Planned Gamma Knife Boost After Chemoradiotherapy for Selected Sinonasal and Nasopharyngeal Cancers

• Published in: World neurosurgery Vol. 119; pp. e467 - e474
• Main Authors: Díaz-Martínez, José Armando, Esquenazi, Yoshua, Martir, Magda, Citardi, Martin J., Karni, Ron J., Blanco, Angel I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018
• Subjects: Adult; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Feasibility Studies; Female; Gamma knife; Humans; Male; Middle Aged; Nasopharyngeal carcinomas; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - therapy; Paranasal Sinus Neoplasms - diagnostic imaging; Paranasal Sinus Neoplasms - therapy; Radiosurgery - adverse effects; Radiosurgery - methods; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Retrospective Studies; Sinonasal malignancies; Stereotactic radiosurgery; Young Adult; NPC; LINAC; RT; GK; IMRT; OS; MRI; GTV; Sinonasal malignancies; Nasopharyngeal carcinomas; Chemoradiotherapy; DFS; Stereotactic radiosurgery; CT; PTV; SNM; SRS; LC; Gamma knife
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.07.183

To determine the feasibility of a Gamma Knife boost after intensity-modulated radiation therapy in combination with multimodal therapy in patients with nasopharyngeal carcinoma and sinonasal malignancies with skull base or cavernous sinus involvement. Nine patients were treated with intensity-modulated radiation therapy followed by a Gamma Knife boost. In one case Gamma Knife was given as salvage treatment after resection. Five patients had sinonasal malignancies and 4 had nasopharyngeal carcinoma. The mean radiation therapy dose was 64.3 Gy (range, 54–70 Gy) at 2 Gy per fraction. The median interval from completion of radiation therapy to Gamma Knife boost was 2.2 months (range, 1–4 months). The most common indication for Gamma Knife boost was involvement of the cavernous sinus, which was identified in 7 patients. The median margin Gamma Knife dose delivered was 13 Gy (range, 12–20 Gy), with median prescription isodose of 50%. All patients tolerated the procedure well, with minimal toxicity. Local control rates were achieved in all patients and no acute grade 3–5 toxicity was observed. One patient experienced late grade 4 toxicity, which was potentially attributable to treatment. Distant failure occurred in 3 patients (1 patient with nasopharyngeal carcinoma and 2 patients with sinonasal malignancies). Planned Gamma Knife boost followed intensity-modulated radiation therapy is feasible, safe, and provides excellent local control in patients with sinonasal malignancies and nasopharyngeal carcinoma, particularly in cases with cavernous sinus involvement. Further follow-up will be necessary to determine the long-term effectiveness and complication profile. •Treatment of both sinonasal malignancies and nasopharyngeal carcinoma is complex and requires a multimodal approach.•Surgery and conventional radiation approaches provide suboptimal tumor control for tumors invading intracranial structures.•Gamma Knife radiosurgery boost appears to improve local control selected cases with acceptable toxicity.