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

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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.

TidsskriftRadiotherapy & Oncology
Sider (fra-til)58-65
Antal sider8
StatusUdgivet - 2020


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