Intensity modulated radiotherapy for sinonasal malignancies with a focus on optic pathway preservation
Affiliation
Department of Radiation Oncology, West Virginia University, 1 Medical Center Dr. Morgantown, Morgantown, WV 26506, USADepartment of Radiation Oncology, University of Arizona, Tucson, AZ, 85724, USA
Department of Hematology Oncology, West Virginia University, Morgantown, WV, 26506, USA
Department of Radiation Oncology, Michael E. Debakey VA Medical Center, Houston, TX, 77030, USA
Issue Date
2013Metadata
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BioMed CentralCitation
Chi et al. Journal of Hematology & Oncology 2013, 6:4 http://www.jhoonline.org/content/6/1/4Journal
Journal of Hematology & OncologyRights
© 2013 Chi et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)Collection Information
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.Abstract
PURPOSE:To assess if intensity-modulated radiotherapy (IMRT) can possibly lead to improved local control and lower incidence of vision impairment/blindness in comparison to non-IMRT techniques when treating sinonasal malignancieswhat is the most optimal dose constraints for the optic pathway
and the impact of different IMRT strategies on optic pathway sparing in this setting.METHODS AND MATERIALS:A literature search in the PubMed databases was conducted in July, 2012.RESULTS:Clinical studies on IMRT and 2D/3D (2 dimensional/3 dimensional) RT for sinonasal malignancies suggest improved local control and lower incidence of severe vision impairment with IMRT in comparison to non-IMRT techniques. As observed in the non-IMRT studies, blindness due to disease progression may occur despite a lack of severe toxicity possibly due to the difficulty of controlling locally very advanced disease with a dose less than or equal to] 70Gy. Concurrent chemotherapy's influence on the the risk of severe optic toxicity after radiotherapy is unclear. A maximum dose of less than or equal to] 54Gy with conventional fractionation to the optic pathway may decrease the risk of blindness. Increased magnitude of intensity modulation through increasing the number of segments, beams, and using a combination of coplanar and non-coplanar arrangements may help increase dose conformality and optic pathway sparing when IMRT is used.CONCLUSION:IMRT optimized with appropriate strategies may be the treatment of choice for the most optimal local control and optic pathway sparing when treating sinonasal malignancy.