title: Radiation therapy for sinonasal inverted papilloma.
abstract: OBJECTIVE
  We retrospectively reviewed long-term outcomes of patients with inverted papilloma (IP) treated with radiation therapy at our institution.
  
  
  METHODS
  From 1969 to 2008, 13 patients with advanced or recurrent IP (n = 12) or cylindrical papilloma (n = 1) were treated with radiation therapy. The median age at radiation therapy was 53 years old (range, 32-84). Nine patients received postoperative radiation therapy, 3 received definitive radiation therapy, and 1 received preoperative radiation therapy. Of the 10 patients treated with combined-modality treatment, 1 underwent craniofacial resection and 9 underwent open resection. Eight patients, 4 patients, and 1 patient received once-daily fractionation, twice-daily fractionation, and planned split-course radiation therapy, respectively, to a median dose of 65 Gy (range, 45.3-70.4 Gy).
  
  
  RESULTS
  The median follow-up was 16.2 years. Actuarial 15-year overall and cause-specific survival rates were 62% and 82%. Fifteen-year actuarial local and regional control rates were 45% and 73%. Fifteen-year local-regional control rates for IP alone and IP associated with squamous cell carcinoma (IP-SCC) at the time of treatment were 80% and 16%. Fifteen-year overall survival rates for IP alone and IP-SCC were 40% and 50%. The only severe treatment complication was a grade 3 central nervous system radionecrosis. The most common grade 1-2 toxicities were mucositis (61%), pain (46%), conjunctivitis (31%), xerostomia (31%), epiphora (31%), and anorexia (31%).
  
  
  CONCLUSIONS
  While surgery is the primary treatment for IP, radiation therapy should be considered in patients with SCC, multiply recurrent IPs, and incompletely resectable IP. Radiation therapy is associated with a relatively low risk of severe complications. Despite more aggressive treatment, local failure remains a considerable challenge.
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Michael
authors.initials: M
authors.lastname: Rutenberg
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kirwan
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.affiliation: Department of Otolaryngology, University of Florida, Gainesville, Florida.
authors.forename: John W
authors.initials: JW
authors.lastname: Werning
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida. Electronic address: mendwm@shands.ufl.edu.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall