Survival, Tumor Control, and Safety Outcomes of Proton Therapy in Sinonasal Cancer Population: A Systematic Review and Meta-Analysis

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-01-23 DOI:10.1002/hed.28082

Srivatsa Surya Vasudevan, Estephania Candelo, Alireza Sharifi, Daniel J. Ma, Samir H. Patel, David M. Routman, Adam L. Holtzman, Homan Mohammadi, Angela M. Donaldson

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Abstract

Background

In sinonasal cancer (SNC), treatment with proton therapy (PT) provides excellent local control, especially after gross total resection. Because of the heterogeneity and rarity of this disease site, a comprehensive assessment of toxicity, survival, and control rates is lacking. Our primary objective was to assess the toxicity outcomes of PT in SNC patients, with a secondary aim of assessing survival and tumor control after PT.

Methods

PubMed, Embase, EBSCO, Scopus, Science Direct, Web of Science, Ovid, Proquest, and Cochrane Library were searched from inception to August 2024 reporting PT acute and late toxicity, survival, and tumor control outcomes in SNC patients. A random-effect meta-analysis was used to assess the pooled safety, survival, and tumor control outcomes. The primary analysis was to report acute and late toxicity. The secondary aims included overall survival (OS), disease-free survival (DFS), local control (LC), regional control (RC), and distant metastasis control (DMC) rate.

Results

Fourteen studies were included for qualitative analysis. We pooled data from 756 patients who received PT for SNC. Among acute toxicity (AT), there was a 31.9% occurrence rate of grade ≥ 3 events, whereas within late toxicity (LT), grade ≥ 3 events occurred at a rate of 35.3%. Most LT (62.1%) were classified as grade 2, with the most frequent being ocular (24.8%) or neurological (18.4%) toxicities. The most common grade ≥ 3 toxicities were mucositis (15.3%) in AT and ocular toxicity (9.6%) in LT. The pooled 5-year OS, DFS, LC, RC, and DMC were 36.8%, 34.2%, 35.6%, 28.6%, and 54.3%, respectively.

Conclusion

Our analysis demonstrates that PT-treated SNC patients experience acceptable rates of acute and LT consistent with other published outcomes with highly conformal radiation techniques. PT demonstrates favorable OS and DFS. Further prospective and comparative effectiveness research is needed to better quantify the magnitude of the benefit of PT or other forms of radiation modalities.

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鼻窦癌患者质子治疗的生存、肿瘤控制和安全性：系统回顾和荟萃分析。

背景：在鼻窦癌（SNC）中，质子治疗（PT）提供了良好的局部控制，特别是在全切除后。由于该疾病部位的异质性和罕见性，缺乏对毒性、生存率和控制率的综合评估。我们的主要目的是评估PT在SNC患者中的毒性结果，次要目的是评估PT后的生存和肿瘤控制。方法：检索PubMed， Embase， EBSCO, Scopus, Science Direct, Web of Science, Ovid， Proquest和Cochrane图书馆，从成立到2024年8月报道的SNC患者的PT急性和晚期毒性，生存和肿瘤控制结果。随机效应荟萃分析用于评估合并安全性、生存率和肿瘤控制结果。主要分析报告急性和晚期毒性。次要目标包括总生存期（OS）、无病生存期（DFS）、局部控制（LC）、区域控制（RC）和远处转移控制率（DMC）。结果：纳入14项研究进行定性分析。我们汇集了756例接受SNC PT治疗的患者的数据。急性毒性（AT）组≥3级事件发生率为31.9%，而晚期毒性（LT）组≥3级事件发生率为35.3%。大多数LT（62.1%）被归类为2级，最常见的是眼部毒性（24.8%）或神经毒性（18.4%）。最常见的≥3级毒性是AT组的粘膜炎（15.3%）和lt组的眼毒性（9.6%）。5年总OS、DFS、LC、RC和DMC分别为36.8%、34.2%、35.6%、28.6%和54.3%。结论：我们的分析表明，pt治疗的SNC患者的急性和LT发生率与其他已发表的高适形放射技术的结果一致。PT表现出良好的OS和DFS。需要进一步的前瞻性和比较有效性研究，以更好地量化PT或其他形式的放射方式的益处程度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.