Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_31_2475 - Outcomes of Intensity Modulated Irradiation for Sinonasal Cancers in the Modern Era

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Outcomes of Intensity Modulated Irradiation for Sinonasal Cancers in the Modern Era
H. Bahig, E. Y. Hanna, A. S. Garden, S. P. Ng, T. Nguyen, S. J. Frank, G. B. Gunn, D. I. Rosenthal, C. D. Fuller, W. H. Morrison, R. Ferrarotto, D. Bell, S. Y. Su, and J. Phan; The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): To report outcomes, patterns of failure and predictive factors of disease free survival (DFS) in sinonasal cancers treated with intensity modulated irradiation.

Materials/Methods: A retrospective analysis of patients with sinonasal cancers treated with either intensity modulated radiotherapy (IMRT) or intensity modulated proton therapy (IMPT) using conventional fractionation at MD Anderson Cancer Center from 2000 to 2016 was conducted. Patients with prior radiotherapy (RT), melanoma or lymphoma histologies were excluded. Kaplan Meier method was used for estimation of local control (LC), regional control (RC), distant metastasis rate (DM), DFS and overall survival (OS). Cox proportional hazard ratio models were used for univariate and multivariate analysis of potential predictive variables of DFS. Variables associated with DFS in univariate analysis (p<0.05) were entered in a recursive partitioning analysis (RPA) to identify appropriate cut-off points.

Results: 349 patients were included in the analysis, including 331 patients treated with IMRT and 18 with IMPT. Median age was 57 year-old (range, 20-90). The most common primary sites were nasal cavity (41%), maxillary sinus (29%) and ethmoid sinus (15%); the most common histologies included squamous cell carcinoma (35%), adenoid cystic (14%), sinonasal undifferentiated carcinoma (14%) and esthesioneuroblastoma (12%). Sixty six percent of patients had stage T4 disease and 12% had N positive disease. Sixty five percent of patients were treated with surgery and adjuvant RT +/- chemotherapy (CT) while 35% were treated with definitive RT +/- CT. Induction CT was given to 46% of patients and 40% were treated with concurrent chemoradiation. Median follow-up was 43 months (range; 1-186). Five-year LC, RC and DM rates were 82%, 92%, and 21%, respectively. DFS at 2- and 5-year was 68% and 52%, while OS at 2- and 5- year was 80% and 66%, respectively. On univariate analysis, age (p=0.006), history of tobacco use (p=0.004), T stage (p=0.0001), N stage (p=0.004), RT dose (p=0.04) and use of induction chemotherapy were associated with DFS. Outcomes were similar between the adjuvant RT vs. definitive RT groups, as well as across histologies. On multivariate analysis, increasing age (0.04), T stage (p<0.0001) and N stage (p=0.04) were predictive of DFS. RPA identified age ≥ 43 years, T4 stage and N stage ≥ 2 as significant cut-offs for adverse DFS outcome; in the adjuvant RT group, a dose < 64.8 Gy was associated with adverse DFS outcome.

Conclusion: Results from this large cohort of sinonasal cancer support good disease control rates and acceptable survival outcomes with intensity modulated irradiation. Comparable outcomes across histologies is likely explained by selective treatment intensification. Age, T stage and N stage are independent correlates of worse DFS.

Author Disclosure: H. Bahig: Research Grant; Varian medical systems. Honoraria; Siemens. E.Y. Hanna: None. A.S. Garden: None. S. Ng: Employee; The University of Texas MD Anderson Cancer Center. S.J. Frank: Research Grant; C4 Imaging, ELEKTA, U19. Founder and Director; C4 Imaging. Honoraria; ELEKTA, Varian Medican Systems, Inc. Advisory Board; Varian Medican Systems, Inc. Stock; C4 Imaging. Royalty; C4 Imaging. Patent/License Fees/Copyright; C4 Imaging. Chairman; American Brachytherapy Society. Director; C4 Imaging. Director-at-large; North America Skull Base Society. G.B. Gunn: Associate Medical Director; MD Anderson Cancer Center - Proton Therapy. D.I. Rosenthal: None. C.D. Fuller: Research Grant; National Institutes of Health, National Science Foundation, Elekta AB. Grant funding; Elekta AB. Honoraria; Nederlandse Organisatie voor Wetenschappelijk Onde. Consultant; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Travel Expenses; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Reviewer; Radiological Society of North America. Associate Editor; Radiographics. Data Management Task Force Committee Member; MR-LinAc Consortium. Member; National Cancer Institute. Task Group Member; American Association of Physicists in Medicine. W.H. Morrison: Advisory Board; Regeneron. Stock; Merck, Baxter, Johnson and Johnson. Member; NCCN Nonmelanoma Skin and Merkel Cell Committees. R. Ferrarotto: None. D. Bell: None.

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