TY - JOUR

T1 - A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer

AU - Sharma, Maja Bendtsen

AU - Jensen, Kenneth

AU - Urbak, Steen Fiil

AU - Funding, Mikkel

AU - Johansen, Jørgen

AU - Bechtold, Dorte

AU - Amidi, Ali

AU - Eskildsen, Simon Fristed

AU - Jørgensen, Jens Otto Lunde

AU - Grau, Cai

N1 - Copyright © 2020. Published by Elsevier B.V.

PY - 2020

Y1 - 2020

N2 - PURPOSE: To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations.METHODS: Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life- (QoL) and dose-response analyses.RESULTS: Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19 %) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p=0.01; grade 3 OR 1.14, p=0.02) and dose constraint violations (grade 2, OR=21, p<0.01; grade 3, OR=41, p<0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63 %) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR=3.32, p=0.03). Three patients (11 %) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63 %). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56 %) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11 %) had radiation-related impaired function in all examined OARs.CONCLUSION: Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.

AB - PURPOSE: To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations.METHODS: Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life- (QoL) and dose-response analyses.RESULTS: Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19 %) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p=0.01; grade 3 OR 1.14, p=0.02) and dose constraint violations (grade 2, OR=21, p<0.01; grade 3, OR=41, p<0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63 %) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR=3.32, p=0.03). Three patients (11 %) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63 %). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56 %) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11 %) had radiation-related impaired function in all examined OARs.CONCLUSION: Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.

KW - Hypopituitarism

KW - Intensity modulated radiotherapy

KW - Late toxicity

KW - Ocular toxicity

KW - Sinonasal cancer

UR - http://www.scopus.com/inward/record.url?scp=85088654677&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2020.07.029

DO - 10.1016/j.radonc.2020.07.029

M3 - Journal article

C2 - 32697945

VL - 151

SP - 58

EP - 65

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

SN - 0167-8140

ER -