Function preservation and optimal outcomes—definitive chemoradiotherapy with multi-phase treatment planning for locally advanced sinonasal cancer

Objectives The aim of this study is to review radiotherapy (RT) techniques and outcomes for definitive RT or chemoradiotherapy (CRT) for very locally advanced or unresectable sinonasal cancer (SNC) at a single institution. Methods Between 1998 and 2010, there were 11 patients with very locally advanced or unresectable SNCs treated with definitive CRT (8) and RT alone (3) at the University of Utah. CRT was given to stage IVA (5) and stage IVB (3) patients; RT alone was given to stage III (1) and stage IVA (2) patients. All patients were treated with intensity-modulated radiation therapy (IMRT). The median dose was 70.2 Gy (70–72.4 Gy). Most patients underwent two treatment planning phases in order to prevent critical structures from receiving a high dose due to tumor regression and weight loss. The most common chemotherapy was cisplatin 40 mg/m 2 given on a weekly basis for 6–7 cycles. A flexible nasal endoscopy with a biopsy was performed 3 months posttreatment to evaluate tumor response. Results With a median follow-up of 41 months (2–114), overall local control was seen in 8 out of 11 (72.7 %) patients. There was 1 (9.1 %) regional recurrence and 2 (18.2 %) distant metastasis. The definitive CRT or RT was well tolerated with only 2 patients experiencing a grade 3 late toxicity. Conclusion Definitive CRT or RT is feasible for very locally advanced or unresectable SNC. Local control is encouraging with acceptable treatment-related complications when treating with the described two-phase IMRT treatment technique.