Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Gasser, B.
Comparison of outcomes between brachytherapy and percutaneous radiotherapy after endoscopic resection of sinonasal malignancies – A retrospective study
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 47
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Tomazic Peter Valentin
- Wolf Axel
- Altmetrics:
- Abstract:
- Background: Sinonasal malignancies are rare tumors with poor prognosis, which are often diagnosed at a late stage because they stay asymptomatic for long time. Therapeutic approaches are usually multimodal and combine surgery, radiotherapy and/or chemotherapy. In cases of small tumors, when an open approach is not necessary, an endoscopic resection (FESS) is pursued. Materials and Methods: Between 2001 and 2018 43 patients with primary sinonasal malignancies were endoscopically treated at the Department for General Otorhinolaryngology of the University Hospital Graz and received postoperative radiotherapy afterwards. Radiotherapy was either percutaneous radiotherapy or brachytherapy. The data was retrospectively acquired from the openMEDOCS system and analyzed with Microsoft Excel 2011 and IBM SPSS Statistics 23. Results: 28 male (65.1 %) and 15 female (34.9 %) patients between 27 and 86 years underwent FESS and adjuvant radiotherapy. Histopathologically 22 adenocarcinomas (51.2 %, divided on 4 subtypes), 7 olfactory neuroblastomas (16.3 %), 5 malignant melanomas (11.6 %), 3 undifferentiated sinonasal carcinomas (7.0 %), 2 non-keratizing carcinomas (4.7 %), 2 squamous cell carcinomas (4.7 %), 1 diffuse large B-cell lymphoma (2.3 %), and 1 low-differentiated small-cell neuroendocrine carcinoma (2.3 %) were diagnosed. In 16 cases an endoscopic reconstruction was needed. Used closure materials were fascia lata (n=9), tachosil-sponges (n=6), and fascia temporalis (n=1). 40 of 43 (93.0 %) patients underwent percutaneous radiotherapy, while 3 (7.0 %) were treated with brachytherapy. The overall 3- and 5-year-survial rates of all patients were 71.4 % and 53.6 %. In cases of percutaneous radiotherapy the 3-year-survial was 75.0 % and the 5-year-survial was 56.0 %, while it was 33.3 % each in cases of brachytherapy. The histopathological diagnoses in all cases of brachytherapy were adenocarcinomas; the 3- and 5-year-survival rates of adenocarcinomas treated with percutaneous radiotherapy were 84.6 % and 70.0 %. Recurrences were reported in 48.8 % (n=18) of all cases; in 33.3 % of cases of brachytherapy and in 42.5 % of percutaneous radiotherapy. The median and the mean disease-free-interval were 1.05 years each in cases of brachytherapy, and 2.06 (median) and 2.38 ±1.60 years (mean) for cases of percutaneous radiotherapy. Adverse effects and radiation damages were reported in 21 cases (48.8 %), among those was 1 treated with brachytherapy. Severe damages, as amaurosis or leukoencephalopathy occurred only in cases of percutaneous radiotherapy. Conclusion: The analysis of this retrospective study shows that brachytherapy had poorer results of survival rates compared to percutaneous radiotherapy, but better results as regards recurrences and radiation damages. Based on what we know, this is the first study with this focus, but the number of cases (especially of brachytherapy) was low. Therefore, for a sufficiently powered statistical comparison, a prospective study should be achieved.