Proton beam radiation had good long-term outcomes in sinonasal malignancies

Multidisciplinary Head and Neck Cancer Symposium

(March 2010)

Proton beam radiation therapy demonstrated encouraging outcomes in patients with locally advanced sinonasal malignancies, according to findings presented by Annie Chan, MD, at the Multidisciplinary Head and Neck Cancer Symposium in Chandler, Ariz.

“When compared to other studies, our results are very encouraging,” said Chan, assistant professor of radiation oncology and a radiation oncologist at Massachusetts General Hospital at Harvard Medical School, during a news briefing.

Typically, conventional radiation therapy results in poor local control rate and is associated with treatment-related toxicity due to the anatomical location of sinonasal malignancies. Researchers conducted this study to determine the long-term treatment outcome and prognostic factors in these patients when treated with proton beam therapy.

Ninety-nine patients with newly diagnosed sinonasal cancers were assigned to proton beam therapy between 1991 and 2003. Sixty-seven percent of patients had surgery prior to radiation; the median total dose to the primary tumor was 70 Gy. Median follow-up was 8.5 years.

The five-year local control rate was 87% and the eight-year local control rate was 83%. No statistically significant difference was observed in local control per histological subtype, T stage and surgery vs. biopsy. The distant metastasis–free survival rate was 69% at five and eight years. Results of a multivariate analysis indicated that only T4b disease was associated with a decreased distant metastases-free survival (P=.024).

OS was 57% at five years and 46% at eight years. T4b disease (P=.001), squamous cell carcinoma (P=.002), and Karnofsky performance status <80 (P=.005) were all associated with decreased OS, according to the results of a multivariate analysis.

At five years, freedom from grade-3 or higher late toxicity was 78%. For five-year grade-3 or higher late toxicity, the rate was 29% for patients with surgery before radiation and 7% for patients without surgery before radiation (P=.07). Soft tissue toxicity was the most common grade-3 or higher adverse event. – by Christen Haigh

For more information:

  • Cianchetti M. #3. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 25-27, 2010; Chandler, Ariz.


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