title: Lymph node metastasis in sinonasal squamous cell carcinoma treated with IMRT/3D-CRT.
abstract: OBJECTIVE
  To analyze the patterns of neck and retropharyngeal lymph nodes (RPLNs) metastases with magnetic resonance imaging (MRI) in patients with sinonasal squamous cell carcinoma (SCC), and to explore the patterns of treatment failure treated with intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT). We also attempt to discuss the role of elective neck irradiation (ENI) in the treatment of cervical negative patients.
  
  
  METHODS
  Between July 2004 and February 2011, 59 patients with histopathologically proven sinonasal SCC were treated with curative intent at our hospital. Among them, 18 (30.5%) patients had neck or RPLN lymph node involvement at diagnosis. RPLN, level Ib, and level IIa were the most common sites of initial nodal involvement. All patients received IMRT or 3D-CRT, while 19 patients further received surgical resection, and other 40 patients received cisplatin based chemotherapy. Median follow-up durations were 28 months (range, 6-81 months) for the entire patient population and 40 months (range, 7-81 months) among the surviving patients, respectively.
  
  
  RESULTS
  The estimated 3-year local-regional control rate, distant-metastasis free survival rate, disease-free survival rate, and overall survival rate were 63.3%, 81.9%, 60.1%, and 68.9%, respectively. On multivariate analysis, old age (>60 years) significantly influenced the overall survival rate(HR=9.428, p=0.000). As for the pattern of treatment failures developed in 26 patients in the follow-up time, local failure, neck recurrence, and distant metastases were seen in 18, 7, and 9 patients, respectively. Level Ib and level IIa were the most common sites of cervical nodal recurrence. None of the 11 patients who received ENI developed failure in the neck.
  
  
  CONCLUSIONS
  For sinonasal SCC patients treated with IMRT or 3D-CRT, our results were generally consistent with findings of other studies, local failure still remain the predominant pattern of treatment failure. However, RPLN metastasis occurred more frequently than previously recognized through detection by MRI in our study. ENI seems to have effectively prevented regional relapse. We recommend ipsilateral level Ib and level IIa neck irradiation for T3-4 sinonasal SCC patients.
authors.affiliation: Department of Radiation Oncology, Cancer Center of Fudan University, Shanghai, China.
authors.forename: Xiyin
authors.initials: X
authors.lastname: Guan
authors.forename: Xiaoshen
authors.initials: X
authors.lastname: Wang
authors.forename: Yujie
authors.initials: Y
authors.lastname: Liu
authors.forename: Chaosu
authors.initials: C
authors.lastname: Hu
authors.forename: Guopei
authors.initials: G
authors.lastname: Zhu
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000556:secondary*; D002423:Cause of Death; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005005:Ethmoid Sinus / Q000473:pathology / Q000528:radiation effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000473:pathology / Q000532:radiotherapy; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology / Q000528:radiation effects; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin