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Open Access Review

Intensity modulated radiotherapy for sinonasal malignancies with a focus on optic pathway preservation

Alexander Chi1*, Nam P Nguyen2, William Tse3, Gill Sobremonte4, Patrick Concannon4 and Angela Zhu4

Author Affiliations

1 Department of Radiation Oncology, West Virginia University, 1 Medical Center Dr. Morgantown, Morgantown, WV 26506, USA

2 Department of Radiation Oncology, University of Arizona, Tucson, AZ, 85724, USA

3 Department of Hematology Oncology, West Virginia University, Morgantown, WV, 26506, USA

4 Department of Radiation Oncology, Michael E. Debakey VA Medical Center, Houston, TX, 77030, USA

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Journal of Hematology & Oncology 2013, 6:4  doi:10.1186/1756-8722-6-4

Published: 7 January 2013

Abstract

Purpose

To assess if intensity-modulated radiotherapy (IMRT) can possibly lead to improved local control and lower incidence of vision impairment/blindness in comparison to non-IMRT techniques when treating sinonasal malignancies; what is the most optimal dose constraints for the optic pathway; and the impact of different IMRT strategies on optic pathway sparing in this setting.

Methods and materials

A literature search in the PubMed databases was conducted in July, 2012.

Results

Clinical studies on IMRT and 2D/3D (2 dimensional/3 dimensional) RT for sinonasal malignancies suggest improved local control and lower incidence of severe vision impairment with IMRT in comparison to non-IMRT techniques. As observed in the non-IMRT studies, blindness due to disease progression may occur despite a lack of severe toxicity possibly due to the difficulty of controlling locally very advanced disease with a dose ≤ 70 Gy. Concurrent chemotherapy’s influence on the the risk of severe optic toxicity after radiotherapy is unclear. A maximum dose of ≤ 54 Gy with conventional fractionation to the optic pathway may decrease the risk of blindness. Increased magnitude of intensity modulation through increasing the number of segments, beams, and using a combination of coplanar and non-coplanar arrangements may help increase dose conformality and optic pathway sparing when IMRT is used.

Conclusion

IMRT optimized with appropriate strategies may be the treatment of choice for the most optimal local control and optic pathway sparing when treating sinonasal malignancy.

Keywords:
Intensity modulated radiotherapy; Sino-nasal malignancies; Optic toxicity; Blindness