title: Carcinomas of the paranasal sinuses and nasal cavity treated with radiotherapy at a single institution over five decades: are we making improvement?
abstract: OBJECTIVE
  To compare clinical outcomes of patients with carcinomas of the paranasal sinuses and nasal cavity according to decade of radiation treatment.
  
  
  METHODS
  Between 1960 and 2005, 127 patients with sinonasal carcinoma underwent radiotherapy with planning and delivery techniques available at the time of treatment. Fifty-nine patients were treated by conventional radiotherapy; 45 patients by three-dimensional conformal radiotherapy; and 23 patients by intensity-modulated radiotherapy. Eighty-two patients (65%) were treated with radiotherapy after gross total tumor resection. Nineteen patients (15%) received chemotherapy. The most common histology was squamous cell carcinoma (83 patients).
  
  
  RESULTS
  The 5-year estimates of overall survival, local control, and disease-free survival for the entire patient population were 52%, 62%, and 54%, respectively. There were no significant differences in any of these endpoints with respect to decade of treatment or radiotherapy technique (p > 0.05, for all). The 5-year overall survival rate for patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s was 46%, 56%, 51%, 53%, and 49%, respectively (p = 0.23). The observed incidence of severe (Grade 3 or 4) late toxicity was 53%, 45%, 39%, 28%, and 16% among patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s, respectively (p = 0.01).
  
  
  CONCLUSIONS
  Although we did not detect improvements in disease control or overall survival for patients treated over time, the incidence of complications has significantly declined, thereby resulting in an improved therapeutic ratio for patients with carcinomas of the paranasal sinuses and nasal cavity.
authors: Department of Radiation Oncology, University of California, San Francisco (UCSF) Comprehensive Cancer Center, San Francisco, CA, USA. allenmchen@yahoo.com
authors: Allen M
authors: AM
authors: Chen
authors: Megan E
authors: ME
authors: Daly
authors: M Kara
authors: MK
authors: Bucci
authors: Ping
authors: P
authors: Xia
authors: Clayton
authors: C
authors: Akazawa
authors: Jeanne M
authors: JM
authors: Quivey
authors: Vivian
authors: V
authors: Weinberg
authors: Joaquin
authors: J
authors: Garcia
authors: Nancy Y
authors: NY
authors: Lee
authors: Michael J
authors: MJ
authors: Kaplan
authors: Ivan
authors: I
authors: El-Sayed
authors: David W
authors: DW
authors: Eisele
authors: Karen K
authors: KK
authors: Fu
authors: Theodore L
authors: TL
authors: Phillips
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009364:Neoplasm Recurrence, Local; D009669:Nose Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000517:prevention & control; D011878:Radiotherapy / Q000009:adverse effects / Q000639:trends; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome