinus, or surgical margin of the hard palate. In contrast, 68 Gy high-dose regions entirely covered the GTV in the plan with balloons. These results suggest that placing a water-filled balloon in the resection cavity for postoperative IMRT of maxillary sinus carcinoma can reduce low-dose regions and markedly and simultaneously increase dose homogeneity and conformity of target volumes.

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Stage III-IV Sinonasal and Nasal Cavity Carcinoma Treated with Three-Dimensional Conformal Radiotherapy

Abstract: The local control rate for these tumors remains low. The prognosis depends on localization, tumor stage and treatment modality. Three-dimensional conformal radiotherapy reduces the risk on optical pathways but does not modify outcome.

Cited by 22 publications

References 23 publications

Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus

Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus

Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center

Water-filled balloon in the postoperative resection cavity improves dose distribution to target volumes in radiotherapy of maxillary sinus carcinoma

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