Intra-arterial cisplatin and concomitant radiation therapy followed by surgery for advanced paranasal sinus cancer.
OBJECTIVE
To report the long-term efficacy of a combined regimen of intra-arterial high-dose cisplatin chemotherapy and concomitant radiation therapy followed by organ-sparing surgery when possible in the treatment of advanced paranasal sinus cancer.


METHODS
Review of prospectively collected data.


METHODS
Academic referral center. Patients Nineteen patients with advanced paranasal sinus malignancies with a minimum follow-up of 2 years. Malignancies included 14 squamous cell carcinomas (74%), 2 adenocarcinomas (10%), 2 adenoid cystic carcinomas (10%), and 1 undifferentiated carcinoma (5%). Sixteen patients (84%) had T4 disease. Intervention Treatment consisted of preoperative radiation therapy (2.0 Gy/fraction per day; total dose, 50 Gy in 5 weeks) given concomitantly with 3 to 4 weekly infusions of intra-arterial cisplatin (150 mg/m(2) per week) and systemic sodium thiosulfate neutralization. The regimen included planned surgery performed approximately 8 weeks after completion of radiation therapy. Ten patients underwent a transcranial anterior craniofacial resection; 1, a medial maxillectomy; and 1, an endoscopic restaging only.


RESULTS
After a median follow-up of 53 months, actuarial overall survival at 2 and 5 years was 68% and 53%, respectively. One patient died of myocardial infarction during treatment. No other treatment-limiting toxic effect was noted. Although 3 patients had persistence of disease, delayed local failure occurred only in 2 and distant metastasis in 3. Except for cataract in 2 patients, no visual loss developed.


CONCLUSIONS
Despite the advanced stage and unfavorable nature of cancer in this cohort, our results indicate that this regimen holds promise and merits further study.
Department of Otolaryngology--Head and Neck Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, USA. ssamant@utmem.edu
Sandeep
S
Samant
K Thomas
KT
Robbins
M
M
Vang
Jim
J
Wan
J
J
Robertson
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003528:Carcinoma, Adenoid Cystic / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005005:Ethmoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D011829:Radiation Dosage; D011881:Radiotherapy, Computer-Assisted; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin