BACKGROUND: The objective was to evaluate the efficacy and toxicity of curative radiotherapy in patients with sinonasal carcinoma and to identify prognostic factors influencing treatment outcomes. MATERIALS AND METHODS: The authors conducted a retrospective study of 61 consecutive patients treated with postoperative or definitive radiotherapy from 2002 to 2018 (median age 59 years, current/former smokers 71%, maxillary sinus 67%, nasal cavity 26%). The majority of patients were diagnosed with locally advanced disease (85% clinical stage ≥ III). Regional cervical metastases were initially diagnosed in 23% of patients. The most common histology was squamous cell carcinoma (61%). Radiation therapy was preceded by radical surgery in 64% of patients. 29 patients received chemotherapy (48%). RESULTS: The median follow-up was 53 months. The median total dose of radiotherapy achieved was 70 Gy. The 5- and 10-year locoregional control, distant control, overall survival, and disease-free survival were 74% and 64%, 90% and 90%, 51% and 35%, and 38% and 25%, respectively. Severe acute toxicity occurred in 36%, severe late toxicity in 23% of patients. Severe unilateral visual impairment occurred in 6 patients, temporal lobe necrosis in 1 patient, and osteoradionecrosis requiring surgery in 2 patients. CONCLUSION: The results of the study demonstrated the high effectiveness of curative treatment in patients with sinonasal carcinoma with long-term locoregional and distant control. The multivariate analysis indicated that N-staging, age, comorbidity score [as assessed by Adult Comorbidity Evaluation 27 (ACE-27)] and initial response to treatment were the strongest prognostic factors.

Department of Otorhinolaryngology Bulovka University Hospital Prague Czech Republic

Department of Radiation Oncology Bulovka University Hospital Institute of Radiation Oncology Prague Czech Republic

Radiophysics Department Bulovka University Hospital Prague Czech Republic

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Golusinski W, Leszczyńska M, Waśeniewska E, et al. [Why do maxillary-ethmoidal massive tumours need combined therapy?]. Rep Practic Oncol Radiother. 2004;9(6):253–256. doi: 10.1016/s1507-1367(04)71036-6. DOI

Le QT, Fu KK, Kaplan M, et al. Treatment of maxillary sinus carcinoma: a comparison of the 1997 and 1977 American Joint Committee on cancer staging systems. Cancer. 1999;86(9):1700–1711. PubMed

Jansen EP, Keus RB, Hilgers FJ, et al. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys. 2000;48(1):27–35. doi: 10.1016/s0360-3016(00)00594-0. PubMed DOI

Blanco AI, Chao KS, Ozyigit G, et al. Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy. Int J Radiat Oncol Biol Phys. 2004;59(1):51–58. doi: 10.1016/j.ijrobp.2003.09.101. PubMed DOI

Dirix P, Nuyts S, Geussens Y, et al. Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(4):1042–1050. doi: 10.1016/j.ijrobp.2007.04.044. PubMed DOI

Takes RP, Ferlito A, Silver CE, et al. Biologically aggressive papillomas of the nasal cavity: the role of radiation therapy. Laryngoscope. 1985;95(3):344–347. doi: 10.1288/00005537-198503000-00022. PubMed DOI

Paulino AC, Fisher SG, Marks JE. Is prophylactic neck irradiation indicated in patients with squamous cell carcinoma of the maxillary sinus? Int J Radiat Oncol Biol Phys. 1997;39(2):283–289. doi: 10.1016/s0360-3016(97)00293-9. PubMed DOI

Bhattacharyya N. Cancer of the nasal cavity: survival and factors influencing prognosis. Arch Otolaryngol Head Neck Surg. 2002;128(9):1079–1083. doi: 10.1001/archotol.128.9.1079. PubMed DOI

Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291(20):2441–2447. doi: 10.1001/jama.291.20.2441. PubMed DOI

Katz TS, Mendenhall WM, Morris CG, et al. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck. 2002;24(9):821–829. doi: 10.1002/hed.10143. PubMed DOI

Passali D, Capua BD, Lauretis AD, et al. Squamous cell carcinoma of the maxillary sinus: A retrospective analysis of 36 cases. Indian J Otolaryngol Head Neck Surg. 1999;51(1):15–20. doi: 10.1007/BF02996837. PubMed DOI PMC

Hoppe BS, Stegman LD, Zelefsky MJ, et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting--the MSKCC experience. Int J Radiat Oncol Biol Phys. 2007;67(3):691–702. doi: 10.1016/j.ijrobp.2006.09.023. PubMed DOI

Russo AL, Adams JA, Weyman EA, et al. Long-Term Outcomes After Proton Beam Therapy for Sinonasal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2016;95(1):368–376. doi: 10.1016/j.ijrobp.2016.02.042. PubMed DOI

Suzuki H, Hanai N, Nishikawa D, et al. The Charlson comorbidity index is a prognostic factor in sinonasal tract squamous cell carcinoma. Jpn J Clin Oncol. 2016;46(7):646–651. doi: 10.1093/jjco/hyw049. PubMed DOI

Duthoy W, Boterberg T, Claus F, et al. Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: clinical results in 39 patients. Cancer. 2005;104(1):71–82. doi: 10.1002/cncr.21100. PubMed DOI

Dulguerov P, Jacobsen M, Allal A, et al. Nasal and paranasal sinus carcinoma: Are we making progress? Cancer. 2001;92(12):3012–3029. doi: 10.1002/1097-0142(20011215)92:12<3012::aid-cncr10131>3.0.co;2-e. PubMed DOI

Duprez F, Madani I, Morbée L, et al. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys. 2012;83(1):252–259. doi: 10.1016/j.ijrobp.2011.06.1977. PubMed DOI

Porceddu S, Martin J, Shanker G, et al. Paranasal sinus tumors: Peter MacCallum Cancer Institute experience. Head Neck. 2004;26(4):322–330. doi: 10.1002/hed.10388. PubMed DOI

Dagan R, Uezono H, Bryant C, et al. Outcomes of Sinonasal Cancer Treated With Proton Therapy. Int J Radiat Oncol Biol Phys. 2016;95(1):377–385. doi: 10.1016/j.ijrobp.2016.02.019. PubMed DOI

Madani I, Bonte K, Vakaet L, et al. Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys. 2009;73(2):424–432. doi: 10.1016/j.ijrobp.2008.04.037. PubMed DOI

Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) Int J Radiat Oncol Biol Phys. 1995;31(5):1341–1346. doi: 10.1016/0360-3016(95)00060-C. PubMed DOI

Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291(20):2441–2447. doi: 10.1001/jama.291.20.2441. PubMed DOI

Jiang GL, Ang KK, Peters LJ, et al. Maxillary sinus carcinomas: natural history and results of postoperative radiotherapy. Radiother Oncol. 1991;21(3):193–200. doi: 10.1016/0167-8140(91)90037-h. PubMed DOI

Waldron JN, O’Sullivan B, Gullane P, et al. Carcinoma of the maxillary antrum: a retrospective analysis of 110 cases. Radiother Oncol. 2000;57(2):167–173. doi: 10.1016/s0167-8140(00)00256-5. PubMed DOI

Chen AM, Daly ME, Bucci MK, et al. Carcinomas of the paranasal sinuses and nasal cavity treated with radiotherapy at a single institution over five decades: are we making improvement? Int J Radiat Oncol Biol Phys. 2007;69(1):141–147. doi: 10.1016/j.ijrobp.2007.02.031. PubMed DOI

Khademi B, Moradi A, Hoseini S, et al. Malignant neoplasms of the sinonasal tract: report of 71 patients and literature review and analysis. Oral Maxillofac Surg. 2009;13(4):191–199. doi: 10.1007/s10006-009-0170-8. PubMed DOI

Rischin D, Porceddu S, Peters L, et al. Promising results with chemoradiation in patients with sinonasal undifferentiated carcinoma. Head Neck. 2004;26(5):435–441. doi: 10.1002/hed.10396. PubMed DOI

Rietbergen MM, Brakenhoff RH, Bloemena E, et al. Human papillomavirus detection and comorbidity: critical issues in selection of patients with oropharyngeal cancer for treatment De-escalation trials. Ann Oncol. 2013;24(11):2740–2745. doi: 10.1093/annonc/mdt319. PubMed DOI

Yung KC, Piccirillo JF. The incidence and impact of comorbidity diagnosed after the onset of head and neck cancer. Arch Otolaryngol Head Neck Surg. 2008;134(10):1045–1049. doi: 10.1001/archotol.134.10.1045. PubMed DOI

Daly ME, Chen AM, Bucci MK, et al. Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys. 2007;67(1):151–157. doi: 10.1016/j.ijrobp.2006.07.1389. PubMed DOI

Hoppe BS, Wolden SL, Zelefsky MJ, et al. Postoperative intensity-modulated radiation therapy for cancers of the paranasal sinuses, nasal cavity, and lacrimal glands: technique, early outcomes, and toxicity. Head Neck. 2008;30(7):925–932. doi: 10.1002/hed.20800. PubMed DOI

Weber DC, Chan AW, Lessell S, et al. Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons. Radiother Oncol. 2006;81(3):243–249. doi: 10.1016/j.radonc.2006.09.009. PubMed DOI