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ABSTRACT:Here we are reporting a case of cemento ossifying fibroma (COF) of paranasal sinus in a 45 year female presented with large mass in maxilla and extraosseous component, pain and disfigurement due to facial asymmetry and planned for surgery as the surgery is the main stay of treatment, reviewed with surgical oncologist and it was unresectable because of large extensive mass. Then we planned for radiation therapy as there was no other option available. We reviewed with literature there was not a single case treated with radiation in human being but reports are available treated with radiation therapy in horses and in other animals. On the basis of animal case reports we treated with radiation therapy. After treatment patient was improved symptomatically and living for 2 years till today. Here we are reporting this case and this may be the first reported case treated with radiation therapy in human being as per the literature available.CASE DETAIL: 45 year old female presented with nasal obstruction, Facial swelling, Proptosis left eye [ Fig. 1], Pain due to expansion of tumour, duration of more than one year. CT scan showed Mass involving bilateral maxillary sinus, eroding the pterygoid plates, destruction of sphenoid sinus, involving the orbital cavity and pushing of right eye outwards [ Fig. 2]. Tumour volume on imaging was 250cc approx. biopsy of the tumour showed [ Fig. 5] cement ossifying fibroma. Because of huge mass, bony involvement, surgery was not feasible sent for radiation oncologist for opinion. Radiation planning was done by intensity modulated radiotherapy technique [ Fig. 3] with an aim of sparing the opposite optical apparatus. Plan evaluated with acceptable constraint specification planned for 50Gy in 25 fractions. Patient completed radiation therapy over 5 weeks and with dry desquamation of skin [RTOG grade II]. Patient planned for radiation and total dose delivered 50Gy @2Gy/# Over 5 weeks. Only primary treated and lymph node spared. Patient completed radiation with RTOG grade 2 skin reactions [dry desquamation]. There was no significant morphological change at the end of radiation. At 3 month follow-up Proptosis decreased, facial swelling came down [ Fig. 4], Patient was symptom free, planned for imaging, CT scan showed decrease in tumour volume to 170cc and planned for next visit after 3 months. At the end of the treatment the response evaluated morphologically and which is an insignificant response, then patient was kept under follow up. After 3 months the Proptosis decreased, pain was minimal and patient was better than before. CT scan volume revealed around 170 cc comparing pre radiation volume of 250cc.DISCUSSION: Cemento ossifying fibroma [COF] IS a bony origin of benign cause. [1] WHO classifies COF as a fibro-osseous neoplasm, included among the non-odontogenic tumors, derived from the mesenchymal blast cells of the periodontal ligament, and with a potential to form fibrous tissue,

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