Madani 2009 (IMRT Sinonasal Tumors)

Background

Retrospective single-institution series (Ghent). N=84, sinonasal tumors treated with IMRT 1998–2006; median 70 Gy in 35 fractions. Histology: adenocarcinoma 64% (n=54), SCC 20% (n=17), esthesioneuroblastoma 11% (n=9), adenoid cystic 5% (n=4). 75 post-op IMRT; 9 primary IMRT (unresectable). Goal: optic pathway sparing.

Interventions and follow up

Treatment: IMRT (median 70 Gy / 35 fractions); 75 post-operative, 9 primary for unresectable disease
Primary endpoint: local control, OS, disease-specific survival, toxicity
mFollow up: 40 mo (range 8–106)

Results

5-yr local control: 70.7%
5-yr OS: 58.5%
5-yr disease-specific survival: 67.0%
5-yr disease-free survival: 59.3%
Radiation-induced blindness: 0
Cribriform plate invasion (MV analysis): lower LC (P=.0001) and OS (P=.0001)

Adverse events

Radiation-induced blindness: 0
Grade 3 retinopathy/neovascular glaucoma: 1 (1.2%)
Complete lacrimal duct stenosis: 1
Brain necrosis: 3 (3.6%)
Osteoradionecrosis maxilla (re-irradiated): 1/5
Note: late toxicity lower than historical 2D RT rates

Conclusions

IMRT for sinonasal tumors achieves 5-yr local control of 70.7% and eliminates radiation-induced blindness vs historical 2D techniques; cribriform plate invasion is the dominant adverse prognostic factor.

Key Limitations

Single-institution retrospective; small heterogeneous cohort (mixed histologies, sites, primary vs post-op); no randomized comparator; historical-control toxicity comparison.

Clinical Context

Supports IMRT as treatment of choice for sinonasal malignancies by sparing optic structures while maintaining target coverage; informed adoption of conformal techniques over 2D RT.

References