title: Perioperative image-adapted brachytherapy for the treatment of paranasal sinus and nasal cavity malignancies.
abstract: OBJECTIVE
  Sinonasal malignancies are a rare group of cancers often associated with late presentation and poor prognosis. In the past, there was little progress regarding survival rate, and often, multimodal treatment regimens are required. The aim of this study was to evaluate the clinical outcome of perioperative image-adapted brachytherapy (IABT) as part of a multidisciplinary treatment regimen for the therapy of sinonasal cancer.
  
  
  METHODS
  Since 2006, patients with sinonasal cancer at the University Hospital of Schleswig-Holstein Campus Luebeck, Germany, were offered a multimodal treatment concept including head and neck surgery, perioperative IABT with or without external beam radiation therapy, and chemotherapy. In a retrospective study, such patients were analyzed for survival rate, tumor control, and toxicity of the interdisciplinary treatment.
  
  
  RESULTS
  Thirty-five consecutive patients were analyzed. The majority of patients (63%) were treated for a primary tumor and 62% presented with tumor Stages III-IV. The mean follow-up time with IABT was 28 months. Overall survival estimate was 72% after 3 years. Disease-specific survival, disease-free survival, and local control rates were 83%, 63%, and 67%, respectively. On univariate analysis, a significant better disease-free survival rate was found in patients treated for primary, but not recurrent, sinonasal cancer (p = 0.006). The overall treatment toxicities were mainly classified Grade I.
  
  
  CONCLUSIONS
  Interdisciplinary perioperative IABT is associated with excellent locoregional control and survival rates. IABT is well tolerated and shows low toxicity. Furthermore, visual acuity can be preserved in advanced cases. The implementation of perioperative IABT into multimodal treatment regimens improves the oncologic outcome.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Asklepios Klinik Altona, Hamburg, Germany. Electronic address: I.Teudt@asklepios.com.
authors.forename: Ingo U
authors.initials: IU
authors.lastname: Teudt
authors.affiliation: Department of Otolaryngology, Head, Neck and Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Jens E
authors.initials: JE
authors.lastname: Meyer
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Ritter
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wollenberg
authors.affiliation: Department of Otolaryngology, Head, Neck and Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kolb
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, City Hospital Cologne-Holweide, Cologne, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Maune
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck, Luebeck, Germany.
authors.forename: György
authors.initials: G
authors.lastname: Kovàcs
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy*; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009669:Nose Neoplasms / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Brachytherapy; Brachytherapy tube; Multimodal treatment; Nasal cavity cancer; Paranasal sinus cancer; Survival; Toxicity