Bilateral pansinusitis was the most common cause. All patients received an initial trial of intravenous antibiotics. Based on the Fisher exact test, no statistically significant differences were detected for age, sex, presence of gaze restriction, and radiographic findings. Based on multiple logistic regression, degree of proptosis was the only significant multivariate predictor of surgery (P =.003). The estimated probability of surgery was 6% when there was no proptosis, and 92% for 2 mm of proptosis. The location of the SPA determined the route of surgical drainage. Eleven patients with a medially based SPA underwent drainage via the transnasal endoscopic approach, and 3 with a superior SPA underwent drainage externally. The external approach was associated with a longer hospital stay (median, 7 days) than either the endoscopic or the intravenous antibiotic approach (median, 5 days).

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BACKGROUND The leading cause of death for patients with hereditary retinoblastoma is second malignancy. Radiotherapy (RT), despite its high rate of efficacy, is often avoided due to fear of inducing a secondary tumor. Proton RT allows for significant sparing of non-target tissue. We compared the risk of second malignancy in retinoblastoma patients treated with photon and proton RT. METHODS We performed a retrospective review of patients with retinoblastoma treated with proton RT at the Massachusetts General Hospital or photon RT at Children’s Hospital Boston between 1986 and 2011. RESULTS Eighty-six patients were identified. Fifty-five patients received proton RT, and 31 patients received photon RT. Patients were followed for a median of 6.9 years (range, 1.0 to 24.4) in the proton cohort and 13.1 years (range, 1.4 to 23.9) in the photon cohort. The 10-year cumulative incidence of RT-induced or in-field second malignancies was significantly different between radiation modalities (Proton vs. Photon; 0% vs. 14%; p=0.015). The 10-year cumulative incidence of all second malignancies was also different, though with borderline significance (5% vs. 14%; p=0.120). CONCLUSION Retinoblastoma is highly responsive to radiation. The central objection to the use of radiation--the risk of second malignancy--is founded on studies of patients treated with antiquated, relatively non-conformal techniques. We present the first series of patients treated with the most conformal of currently available external beam therapy modalities. While longer follow up is necessary, our preliminary data suggest that proton RT significantly lowers the risk of RT-induced malignancy.

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