Proton beam therapy for unresectable malignancies of the nasal cavity and paranasal sinuses.
OBJECTIVE
The cure rate for unresectable malignancies of the nasal cavity and paranasal sinuses is low. Because irradiation with proton beams, which are characterized by their rapid fall-off at the distal end of the Bragg peak and sharp lateral penumbra, depending on energy, depth, and delivery, provide better dose distribution than X-ray irradiation, proton beam therapy (PBT) might improve treatment outcomes for conditions located in proximity to risk organs. We retrospectively analyzed the clinical profile of PBT for unresectable malignancies of the nasal cavity and paranasal sinuses.


METHODS
We reviewed 39 patients in our database fulfilling the following criteria: unresectable malignant tumors of the nasal cavity, paranasal sinuses or skull base; N0M0 disease; and treatment with PBT (>60 GyE) from January 1999 to December 2006.


RESULTS
Median patient age was 57 years (range, 22-84 years); 22 of the patients were men and 17 were women. The most frequent primary site was the nasal cavity (n=26, 67%). The local control rates at 6 months and 1 year were 84.6% and 77.0%, respectively. With a median active follow-up of 45.4 months, 3-year progression-free and overall survival were 49.1% and 59.3%, respectively. The most common acute toxicities were mild dermatitis (Grade 2, 33.3%), but no severe toxicity was observed (Grade 3 or greater, 0%). Five patients (12.8%) experienced Grade 3 to 5 late toxicities, and one treatment-related death was reported, caused by cerebrospinal fluid leakage Grade 5 (2.6%).


CONCLUSIONS
These findings suggest that the clinical profile of PBT for unresectable malignancies of the nasal cavity and paranasal sinuses make it is a promising treatment option.
Division of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan. szenda@east.ncc.go.jp
Sadamoto
S
Zenda
Ryosuke
R
Kohno
Mitsuhiko
M
Kawashima
Satoko
S
Arahira
Teiji
T
Nishio
Makoto
M
Tahara
Ryuichi
R
Hayashi
Seiji
S
Kishimoto
Takashi
T
Ogino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D058958:Organs at Risk / Q000528:radiation effects*; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
D011522:Protons