Advanced carcinoma of the paranasal sinuses treated with 7.5 MeV fast neutrons

The poor prognosis of paranasal sinus carcinoma relates to its often late and advanced presentation. There are difficulties in achieving local control of the tumour and improving the quality and duration of survival with combinations of surgery and megavoltage radiotherapy. In this series of 43 patients with advanced sinus tumours treated with neutrons, the median survival was 33 months with a 75% local control rate. At 5 years the local control rate was 50% with 30% surviving. The complication rate was 5% at 12 months rising to 30% by 27 months with no further increase after this. The possible benefits of neutron therapy in treating the advanced tumours are discussed. Despite the disadvantages of low energy (7.5 MeV) neutron beams and the poor general condition of many of the patients in this series and the advanced nature of their tumours, a high local tumour control rate was observed and major facial surgery avoided.