title: Intensity modulated radiation therapy (IMRT) for sinonasal tumors: a single center long-term clinical analysis.
abstract: BACKGROUND
  Radiotherapy has a central role in the treatment of sinonasal malignancies, either as postoperative or as primary therapy. To study the efficacy and safety of intensity modulated radiotherapy (IMRT) for sinonasal tumors a single center retrospective evaluation focusing on survival and therapy related toxicity was performed.
  
  
  METHODS
  One hundred twenty two patients with primary (n = 82) or recurrent (n = 40) malignant sinonasal tumors were treated with intensity modulated radiotherapy between 1999 and 2009 at the University Clinic of Heidelberg and the German Cancer Research Center and retrospectively analyzed. Most patients had adenoid cystic carcinomas (n = 47) or squamous cell carcinoma (n = 26). 99 patients received postoperative radiotherapy. The median total dose was 64 Gy in conventional fractionation (1.8-2 Gy). Overall survival (OS), progression free survival (PFS) and local recurrence free survival (LRFS) rates were calculated using the Kaplan-Meier method. The log-rank test and Fishers Exact test were applied for univariate analysis, Cox-regression was used for multivariate analysis.
  
  
  RESULTS
  Median follow up was 36 months. 1-, 3- and 5-year estimated overall survival rates were 90, 70 and 54 % respectively. Median progression free survival and local recurrence free survival was 45 and 63 months respectively. Progression free survival and local recurrence free survival at 1, 3 and 5 years were 76, 57 and 47, and 79, 60 and 51 % respectively. 19 patients (15.5 %) were diagnosed with distant metastases. Univariate analysis revealed significantly improved OS and LRFS for treatment of tumors after primary diagnosis, first series of irradiation and radiation dose ≥60 Gy. Multivariate analysis revealed only treatment in primary situation as an independent prognostic factor for OS and LRFS. Acute CTC grade III mucositis was seen in 5 patients (4.1 %) and CTC grade II dysgeusia in 19 patients (15.6 %). Dysgeusia, dysosmia and ocular toxicity were the most common late adverse events.
  
  
  CONCLUSIONS
  Our data support the results of previous studies and indicate that intensity modulated radiation therapy (IMRT) represents an effective and safe treatment approach for patients with sinonasal carcinomas.
authors: CCU Mol&Radiation Oncology, German Cancer Research Center (DKFZ), 280 INF, Heidelberg, 69120, Germany. v.askoxylakis@gmail.com.
authors: Vasileios
authors: V
authors: Askoxylakis
authors: CCU Mol&Radiation Oncology, German Cancer Research Center (DKFZ), 280 INF, Heidelberg, 69120, Germany. p.hegenbarth@dkfz.de.
authors: Pia
authors: P
authors: Hegenbarth
authors: CCU Mol&Radiation Oncology, German Cancer Research Center (DKFZ), 280 INF, Heidelberg, 69120, Germany. c.timke@dkfz.de.|Department of Radiation Oncology, Malteserkrankenhaus, Flensburg, Germany. c.timke@dkfz.de.
authors: Carmen
authors: C
authors: Timke
authors: CCU Mol&Radiation Oncology, German Cancer Research Center (DKFZ), 280 INF, Heidelberg, 69120, Germany. Ladan.SalehEbrahimi@med.uni-muenchen.de.|Department of Radiation Oncology, University Hospital of Munich (LMU), Munich, Germany. Ladan.SalehEbrahimi@med.uni-muenchen.de.
authors: Ladan
authors: L
authors: Saleh-Ebrahimi
authors: Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. Juergen.debus@med.uni-heidelberg.de.
authors: Juergen
authors: J
authors: Debus
authors: CCU Mol&Radiation Oncology, German Cancer Research Center (DKFZ), 280 INF, Heidelberg, 69120, Germany. Falk.Roeder@med.uni-muenchen.de.|Department of Radiation Oncology, University Hospital of Munich (LMU), Munich, Germany. Falk.Roeder@med.uni-muenchen.de.
authors: Falk
authors: F
authors: Röder
authors: CCU Mol&Radiation Oncology, German Cancer Research Center (DKFZ), 280 INF, Heidelberg, 69120, Germany. p.huber@dkfz.de.|Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. p.huber@dkfz.de.
authors: Peter E
authors: PE
authors: Huber
mesh_terms: D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011184:Postoperative Period; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult