title: Carbon ion therapy for advanced sinonasal malignancies: feasibility and acute toxicity.
abstract: OBJECTIVE
  To evaluate feasibility and toxicity of carbon ion therapy for treatment of sinonasal malignancies. First site of treatment failure in malignant tumours of the paranasal sinuses and nasal cavity is mostly in-field, local control hence calls for dose escalation which has so far been hampered by accompanying acute and late toxicity. Raster-scanned carbon ion therapy offers the advantage of sharp dose gradients promising increased dose application without increase of side-effects.
  
  
  METHODS
  Twenty-nine patients with various sinonasal malignancies were treated from 11/2009 to 08/2010. Accompanying toxicity was evaluated according to CTCAE v.4.0. Tumor response was assessed according to RECIST.
  
  
  RESULTS
  Seventeen patients received treatment as definitive RT, 9 for local relapse, 2 for re-irradiation. All patients had T4 tumours (median CTV1 129.5 cc, CTV2 395.8 cc), mostly originating from the maxillary sinus. Median dose was 73 GyE mostly in mixed beam technique as IMRT plus carbon ion boost. Median follow-up was 5.1 months [range: 2.4-10.1 months]. There were 7 cases with grade 3 toxicity (mucositis, dysphagia) but no other higher grade acute reactions; 6 patients developed grade 2 conjunctivits, no case of early visual impairment. Apart from alterations of taste, all symptoms had resolved at 8 weeks post RT. Overall radiological response rate was 50% (CR and PR).
  
  
  CONCLUSIONS
  Carbon ion therapy is feasible; despite high doses, acute reactions were not increased and generally resolved within 8 weeks post radiotherapy. Treatment response is encouraging though follow-up is too short to estimate control rates or evaluate potential late effects. Controlled trials are warranted.
authors.affiliation: Dept of Radiation Oncology INF 400 69120 Heidelberg, Germany. alexandra.jensen@med.uni-heidelberg.de
authors.forename: Alexandra D
authors.initials: AD
authors.lastname: Jensen
authors.forename: Anna V
authors.initials: AV
authors.lastname: Nikoghosyan
authors.forename: Swantje
authors.initials: S
authors.lastname: Ecker
authors.forename: Malte
authors.initials: M
authors.lastname: Ellerbrock
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Marc W
authors.initials: MW
authors.lastname: Münter
mesh_terms: D000328:Adult; D000368:Aged; D002250:Carbon Radioisotopes / Q000627:therapeutic use*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D009669:Nose Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
chemical_list: D002250:Carbon Radioisotopes