The Study On Prognostic Factors Of Patients With Nasal Cavity And Sinonasal Carcinoma Followed By Accurate Radiotherapy And Prospective Analysis Of Treatment For Late Complications

Purpose of study:It is a critical question to evaluate prognostic factors of the patients with nasal cavityand paranasal sinus carcinoma followed by intensity-modulated radiotherapy (IMRT) andthree-dimensional conformal radiotherapy (3D-CRT), and prospective of treatment for thelate complications. By analysis of the dose-volume pattern associating with radioactivesinusitis (RNS) in patients with sinonasal tumors treated by accurate radiation therapy, weshall expect to provide new evidence for understanding of RNS and extablishing oftherapeutic stretagy against RNS clinically.Methods:(1) Retrospective analysis was performed on155patients with nasal cavity and paranasalsinus carcinoma followed by the radiotherapy in Department of RadiotherapyOncology of Xijing Hospital from2002to2011, in order to investigate rates of theradioactive sinusitis and prognostic factors of patients with nasal cavity and paranasal sinus carcinoma.(2) The radioactive sinusitis was diagnostically determineed by subjective and objectiveevaluation methods, visual analogue scale (VAS), nasal endoscopy by Lund-Kennedyscoring system, and Lund-Mackay CT scoring system before treatment and sixmonths after the treatment. For reducement of radioactive sinusitis and securement ofclinical efficacy, the prospective randomized controlled study was designed bygroups of standard myrtle oil capsules and chymotrypsin in experimental group, nasalwash with physiological saline in control group.(3) According to a standard grading method, i.e. Common Toxicity Criteria3.0(CTC3.0),radiation nasosinusitis was evaluate to show delineation of normal sinus mucosa,mean sinonasal dose and V10,V20,V30,V40,V50,V60of sinus mucosa from thedose-volume histogram system, to analysize concentration response relationshipbetween radiation dose and volume.Results:(1) In this study, five-year local control (LC), freedom from distant metastasis (FFDM),and overall survival (OS) were78%,68%, and60%among all patients. Onmultivariate analysis, squamous cell carcinoma (SCC) and Residual disease hadworse LC (p<0.05) and OS (p<0.05). Pterygoid fossa invasion and infratemporalinvasion also had worse LC (p<0.05). SCC and N+had worse FFDM (p<0.05) andOS (p<0.05). Radiation nasosinusitis was observed in137patients (88.4％). Nopatients had Grade4late toxicity including one optictoxicity.(2) Randomized controlled study showed that, the VAS score, Lund-Kennedy andLund-Mackey score increased significantly in the patients after therapy in the controlgroup. In other word, the incidence of sinusitis increased after radiation comparedwith pre-radiation in this control group (P<0.05). But in the experimental group,these scores did not increase significantly in the patients after radiotherapy (P>0.05).Data thus indicated that application of intervention was valid for the prevention ofradioactive sinusitis. (3) V50, planning target volume and mean dose were significantly correlated with acuteof RNS of≥grade1. The acute RNS of≥grade1was significantly increased whenV50， mean dose and PTV volume were more than61.8%,48GY、223cm3,respectively.Conclusion:Clinical outcome and rate of late complications were analyzed for patients with nasalcavity and sinonasal carcinoma followed by accurate radiotherapy. It was effective to treatRNS with myrtol standardized enteric capsules and chymotrypsin confirmed byrandomized controlled trial (RCT). The dose-volume V50<61.8%, mean dose <48GY andPTV<223cm3were effective in predicting RNS. Results of this study overall have thusprovided new evidence for further radiotherapy plan optimization of patient with nasalcavity and paranasal sinus carcinoma.