Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons.
OBJECTIVE
To investigate the visual outcomes of patients with advanced sinonasal malignancies treated with proton/photon accelerated fractionated radiation (AFR).


METHODS
Between 1991 and 2001, AFR was used to treat 36 patients with advanced stage primary (n=33) or recurrent (n=3) nasal or paranasal malignant tumors. Full ophthalmologic follow-up was documented. The median dose to the gross tumor volume (GTV) was 69.6 CGE (range 60.8-77). Visual complications were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) and the late effects of normal tissue (LENT) scoring systems. The median follow-up was 52.4 months (range 17-122.8).


RESULTS
Thirteen patients developed late visual/ocular toxicity. Cataracts were LENT grade 1 and 3 in 2 patients and 1 patient, respectively. One LENT grade 1 vascular retinopathy and 1 optic neuropathy were also observed. Three and five patients presented with nasolacrimal duct stenosis (CTC grade 2, 2 patients; CTC grade 3, 1 patient) and dry-eye syndrome (CTC grade 1, 1 patient; CTC grade 2, 4 patients), respectively. The 3- and 5-year probability of LENT/CTC grade > or =2 visual toxicity were 15.8+/-6.7% and 20.7+/-7.8%, respectively.


CONCLUSIONS
AFR for locally advanced nasal cavity and paranasal sinus tumors enables delivery of 70 CGE to the tumor with acceptable ophthalmologic complications.
Weber
Damien C
DC
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. damien.weber@hcuge.ch
Chan
Annie W
AW
Lessell
Simmons
S
McIntyre
James F
JF
Goldberg
Saveli I
SI
Bussiere
Marc R
MR
Fitzek
Markus M
MM
Thornton
Allan F
AF
Delaney
Thomas F
TF
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000532:radiotherapy; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D005128:Eye Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000150:complications / Q000532:radiotherapy*; D017785:Photons / Q000627:therapeutic use*; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D011522:Protons
D011522:Protons