Intensity Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical...
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Conclusions: We have constructed a web-based nomogram that can be used to make predictions of the expected benefit from adjuvant radiotherapy for patients with resected OCSCC. This tool can be used as a decision aid to help make individualized adjuvant radiotherapy treatment recommendations. Author Disclosure: S.J. Wang, None; S.G. Patel, None; J.P. Shah, None; L.P. Kowalski, None; J. Kalpathy-Cramer, None; C.R. Thomas, None; N.D. Gross, None. 2581 Intensity Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical Outcomes and Patterns of Failure E. A. Wiegner, M. E. Daly, C. H. Chapman, Y. Yu, A. D. Colevas, M. J. Kaplan, N. Fischbein, Q. T. Le, D. T. Chang Stanford University, Stanford, CA Purpose/Objective(s): To report outcomes in patients treated with intensity-modulated radiotherapy (IMRT) for tumors of the nasal cavity and paranasal sinuses. Materials/Methods: Between June 2000-December 2009, 53 patients with tumors of the nasal cavity or paranasal sinuses were treated with IMRT. Twenty-nine patients had squamous cell carcinoma (SCCA), 8 patients had sinonasal undifferentiated carci- noma (SNUC), 7 patients had esthesioneuroblastoma, 5 patients had adenoid cystic carcinoma, and 4 patients with other tumor histology. A gross total resection was achieved in 41 patients (77%), a sub-total resection was done in 7 patients (13%), and a biopsy only was done in 5 patients (9%). The median dose was 66 Gy (range: 44-74.4) and 31 patients received nodal radiation. Twenty- nine patients received systemic chemotherapy. The median follow-up was 21 months (range 5 -111) for all patients and 24 months for living patients. Results: Nineteen patients (36%) developed a local-regional failure (LRF) at median time of 7.2 months (range: 3 - 57). There were 14 local failures and 6 regional failures with one patient failing simultaneously in both. Twelve of the 14 (86%) local failures were in field and 2 (14%) were marginal. Two of the 6 (33%) regional failures were in-field and 4 (67%) were out-of-field. Fifteen pa- tients (28%) developed a distant failure (5 were synchronous with a local failure) at median time of 9.5 months (range 2.5 -110). Two-year local-regional control (LRC), freedom from distant metastasis, disease free survival and overall survival (OS) were 62%, 72%, 47% and 68% respectively. On univariate analysis, LRC was significantly worse for patients with a SCCA or SNUC (p = 0.039), more than 1 paranasal sinus/nasal cavity subsite involved (p = 0.003), or residual micro/macroscopic disease (p = 0.009). OS was also significantly worse on univariate analysis for patients with a SCCA or SNUC (p = 0.006), more than 1 para- nasal sinus/nasal cavity subsite involved (p = 0.02), or residual micro/macroscopic disease (p = 0.002). Acute toxicities included grade 3 mucositis in 15 patients (28%), grade 4 mucositis in 2 patients (4%), and grade 3 dermatitis in 9 patients (17%). Osteor- adionecrosis occurred in 3 patients (6%). One patient developed a grade 3 right optic neuropathy. Conclusions: Outcomes using IMRT for patients with nasal cavity and paranasal sinus tumors treated with IMRT are encouraging compared to historical series and have a favorable toxicity profile. LRF is the predominant pattern of failure despite combined modality therapy. Author Disclosure: E.A. Wiegner, None; M.E. Daly, None; C.H. Chapman, None; Y. Yu, None; A.D. Colevas, None; M.J. Kaplan, None; N. Fischbein, None; Q.T. Le, None; D.T. Chang, None. 2582 Postoperative Radiotherapy with Extensive Fields to Treat Lymphoepithelial Carcinoma of Major Salivary Glands: A Prospective Single Institute Analysis of 32 Patients G. Zhu, C. Huang, H. Ying, X. Guan, Q. Ji Cancer Hospital of Fudan University, Shanghai, China Purpose/Objective(s): (1) To evaluate the role of extensive-field postoperative radiotherapy treating lymphoepithelial carcinoma of major salivary glands (2) To identify patterns of failure and important clinical/pathologic prognostic factors for optimal treatment of lymphoepithelial carcinoma. Materials/Methods: Clinical data of 32 patients with pathologically confirmed primary lymphoepithelial carcinoma of salivary gland and excluding of nasopharyngeal carcinoma by MRI and nasopharyngoscope examination, treated in the Fudan University from 2005 to 2009, was examined and enter this study. The 2002 AJCC staging for major salivary glands carcinomas was used to retrospectively stage these patients. The prescription doses of postoperative radiotherapy ranged from 6000 cGy to 6600 cGy. A forward-planned multisegment 3DCRT technique was used which can spare the contra lateral salivary glands, eyes, spinal cord and brainstem. All treatment plans were normalized to achieve 95% volume coverage of the target by the prescription dose. The target volume include the operative bed and ipsilateral level Ib, II and III cervical lymph nodes for N0 patients, Ia nodes were not routinely irradiated except for the submandibular glands cases. Ipsilateral whole neck was treated for any N+ patients. The survival analysis was performed using Kaplan-Meier curves. All these analysis were calculated on the platform of SPSS software version 13th. Results: The median age at presentation was 46.5 years. The median follow-up was 15.3 months. Twenty-one males and 11 fe- males accounted for 21% stage I, 37% stage II, 24% stage III, and 18% stage IV disease. Three patients (9.4%) had positive surgical margins or residual lesion and 8 (25%) had cervical lymph node involvement. Locoregional recurrence occurred in 2 patients, one was in the primary site, and another one developed recurrence outside the treatment field. A total of 4 distant metastases were found, including 1 bone, 1 lung, 1 both and 1 nasal cavity. Among of them, the patient with lung metastasis died during this follow-up. The 2-year survival rate was 82.2% for all the patients. The 2-year disease free survival rate was 87.5%. Conclusions: The extensive-field postoperative radiotherapy provided an exciting local control outcome for lymphoepithelial carcinoma of major salivary glands. A relative high frequency of distant metastasis may indicate the potential of chemotherapy. Author Disclosure: G. Zhu, None; C. Huang, None; H. Ying, None; X. Guan, None; Q. Ji, None. Proceedings of the 52nd Annual ASTRO Meeting S463
Transcript of Intensity Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical...
Proceedings of the 52nd Annual ASTRO Meeting S463
Conclusions: We have constructed a web-based nomogram that can be used to make predictions of the expected benefit fromadjuvant radiotherapy for patients with resected OCSCC. This tool can be used as a decision aid to help make individualizedadjuvant radiotherapy treatment recommendations.
Author Disclosure: S.J. Wang, None; S.G. Patel, None; J.P. Shah, None; L.P. Kowalski, None; J. Kalpathy-Cramer, None; C.R.Thomas, None; N.D. Gross, None.
2581 Intensity Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical
Outcomes and Patterns of FailureE. A. Wiegner, M. E. Daly, C. H. Chapman, Y. Yu, A. D. Colevas, M. J. Kaplan, N. Fischbein, Q. T. Le, D. T. Chang
Stanford University, Stanford, CA
Purpose/Objective(s): To report outcomes in patients treated with intensity-modulated radiotherapy (IMRT) for tumors of thenasal cavity and paranasal sinuses.
Materials/Methods: Between June 2000-December 2009, 53 patients with tumors of the nasal cavity or paranasal sinuses weretreated with IMRT. Twenty-nine patients had squamous cell carcinoma (SCCA), 8 patients had sinonasal undifferentiated carci-noma (SNUC), 7 patients had esthesioneuroblastoma, 5 patients had adenoid cystic carcinoma, and 4 patients with other tumorhistology. A gross total resection was achieved in 41 patients (77%), a sub-total resection was done in 7 patients (13%), and a biopsyonly was done in 5 patients (9%). The median dose was 66 Gy (range: 44-74.4) and 31 patients received nodal radiation. Twenty-nine patients received systemic chemotherapy. The median follow-up was 21 months (range 5 -111) for all patients and 24 monthsfor living patients.
Results: Nineteen patients (36%) developed a local-regional failure (LRF) at median time of 7.2 months (range: 3 - 57). There were14 local failures and 6 regional failures with one patient failing simultaneously in both. Twelve of the 14 (86%) local failures werein field and 2 (14%) were marginal. Two of the 6 (33%) regional failures were in-field and 4 (67%) were out-of-field. Fifteen pa-tients (28%) developed a distant failure (5 were synchronous with a local failure) at median time of 9.5 months (range 2.5 -110).Two-year local-regional control (LRC), freedom from distant metastasis, disease free survival and overall survival (OS) were 62%,72%, 47% and 68% respectively. On univariate analysis, LRC was significantly worse for patients with a SCCA or SNUC (p =0.039), more than 1 paranasal sinus/nasal cavity subsite involved (p = 0.003), or residual micro/macroscopic disease (p =0.009). OS was also significantly worse on univariate analysis for patients with a SCCA or SNUC (p = 0.006), more than 1 para-nasal sinus/nasal cavity subsite involved (p = 0.02), or residual micro/macroscopic disease (p = 0.002). Acute toxicities includedgrade 3 mucositis in 15 patients (28%), grade 4 mucositis in 2 patients (4%), and grade 3 dermatitis in 9 patients (17%). Osteor-adionecrosis occurred in 3 patients (6%). One patient developed a grade 3 right optic neuropathy.
Conclusions: Outcomes using IMRT for patients with nasal cavity and paranasal sinus tumors treated with IMRT are encouragingcompared to historical series and have a favorable toxicity profile. LRF is the predominant pattern of failure despite combinedmodality therapy.
Author Disclosure: E.A. Wiegner, None; M.E. Daly, None; C.H. Chapman, None; Y. Yu, None; A.D. Colevas, None; M.J. Kaplan,None; N. Fischbein, None; Q.T. Le, None; D.T. Chang, None.
2582 Postoperative Radiotherapy with Extensive Fields to Treat Lymphoepithelial Carcinoma of Major Salivary
Glands: A Prospective Single Institute Analysis of 32 PatientsG. Zhu, C. Huang, H. Ying, X. Guan, Q. Ji
Cancer Hospital of Fudan University, Shanghai, China
Purpose/Objective(s): (1) To evaluate the role of extensive-field postoperative radiotherapy treating lymphoepithelial carcinomaof major salivary glands (2) To identify patterns of failure and important clinical/pathologic prognostic factors for optimal treatmentof lymphoepithelial carcinoma.
Materials/Methods: Clinical data of 32 patients with pathologically confirmed primary lymphoepithelial carcinoma of salivarygland and excluding of nasopharyngeal carcinoma by MRI and nasopharyngoscope examination, treated in the Fudan Universityfrom 2005 to 2009, was examined and enter this study. The 2002 AJCC staging for major salivary glands carcinomas was used toretrospectively stage these patients. The prescription doses of postoperative radiotherapy ranged from 6000 cGy to 6600 cGy. Aforward-planned multisegment 3DCRT technique was used which can spare the contra lateral salivary glands, eyes, spinal cordand brainstem. All treatment plans were normalized to achieve 95% volume coverage of the target by the prescription dose. Thetarget volume include the operative bed and ipsilateral level Ib, II and III cervical lymph nodes for N0 patients, Ia nodes were notroutinely irradiated except for the submandibular glands cases. Ipsilateral whole neck was treated for any N+ patients. The survivalanalysis was performed using Kaplan-Meier curves. All these analysis were calculated on the platform of SPSS software version13th.
Results: The median age at presentation was 46.5 years. The median follow-up was 15.3 months. Twenty-one males and 11 fe-males accounted for 21% stage I, 37% stage II, 24% stage III, and 18% stage IV disease. Three patients (9.4%) had positive surgicalmargins or residual lesion and 8 (25%) had cervical lymph node involvement. Locoregional recurrence occurred in 2 patients, onewas in the primary site, and another one developed recurrence outside the treatment field. A total of 4 distant metastases were found,including 1 bone, 1 lung, 1 both and 1 nasal cavity. Among of them, the patient with lung metastasis died during this follow-up. The2-year survival rate was 82.2% for all the patients. The 2-year disease free survival rate was 87.5%.
Conclusions: The extensive-field postoperative radiotherapy provided an exciting local control outcome for lymphoepithelialcarcinoma of major salivary glands. A relative high frequency of distant metastasis may indicate the potential of chemotherapy.
Author Disclosure: G. Zhu, None; C. Huang, None; H. Ying, None; X. Guan, None; Q. Ji, None.
