Journal of Neuro-Oncology

, Volume 72, Issue 1, pp 67–75 | Cite as

The treatment of advanced sinonasal malignancies with pre-operative intra-arterial cisplatin and concurrent radiation

  • L. Madison MichaelII
  • Jeffrey M. Sorenson
  • Sandeep Samant
  • Jon H. Robertson
Clinical Study

Abstract

Introduction: Malignancies of the nasal and paranasal sinuses are uncommon tumors, accounting for only 3% of all aerodigestive tract neoplasms. Despite advances in surgical techniques and continued evolution of adjuvant therapies, the 5-year mortality remains unusually high at greater than 50%. In 1996, we begin utilizing a novel strategy in the treatment of advanced sinonasal carcinomas. This consisted of neoadjuvant selective intra-arterial cisplatin with concurrent radiation therapy (acronym RADPLAT) followed by a conservative craniofacial resection. We now report our results for 11 patients treated with this regimen.

Methods: Between July 1996 and April 2003, 11 patients with advanced sinonasal malignancies underwent treatment utilizing the RADPLAT protocol followed by a planned surgical resection via a craniofacial approach. Patient charts, operative notes, follow-up clinic notes, and pre- and post-operative imaging studies were reviewed in detail for each subject.

Results: Histopathological analysis of the tumors revealed seven squamous cell carcinomas (64%), two adenocarcinomas (18%), one adenoid cystic carcinoma (9%), and one sinonasal undifferentiated carcinoma (9%). T4N0M0 disease was present in nine patients (81%), and two patients had T3N0M0 disease (19%). Survival was calculated using the Kaplan–Meier method with an overall survival of 81% at 5 years and a progression-free survival at 5 years of 67%. Mean follow-up is 57.2 months ranging from 12 to 95 months.

Conclusions: The treatment of advanced sinonasal malignancies with pre-operative intra-arterial cisplatin and concurrent radiation results in a significant improvement in survival. This can be done safely with high response rates and excellent loco-regional control in T3 and T4 disease. Although are results are encouraging, there is a need for a cooperative, multi-institutional, prospective study.

Keywords

adenocarcinoma adenoid cystic carcinoma RADPLAT sinonasal malignancy sinonasal undifferentiated carcinoma squamous cell carcinoma 

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Copyright information

© Springer 2005

Authors and Affiliations

  • L. Madison MichaelII
    • 1
  • Jeffrey M. Sorenson
    • 1
    • 3
  • Sandeep Samant
    • 2
  • Jon H. Robertson
    • 1
    • 3
  1. 1.Department of NeurosurgeryUT College of MedicineMemphisUSA
  2. 2.Department of OtolaryngologyThe University of Tennessee at MemphisMemphis
  3. 3.Semmes-Murphey Neurologic and Spine InstituteMemphisUSA

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