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ICAR SINONASAL TUMORS

TABLE XIV.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Zenda et al. 535

1. 3-year PFS 2. 3-year OS

1. PFS49% 2. OS59% 3. 13% experienced grade 3–5 toxicities

2011

4

Retrospective case series

SNM at single

institution primary ( n = 39)

Truong et al. 536

2009 4

Retrospective case series

SNM at single

1. 2-year LC 2. 2-year DFS 3. 2-year OS

1. LC86% 2. DFS31% 3. OS53% 4. Brain invasion was predictive for decreased OS rate

institution ( n = 20)

Nishimura et al. 537

1. LPFS84% 2. RFS71% 3. OS93% 1. LC93% 2. DFS56% 3. OS77% 1. LENT21% 2. DFS81% 3. OS90%

2007 4

Retrospective case series

ONB at single

1. 5-year LPFS 2. 5-year RFS 3. 5-year OS 1. 5-year LC 2. 5-year DFS 3. 5-year OS 1. LENT 2. 5-year DFS 3. 5-year OS

institution ( n = 14)

Pommier et al. 538

2006 4

Retrospective case series

ACC at a single

institute (SNM n = 17)

Weber et al. 539

2006 4

Retrospective case series

SNM at single

institution primary ( n = 33) or recurrent ( n = 3) to review 5-year visual LENT

Fitzek et al. 540

2002 4

Retrospective case series

SNEC at single

1. 5-year LC 2. 5-year OS

1. LC88% 2. OS74%

institution ( n = 19)

Abbreviations: ACC, adenoid cystic carcinoma; CCS, cystic carcinoma survival; CIT, cancer immunotherapy; DFS, disease-free survival; FFDP, freedom from distant progression; FFLR, freedom from locoregional recurrence; ICER, incremental cost-effectiveness ratio; LC, local control; LENT, late effect normal tissue; ONB, olfactory neuroblastoma; OS, overall survival; PFS, progression-free survival; SN, sinonasal; SNM, sinonasal malignancy; QALY, quality-adjusted life year.

infrastructural developments. In addition, while less expensive than other forms of heavy particles, NRT is not widely available, and most of the published data were con ducted with now outdated image guidance and treatment delivery systems. D Carbon ion radiotherapy CIRT is a form of heavy ion particle therapy with limited availability. The construction and treatment cost is higher than even PBT, and most centers deliver treatment using fixed beamlines due to the gantry’s size and weight. 470 This can limit the treatment delivery angles critical for treating SNM’s irregularly shaped geometries or regional lymphatics, and therefore many of the published series combine either IMRT or PBT as a component of therapy or use CIRT as a boost. Similar to NRT, the high RBE (estimated ranges from 2.5 to 5) of carbons may provide for biologic enhancement for unresectable, radioresistant tumors, and the beam penumbra is sharper than with pro tons. However, due to the high RBE throughout the beam path, there is little benefit to conventional fractionation, a treatment strategy used for sparing normal tissue com

plications when tumors directly involve or abut sensitive neural tissues. 471 The largest multi-institutional cohort evaluating the outcomes for SNM is a 458 series from the Japan Carbon Ion Radiation Oncology Study Group (J-CROS). In their 2018 retrospective review of 458 patients, 393 had de novo tumors and 65 were recurrent. The 2-year OS and LC rates were excellent at 80% and 84%, accordingly. Grade 3 and 4 late toxicities developed in nearly one fifth of patients, with visual injury being the most common. 472 Similar dis ease control rates were seen by Mizoe et al., who reported the experience of 116 SNM patients. The 5-year LC and OS rates were 68% and 47%, respectively. While toxicity was reportedly low, four cases of ipsilateral blindness were documented. 473 With regard to outcomes as compared to other modal ities, the locoregional recurrence and OS with CIRT are promising. In a systematic review and meta analysis of 2282 patients with SNM, both LC and OS were significantly higher after CIRT than IMRT or PBT. While these results are encouraging, the authors note that prospective randomized evidence will likely be needed to better define the optimal treatment approach. 474