Carcinoma of the nasal cavity and paranasal sinuses

Authors

  • William M. Mendenhall MD,

    Corresponding author
    1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
    2. University of Florida Proton Therapy Institute, Jacksonville, Florida, U.S.A.
    • Department of Radiation Oncology, University of Florida Health Science Center, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL 32610-0385
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  • Robert J. Amdur MD,

    1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
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  • Christopher G. Morris MS,

    1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
    2. University of Florida Proton Therapy Institute, Jacksonville, Florida, U.S.A.
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  • Jessica Kirwan MA,

    1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
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  • Robert S. Malyapa MD, PhD,

    1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
    2. University of Florida Proton Therapy Institute, Jacksonville, Florida, U.S.A.
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  • Mikhail Vaysberg DO,

    1. Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
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  • John W. Werning MD,

    1. Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
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  • Nancy P. Mendenhall MD

    1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, U.S.A.
    2. University of Florida Proton Therapy Institute, Jacksonville, Florida, U.S.A.
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  • The authors have no conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To determine the outcomes after radiotherapy (RT) alone or combined with surgery at the University of Florida for patients with carcinomas of the nasal cavity and paranasal sinuses.

Methods:

Between November 1964 and June 2005, 109 patients were treated with curative intent. Patients with maxillary sinus carcinomas were excluded. Fifty-six patients were treated with definitive RT, and 53 patients received surgery and preoperative (eight patients) or postoperative (45 patients) RT. Median follow-up was 4.3 years (range, 0.2–35.9 years). Median follow-up on living patients was 9.4 years (range, 2.0–35.9 years).

Results:

The 5-year local control rates were: T1-T3, 82%; T4, 50%; and overall, 63%. Local control at 5 years was 43% after definitive RT versus 84% after surgery and adjuvant RT (P < .0001). Multivariate analysis of local control revealed that both overall stage and treatment group (definitive RT versus surgery and adjuvant RT) significantly impacted this endpoint. Cause-specific survival rates were: stages I to III, 81%; stage IV, 54%; and overall, 62%. Multivariate analysis revealed that T-stage, N-stage, and treatment group significantly influenced this endpoint. Thirty-one (20%) of 109 patients sustained severe complications; 17 of 56 patients (16%) after definitive RT and 14 of 53 patients (25%) after surgery and adjuvant RT.

Conclusions:

The probability of local control and cause-specific survival is better after surgery and RT compared with definitive RT. There is a modest increase in the risk of complications after surgery and RT. Thus, the preferred treatment is surgery combined with preoperative or postoperative RT. Laryngoscope, 2009

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