Upright proton therapy for esthesioneuroblastoma: a single-institution experience

Konstantin Gordon; Igor Gulidov; Daniil Smyk; Alexey Semenov; Kirill Golubev; Alyona Lemaeva; Sergey Koryakin; Enar Jumaniyazova; Polina Vishnyakova; Irina Eremina; Timur Fatkhudinov; Andrey Kaprin

doi:10.3389/fonc.2024.1348291

Upright proton therapy for esthesioneuroblastoma: a single-institution experience

Front Oncol. 2024 Jan 30:14:1348291. doi: 10.3389/fonc.2024.1348291. eCollection 2024.

Authors

Affiliations

¹ Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia.
² Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People's Friendship University of Russia, Moscow, Russia.

Abstract

Aim: This study presents an analysis (efficacy and toxicity) of outcomes in patients with esthesioneuroblastoma after pencil beam proton therapy with a fixed beamline in the upright position.

Background: Esthesioneuroblastoma (ENB) is an extremely rare tumor of sinonasal area located in critical proximity to vital structures. Proton therapy (PT) is often considered the optimal radiation treatment for head-and-neck tumors, although of limited availability. Upright PT delivered using fixed pencil beamline and rotating chair is a fairly promising option.

Methods: This is a single-center experience describing the outcomes of PT in 14 patients with ENB treated between January 2016 and October 2022; half of the cases had a history of previous irradiation. The therapy was applied using a fixed pencil beamline with 6D-chair for positioning. The median dose was 63 GyRBE (total range 48-70 GyRBE; based on 1.1 RBE multiplier for protons) with 2.0 GyRBE per fraction. The mean gross tumor volume was 109.5 cm³ (17.1-257.7 cm³). Patient demography, pathology, treatment parameters and toxicity data were analyzed. Radiation-induced reactions were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v 4.0.

Results: The median follow-up time was 28 months. The 1- and 2-year locoregional control rates constituted 100% and 88.9%, respectively; the median duration of local control was 52 months. The 1- and 2-year progression-free survival (PFS) rates constituted 92.9% and 75.0%, respectively; the median PFS duration was 52 months. The 1- and 2-year overall survival (OS) rates constituted 92.9% and 84.4%, respectively. Two patients died of non-cancer-related causes (coronavirus-induced pneumonia) and 1 patient died of tumor progression. All patients tolerated PT well without any treatment gaps. Serious late toxicity reactions included glaucoma in 1 patient and cataract in 2 patients, in over half a year since irradiation.

Conclusion: PT with upright design of the unit affords promising outcomes in terms of disease control and toxicity rates in ENB, a sinonasal tumor of complicated localization.

Keywords: brain invasion; esthesioneuroblastoma; proton therapy; radiation therapy; reirradiation; upright position.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was carried out with the financial support of the Ministry of Education and Science of Russia; Agreement dated 7 October 2021 No. 075-15-2021-1356 (internal number of the Agreement: 15.SIN.21.0011); (ID: RF 0951.61321X0012).