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Abstract：
BACKGROUND: Surgery and radiotherapy are current therapeutic options for malignant tumors involving the nasal vestibule. Depending on the location, organ-preserving resection is not always possible, even for small tumors. Definitive radiotherapy is an alternative as an organ-preserving procedure. Carbon ion beam radiotherapy offers highly conformal dose distributions and more complex biological radiation effects eventually resulting in optimized normal tissue sparing and improved outcome. The aim of the current study was to analyze toxicity, local control (LC), and organ preserving survival (OPS) after irradiation of carcinoma of the nasal vestibule with raster-scanned carbon ion radiotherapy boost (CIRT-B) combined with volumetric intensity modulated arc therapy (VMAT) with photons.
METHODS: Between 12/2015 and 05/2021, 21 patients with malignant tumors involving the nasal vestibule were irradiated with CIRT-B combined with VMAT and retrospectively analyzed. Diagnosis was based on histologic findings. A total of 17 patients had squamous cell carcinoma (SCC) and 4 had other histologies. In this series, 10%, 67%, and 24% of patients had Wang stages 1, 2, and 3 tumors, respectively. Three patients had pathologic cervical nodes on MRI. The median CIRT-B dose was 24 Gy(RBE), while the median VMAT dose was 50 Gy. All patients with pathologic cervical nodes received simultaneously integrated boost with photons (SIB) up to a median dose of 62.5 Gy to the pathological lymph nodes. Eight patients received cisplatin chemotherapy. All patients received regular follow-up imaging after irradiation. Kaplan-Meier estimation was used for statistical assessment.
RESULTS: The median follow-up after irradiation was 18.9 months. There were no common toxicity criteria grade 5 or 4 adverse events. A total of 20 patients showed grade 3 adverse events mainly on skin and mucosa. All patients were alive at the end of follow-up. The median OPS after treatment was 56.5 months. The 6- and 24-month OPS were 100% and 83.3%, respectively. All local recurrences occurred within 12 months after radiotherapy. The median progression free survival (PFS) after treatment was 52.4 months. The 6-, 12-, and 24-month PFS rates were 95%, 83.6%, and 74.3%, respectively.
CONCLUSIONS: CIRT-B combined with VMAT in malignant tumors of the nasal vestibule is safe and feasible, results in high local control rates, and thus is a good option as organ-preserving therapy. No radiation-associated grade 4 or 5 acute or late AE was documented.
METHODS: Between 12/2015 and 05/2021, 21 patients with malignant tumors involving the nasal vestibule were irradiated with CIRT-B combined with VMAT and retrospectively analyzed. Diagnosis was based on histologic findings. A total of 17 patients had squamous cell carcinoma (SCC) and 4 had other histologies. In this series, 10%, 67%, and 24% of patients had Wang stages 1, 2, and 3 tumors, respectively. Three patients had pathologic cervical nodes on MRI. The median CIRT-B dose was 24 Gy(RBE), while the median VMAT dose was 50 Gy. All patients with pathologic cervical nodes received simultaneously integrated boost with photons (SIB) up to a median dose of 62.5 Gy to the pathological lymph nodes. Eight patients received cisplatin chemotherapy. All patients received regular follow-up imaging after irradiation. Kaplan-Meier estimation was used for statistical assessment.
RESULTS: The median follow-up after irradiation was 18.9 months. There were no common toxicity criteria grade 5 or 4 adverse events. A total of 20 patients showed grade 3 adverse events mainly on skin and mucosa. All patients were alive at the end of follow-up. The median OPS after treatment was 56.5 months. The 6- and 24-month OPS were 100% and 83.3%, respectively. All local recurrences occurred within 12 months after radiotherapy. The median progression free survival (PFS) after treatment was 52.4 months. The 6-, 12-, and 24-month PFS rates were 95%, 83.6%, and 74.3%, respectively.
CONCLUSIONS: CIRT-B combined with VMAT in malignant tumors of the nasal vestibule is safe and feasible, results in high local control rates, and thus is a good option as organ-preserving therapy. No radiation-associated grade 4 or 5 acute or late AE was documented.
摘要：
背景：手术和放疗是目前涉及鼻前庭的恶性肿瘤的治疗选择。根据位置,保留器官的切除并不总是可能的，即使是小肿瘤。明确的放射治疗是一种替代器官保存程序。碳离子束放射治疗提供高度适形的剂量分布和更复杂的生物辐射效应，最终导致优化的正常组织保留和改善的结果。本研究的目的是分析毒性，本地控制（LC），用光栅扫描碳离子放射疗法增强（CIRT-B）结合体积强度调节电弧疗法（VMAT）对鼻前庭癌进行照射后的器官保存生存期（OPS）。
方法：2015年12月至2021年5月，对21例累及鼻前庭的恶性肿瘤患者行CIRT-B联合VMAT照射，进行回顾性分析。诊断基于组织学发现。共有17例患者患有鳞状细胞癌（SCC），4例患有其他组织学。在这个系列中,10%,67%,24%的患者患有Wang1、2和3期肿瘤，分别。3例患者的MRI表现为病理性颈淋巴结。medianCIRT-B剂量为24Gy（RBE），而中位VMAT剂量为50Gy。所有患有病理性颈淋巴结的患者同时接受了光子（SIB）的整合增强，对病理性淋巴结的中位剂量为62.5Gy。8例患者接受顺铂化疗。所有患者均接受放疗后定期随访。Kaplan-Meier估计用于统计学评估。
结果：照射后中位随访时间为18.9个月。没有常见的毒性标准5级或4级不良事件。共有20例患者出现主要在皮肤和粘膜上的3级不良事件。随访结束时所有患者均存活。治疗后中位OPS为56.5个月。6个月和24个月的OPS分别为100％和83.3％，分别。所有局部复发均发生在放疗后12个月内。治疗后中位无进展生存期（PFS）为52.4个月。6-，12-，24个月的PFS率为95%，83.6%,74.3%,分别。
结论：CIRT-B联合VMAT治疗鼻前庭恶性肿瘤是安全可行的，导致较高的局部控制率，因此作为器官保存疗法是一个很好的选择。没有记录到与辐射相关的4级或5级急性或晚期AE。
方法：2015年12月至2021年5月，对21例累及鼻前庭的恶性肿瘤患者行CIRT-B联合VMAT照射，进行回顾性分析。诊断基于组织学发现。共有17例患者患有鳞状细胞癌（SCC），4例患有其他组织学。在这个系列中,10%,67%,24%的患者患有Wang1、2和3期肿瘤，分别。3例患者的MRI表现为病理性颈淋巴结。medianCIRT-B剂量为24Gy（RBE），而中位VMAT剂量为50Gy。所有患有病理性颈淋巴结的患者同时接受了光子（SIB）的整合增强，对病理性淋巴结的中位剂量为62.5Gy。8例患者接受顺铂化疗。所有患者均接受放疗后定期随访。Kaplan-Meier估计用于统计学评估。
结果：照射后中位随访时间为18.9个月。没有常见的毒性标准5级或4级不良事件。共有20例患者出现主要在皮肤和粘膜上的3级不良事件。随访结束时所有患者均存活。治疗后中位OPS为56.5个月。6个月和24个月的OPS分别为100％和83.3％，分别。所有局部复发均发生在放疗后12个月内。治疗后中位无进展生存期（PFS）为52.4个月。6-，12-，24个月的PFS率为95%，83.6%,74.3%,分别。
结论：CIRT-B联合VMAT治疗鼻前庭恶性肿瘤是安全可行的，导致较高的局部控制率，因此作为器官保存疗法是一个很好的选择。没有记录到与辐射相关的4级或5级急性或晚期AE。
