Results of Proton Beam Radiotherapy for Locally Advanced Squamous Cell Carcinoma of the Paranasal Sinus

• Main Authors: Truong, Minh T, Lin, Derrick T, Curry, William T, Kamat, Urmila R, Chan, Annie W
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2008-1093181

Objective: To evaluate the treatment outcome and potential prognostic factors in patients with locally advanced squamous cell carcinomas (SCC) of the paranasal sinus with highly conformal proton radiotherapy (RT) and surgery. Methods: Between 1991 and 2005, 51 patients with locally advanced (T3 to 4) nonmetastatic SCC of the paranasal sinus received 3D conformal proton RT at the Massachusetts General Hospital. The median age was 56 years (range, 17 to 82 years). The median Karnofsky Performance Status (KPS) was 90. Thirty-one percent of patients underwent gross total resection (GTR) before RT. The median radiation dose to the primary tumor volume was 72 Gray-Equivalent (GyE)(range, 59.4 to 79.4) over 44 days. The median follow-up for all living patients was 48 months. Results: As the first site of failure, 7, 7, and 12 patients developed local, regional, and distant metastasis, respectively. Of the distant recurrences, 6 were leptomeningeal and 6 were systemic. The 3-year actuarial rates of local, regional, and freedom-from-distant-metastasis were 76%, 82%, and 72%, respectively. The disease-free survival and overall survival (OS) rates at 3 years were 37% and 52%, respectively. In multivariate analysis, a higher KPS, a GTR with negative margins, and a higher percentage of protons (70% or more) were significant for predicting improved OS. There were no Common-Toxicity-Criteria grade 3 to 5 ocular RT-induced toxicities. Conclusions: Multimodality therapy with resection, attaining a GTR and proton RT, results in promising local control and survival for patients with locally advanced SCC of the paranasal sinus, with acceptable toxicity.