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Case Reports
. 2009 Nov;19(6):409-16.
doi: 10.1055/s-0029-1220207.

Efficacy of Proton Beam Therapy in the Treatment of Ewing's Sarcoma of the Paranasal Sinuses and Anterior Skull Base

Stacey Tutt Gray  1 , Yen-Lin Chen, Derrick T Lin
Affiliations
Case Reports

Efficacy of Proton Beam Therapy in the Treatment of Ewing's Sarcoma of the Paranasal Sinuses and Anterior Skull Base

Stacey Tutt Gray et al. Skull Base. 2009 Nov.

Abstract

Ewing's sarcoma involving the sinonasal cavity and anterior skull base is very rare. The purpose of this article is to present our experience with two such cases, which were both treated with combined chemotherapy and proton beam radiation therapy. The patients were selected from a retrospective medical record analysis that was conducted of all patients who were diagnosed with Ewing's sarcoma of the sinonasal cavity at the Massachusetts Eye & Ear Infirmary/Massachusetts General Hospital Cranial Base Center from 2004 to 2008. One of the patients underwent pretreatment endoscopic subtotal resection to facilitate proton beam radiation therapy. Response to treatment was assessed, post-treatment endoscopic biopsies were performed to assure eradication of disease, and treatment complications were recorded. Both patients completed chemotherapy and proton beam radiation therapy without complication. One patient completed treatment in December 2006 and remains disease free. The second patient completed treatment in March 2007 and remains disease free. Both patients developed headaches accompanied by frontal sinus opacification after treatment that required endoscopic drainage. After endoscopic drainage, the opacification and symptoms resolved.

Keywords: Ewing's sarcoma; anterior skull base; endoscopic surgery; proton beam.

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Figures

Figure 1
Figure 1
Preoperative coronal computed tomography (CT) scan of patient 1 showing involvement of the left maxillary sinus, ethmoid sinus, skull base, and orbit.
Figure 2
Figure 2
Axial computed tomography (CT) proton beam radiation planning for patient 1, showing full treatment dosage to the tumor with decreased dosage to the orbit.
Figure 3
Figure 3
Coronal computed tomography (CT) proton beam radiation planning for patient 1, showing full treatment dosage to the tumor with decreased dosage to orbit and frontal lobe.
Figure 4
Figure 4
Preoperative coronal computed tomography (CT) scan of patient 2 showing involvement of the left maxillary sinus, ethmoid sinus, skull base, and orbit, with a frontal sinus mucocele involving the lateral frontal sinus.
See this image and copyright information in PMC

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