title: Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities.
abstract: OBJECTIVE
  To evaluate long-term outcomes and toxicity in patients with unresectable paranasal sinus carcinoma treated with radiotherapy, with or without chemotherapy.
  
  
  METHODS
  Between January 1990 and December 2006, 39 patients with unresectable Stage IVB paranasal sinus carcinoma were treated definitively with chemotherapy plus radiotherapy (n = 35, 90%) or with radiotherapy alone (n = 4, 10%). Patients were treated with three-dimensional conformal radiotherapy (n = 18, 46%), intensity-modulated radiotherapy (n = 12, 31%), or conventional radiotherapy (n = 9, 23%) to a median treatment dose of 70 Gy. Most patients received concurrent platinum-based chemotherapy (n = 32, 82%) and/or concomitant boost radiotherapy (n = 29, 74%).
  
  
  RESULTS
  With a median follow-up of 90 months, the 5-year local progression-free survival, regional progression-free survival, distant metastasis-free survival, disease-free survival, and overall survival were 21%, 61%, 51%, 14%, and 15%, respectively. Patients primarily experienced local relapse (n = 25, 64%), mostly within the irradiated field (n = 22). Nine patients developed neck relapses; however none of the 4 patients receiving elective neck irradiation had a nodal relapse. In 13 patients acute Grade 3 mucositis developed. Severe late toxicities occurred in 2 patients with radionecrosis and 1 patient with unilateral blindness 7 years after intensity-modulated radiation therapy (77 Gy to the optic nerve). The only significant factor for improved local progression-free survival and overall survival was a biologically equivalent dose of radiation >/=65 Gy.
  
  
  CONCLUSIONS
  Treatment outcomes for unresectable paranasal sinus carcinoma are poor, and combined-modality treatment is needed that is both more effective and associated with less morbidity. The addition of elective neck irradiation may improve regional control.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Nelson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Stegman
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Wu
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.forename: David G
authors.initials: DG
authors.lastname: Pfister
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D018579:Patient Selection; D017671:Platinum Compounds / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D016019:Survival Analysis; D017741:Survivors; D055815:Young Adult
chemical_list: D017671:Platinum Compounds