title: Feasibility of reirradiation of recurrent sinonasal carcinoma in the periorbital region using hypofractionated image-guided intensity-modulated radiation therapy.
abstract: BACKGROUND
  Recurrent periorbital tumors pose management challenges because they are often unresectable and chemorefractory. Proximity to critical structures renders reirradiation difficult. With image-guided intensity-modulated radiation therapy (IG-IMRT), real-time corrections to patient setup are possible, enabling significant shrinkage of planning target volume margins and safe dose escalation with hypofractionation. Here, we present our experience with hypofractionated IG-IMRT in a patient with multiply recurrent sinonasal carcinomas in the periorbital region.
  
  
  METHODS
  The patient is a 67-year-old woman with sinonasal carcinoma, treated with surgery and 2 prior courses of high-dose radiotherapy. She developed a second tumor recurrence in the right lateral orbit, which was reirradiated using hypofractionated IG-IMRT (24 Gy in 3 fractions).
  
  
  RESULTS
  Near-complete resolution of her ocular symptoms was observed at 4 months. Progress scans demonstrated a decrease in size of the orbital lesion.
  
  
  CONCLUSIONS
  Preliminary results of reirradiation using hypofractionated IG-IMRT suggest that it is safe and effective.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. thiagara@mskcc.org
authors.forename: Anuradha
authors.initials: A
authors.lastname: Thiagarajan
authors.forename: James
authors.initials: J
authors.lastname: Mechalakos
authors.forename: Nancy
authors.initials: N
authors.lastname: Lee
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D054893:Cone-Beam Computed Tomography; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D009669:Nose Neoplasms / Q000473:pathology; D009918:Orbital Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D010255:Paranasal Sinus Neoplasms / Q000473:pathology; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated