Could the extreme conformality achieved with proton therapy in paranasal sinuses cancers accidentally results in a high rate of leptomeningeal progression?

Orlandi, Ester; Iacovelli, Nicola Alessandro; Cavallo, A.; Resteghini, Carlo; Gandola, Lorenza; Licitra, Lisa; Bossi, Paolo

doi:10.1002/hed.25848

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…It eliminates biases related to low and intermediate doses, which may control microscopic disease. Due to the proximity of the highest nodal station to the oropharyngeal mucosa, omitting low to intermediate doses-which is impossible with high conformal radiotherapy (i.e., IMRT)-could provide valuable insights into the efficacy of not irradiating the primary tumor bed after TORS [96].…”

Section: Tors As a De-escalation Strategy For Ct1-ct2mentioning

confidence: 99%

Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know

Molteni,

Bassani,

Arsie

et al. 2024

Healthcare

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Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and opportunities for treatment, particularly regarding de-escalation strategies to reduce treatment morbidity without compromising oncological outcomes. This paper examines the role of Transoral Robotic Surgery (TORS) as a de-escalation strategy in managing HPV-related OPSCC. We conducted a comprehensive literature review from January 2010 to June 2023, focusing on studies exploring TORS outcomes in patients with HPV-positive OPSCC. These findings highlight TORS’s potential to reduce the need for adjuvant therapy, thereby minimizing treatment-related side effects while maintaining high rates of oncological control. TORS offers advantages such as precise tumor resection and the ability to obtain accurate pathological staging, which can guide the tailoring of adjuvant treatments. Some clinical trials provide evidence supporting the use of TORS in specific patient populations. The MC1273 trial demonstrated promising outcomes with lower doses of adjuvant radiotherapy (RT) following TORS, showing high locoregional tumor control rates and favorable survival outcomes with minimal side effects. ECOG 3311 evaluated upfront TORS followed by histopathologically directed adjuvant therapy, revealing good oncological and functional outcomes, particularly in intermediate-risk patients. The SIRS trial emphasized the benefits of upfront surgery with neck dissection followed by de-escalated RT in patients with favorable survival and excellent functional outcomes. At the same time, the PATHOS trial examined the impact of risk-adapted adjuvant treatment on functional outcomes and survival. The ongoing ADEPT trial investigates reduced-dose adjuvant RT, and the DART-HPV study aims to compare standard adjuvant chemoradiotherapy (CRT) with a reduced dose of adjuvant RT in HPV-positive OPSCC patients. These trials collectively underscore the potential of TORS in facilitating treatment de-escalation while maintaining favorable oncological and functional outcomes in selected patients with HPV-related OPSCC. The aim of this scoping review is to discuss the challenges of risk stratification, the importance of HPV status determination, and the implications of smoking on treatment outcomes. It also explores the evolving criteria for adjuvant therapy following TORS, focusing on reducing radiation dosage and volume without compromising treatment efficacy. In conclusion, TORS emerges as a viable upfront treatment option for carefully selected patients with HPV-positive OPSCC, offering a pathway toward treatment de-escalation. However, selecting the optimal candidate for TORS-based de-escalation strategies is crucial to fully leverage the benefits of treatment de-intensification.

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Section: Tors As a De-escalation Strategy For Ct1-ct2mentioning

confidence: 99%

Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know

Molteni,

Bassani,

Arsie

et al. 2024

Healthcare

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“…Charged particle therapy may better spare the organs at risk than IMRT [ 37 , 59 , 60 , 61 , 62 ] or may be used as an adjunct [ 52 ]. Despite increased sensitivity to anatomy, tumor and cavity filling change during radiotherapy of sinonasal neoplasms with protons versus photons, and organs at risk appear to receive smaller doses with proton therapy than IMRT [ 63 ] using adaptive replanning [ 64 ].…”

Section: Radiotherapymentioning

confidence: 99%

“…This is, however, dependent on the extent and bilaterality of tumors and may be best assessed by provisional dosimetry. Moreover, one risk of extreme conformality is geometric miss and unusual local relapse by unintentional sparing of tumor spread pathways (excess of leptomeningeal relapses have been observed after proton therapy due to better brain/meningeal sparing) [ 61 , 65 ].…”

Section: Radiotherapymentioning

confidence: 99%

Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery

Thariat

Carsuzaa

Marcy³

et al. 2021

Cancers

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Radiotherapy plays an important role in the treatment of sinonasal cancer, mainly in the adjuvant setting after surgical resection. Many technological approaches have been described, including intensity-modulated radiotherapy, concomitant chemoradiotherapy, charged particle therapy or combined approaches. The choice is based on general criteria related to the oncological results and morbidity of each technique and their availability, as well as specific criteria related to the tumor (tumor extensions, pathology and quality of margins). The aims of this review are: (i) to provide an overview of the radiotherapy techniques available for the management of sinonasal malignant tumors and (ii) to describe the constraints and opportunities of radiotherapy owing to the recent developments of endonasal endoscopic surgery. The indication and morbidity of the different techniques will be discussed based on a critical literature review.

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Radiothérapie des tumeurs rares des voies aérodigestives supérieures

Sauvage,

Calugaru,

Janoray

2023

Cancer/Radiothérapie

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Could the extreme conformality achieved with proton therapy in paranasal sinuses cancers accidentally results in a high rate of leptomeningeal progression?

Abstract: http://onlinelibrary.wiley.com/doi/10.1002/hed.25854/full

Cited by 3 publications

References 16 publications

Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know

Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know

Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery

Radiothérapie des tumeurs rares des voies aérodigestives supérieures

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