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Neuroendocrine tumors of the sinonasal tract
Author(s) -
Fitzek Markus M.,
Thornton Allan F.,
Varvares Marc,
Ancukiewicz Marek,
Mcintyre James,
Adams Judy,
Rosenthal Stanley,
Joseph Michael,
Amrein Philip
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10537
Subject(s) - medicine , esthesioneuroblastoma , radiation therapy , etoposide , chemotherapy , surgery , concomitant , progressive disease
BACKGROUND The authors report the results of a prospective study of patients with malignant neuroendocrine tumors of the sinonasal tract who received multimodality treatment incorporating high‐dose proton‐photon radiotherapy. METHODS Nineteen patients with olfactory neuroblastoma (ONB) or neuroendocrine carcinoma (NEC) were treated between 1992 and 1998 on a prospective study. Four patients had Kadish Stage B disease, and 15 patients had Kadish Stage C disease. The median patient age was 44 years. Patients received chemotherapy with 2 courses of cisplatin and etoposide followed by high‐dose proton‐photon radiotherapy to 69.2 cobalt–Gray equivalents (CGE) using 1.6–1.8 CGE per fraction twice daily in a concomitant boost schedule. Two further courses of chemotherapy were given to responders. RESULTS Of 19 patients, 15 patients were alive at the time of this report with a median follow‐up of 45 months (range, 20–92 months). Four patients died from disseminated disease 8–47 months after their original diagnosis. The 5‐year survival rate was 74%. There were two local recurrences, and both patients underwent salvage surgery. The 5‐year local control rate of initial treatment was 88%. Acute toxicity of chemotherapy was tolerable, with no patient sustaining more than Grade 3 hematologic toxicity. Thirteen patients showed a partial or complete response to chemotherapy. One patient developed unilateral visual loss after the first course of chemotherapy; otherwise, visual preservation was achieved in all patients. Four patients who were clinically intact developed radiation‐induced damage to the frontal or temporal lobe by magnetic resonance imaging criteria. Two patients showed soft tissue and/or bone necrosis, and one of these patients required surgical repair of a cerebrospinal fluid leak. CONCLUSIONS Neoadjuvant chemotherapy and high‐dose proton‐photon radiotherapy is a successful treatment approach for patients with ONB and NEC. Radical surgery is reserved for nonresponders. Due to the precision of delivery of radiation with stereotactic setup and protons, no radiation‐induced visual loss was observed. Cancer 2002;94:2623–34. © 2002 American Cancer Society. DOI 10.1002/cncr.10537