Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): In this retrospective analysis we provide long-term follow-up data on 47 patients with anterior skull base tumors treated with electron-based intraoperative radiotherapy (IOERT) over a 17-year period. We evaluated whether IOERT is a viable treatment option in this sensitive anatomical area and if local control and survival could be improved with this treatment modality compared to historical controls.
Materials/Methods: 36 male and 11 female patients between 35 and 73 years of age were treated. The histology consisted of squamous cell carcinoma (30 pts.), adenocarcinoma (11), undifferentiated (4), adenoid cystic carcinoma (3), olfactorius neuroblastoma (3), neuroendocrine and mucoepidermoid carcinoma (2 each ), and nasopharyngeal carcinoma Schmincke, leiomyosarcoma, basalioma, melanoma, transitional cell carcinoma and sebaceous gland carcinoma ( one each). After local tumor excision with different open surgical procedures, IOERT was given in 47 patients: 29 treatments for primary cancer and 18 for recurrent tumors. A maximum dose of 10 Gy was applied with perplex tubes (diameters 4 - 5 cm) and electron energies between 4 and 6 MeV. 33 Patients also received adjuvant external beam radiotherapy (EBRT) with a mean dose of 56.4 Gy (SD 8.83, range 30-71.2 Gy) The anatomical areas most often involved were the paranasal sinuses (26 primaries, 5 recurrent tumors ) followed by nasal cavity (6), nasopharynx (2), buccal mucosa (2),oropharynx (2),orbita (2), parotid gland (1) and recurrence of unknown H&N CUP.
Results: With a median follow-up of 5.7 years ( 0.1-17 years), 12 of 29 patients with advanced primary tumors and 6 of 18 patients with recurrent tumors are alive. Of these, 14 patients have a survival of at least 100 months with local and distant control. Two further patients are controlled locally without distant disease at 77 and 54 months, two patients are locally controlled at 59 and 30 months, but show distant metastases. Out of 18 patients with locally controlled tumors, 15 had also received adjuvant EBRT. 29 patients have died after a mean survival time of 30.2 mths. (1-97) for the following reasons: 9 from local progression, 10 from metastases, 5 patients from secondary malignancies and 5 from intercurrent diseases. Four out of 9 local recurrences developed within the IOERT field, the remaining 5 were noted as marginal/outside. In total, 20 patients at the time of death remained free of local tumor.
Conclusion: To date, this cohort of 47 patients treated with IOERT +/- EBRT at the anterior skull base represents the largest group of patients treated with these treatment modalities. Inclusion of intraoperative radiotherapy in the interdisciplinary treatment of these patients with advanced primaries and recurrent tumors led to long-term local tumor control in 80% of patients and thus to long-term survival in one third of patients, both results comparing favorably to historical reports.
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