Long-term Outcomes from Proton Therapy for Sinonasal Cancers

Area of Science:

• Oncology
• Radiation Oncology
• Head and Neck Surgery

Background:

• Sinonasal cancers are rare but can be aggressive, often diagnosed at advanced stages.
• Proton therapy offers precise radiation delivery, potentially reducing toxicity to surrounding tissues.
• Optimal treatment strategies for locally advanced, high-grade sinonasal cancers are still being investigated.

Purpose of the Study:

• To evaluate the long-term efficacy of proton therapy in treating sinonasal cancer.
• To assess disease control, survival rates, and treatment-related toxicities.
• To identify prognostic factors influencing outcomes in patients treated with proton therapy.

Main Methods:

• Retrospective review of 143 adult patients with nonmetastatic sinonasal cancers.
• Patients received primary or adjuvant proton therapy, often with concurrent chemotherapy.
• Analysis included univariate and multivariate models to determine prognostic factors for survival and local control.

Main Results:

• Five-year outcomes included 80% local control (LC), 78% local-regional control, and 59% overall survival.
• Gross total resection significantly improved LC (87% vs. 62.9% for subtotal resection).
• Late Grade 3+ toxicities occurred in 22%, with central nervous system necrosis (6%) and vision loss (3.5%) being notable.

Conclusions:

• Proton therapy following gross-total resection yields excellent long-term LC for advanced, high-grade sinonasal cancers.
• Local control is a strong predictor of long-term survival in these patients.
• Proton therapy combined with chemotherapy achieves durable LC in approximately 60% of patients with gross residual disease.