Long-term radiotherapy outcomes for nasal cavity and septal cancers

Abstract

Purpose: Carcinoma of the nasal cavity and septum has historically been associated with a poor prognosis. This report updates the long-term outcomes for radiotherapy (RT) of this disease site at the University of Texas M.D. Anderson Cancer Center.

Methods and materials: A retrospective analysis was performed on the data from 68 patients diagnosed with histologically proven carcinoma of the nasal cavity or septum treated with RT for curative intent between 1969 and 2000. The disease histologic type was as follows: 45 (66%) had squamous cell carcinoma, 12 (18%) had adenoid cystic carcinoma, 8 (12%) had adenocarcinoma, and 3 (4%) had poorly/undifferentiated carcinoma. Of the 68 patients, 32 (47%) had received definitive RT. Of these, 23 had received external beam RT and 9 brachytherapy. Of the remaining 36 patients, 3 (4%) underwent preoperative external beam RT and 33 (49%) postoperative external beam RT. Of the 68 patients, 13 (19%) received neck RT. The median dose for patients receiving definitive and postoperative RT was 65 and 58.2 Gy, respectively. The median follow-up for the entire cohort was 11 years (range, 2.4-30.1 years).

Results: Of the 68 patients, 19 (28%) developed a locoregional relapse, 14 (21%) locally and 5 (7%) regionally. The local control rate at 5 and 10 years was 86% and 76%, respectively. The disease-specific survival rate was 86% and 78%, and the overall survival rate was 82% and 62% at 5 and 10 years, respectively.

Conclusion: This extended follow-up of our institutional experience has demonstrated that RT can provide durable long-term locoregional control and survival outcomes for patients with carcinoma of the nasal cavity and septum.

Figure 1

A representative case of a 59 year-old female diagnosed with a T1N0 squamous cell carcinoma of the left nasal septum and columella treated with definitive interstitial brachytherapy. A) The patient presented with a firm 1.5 cm nodule in this location, without direct extension to the nasal ala. B) A total of 13 interstitial needles were placed intraoperatively; eleven 3.5–4.0 cm needles were placed along the septum, left nasal floor, columella, and left nasal ala, and two 4.0–5.0 cm crossing needles were placed in the moustache region. The needles were loaded with 192-Iridium on post-operative day 1, and 60 Gy was delivered to the tumor volume at a dose rate of 85 cGy/hour. C) Treatment results at four months follow-up. The patient remains disease free after 29 months follow-up.

Figure 2

Overall Survival

Figure 3

Disease Specific Survival

Figure 4

Locoregional Disease Control