Meta-Analysis Indicates Better Outcomes With Charged-Particle Therapy vs Photon Therapy in Nasal Cavity and Paranasal Sinus Malignancies
Nasal cavity and paranasal sinus tumors are rare and comprise multiple histologic types, making comparative therapeutic trials difficult. In a systematic review and meta-analysis reported in The Lancet Oncology, Patel et al found that that charged-particle therapy appeared to be associated with better outcomes than photon therapy in this setting.
In the review of the literature, 43 cohorts from 41 noncomparative observational studies were identified, including 13 cohorts (n = 286) treated with charged-particle therapy and 30 (n = 1,186) treated with photon therapy. Mean ages were 57.7 years and 59.2 years, and there were no significant differences between charged-particle therapy and photon therapy groups in sex, advanced disease (stage IV or Kadish stage C), histologic type, radiation dose, or median duration of follow-up.
Improved Outcomes
Median follow-up was 38 months (range, 5–73 months) in the charged-particle therapy group and 40 months (range, 14–97 months) in the photon therapy group. At 5 years, the charged particle group had significantly greater overall survival (relative risk [RR] = 1.51, P = .0038) and disease-free survival (RR = 1.93, P = .0003) but not locoregional control (RR = 1.06, P = .79). At longest follow-up, the charged-particle group had significantly greater overall survival (RR = 1.27, P = .037) and locoregional control (RR = 1.18, P = .031) and borderline greater disease-free survival (RR = 1.51, P = .051).
Analysis restricted to treatment-naive patients showed that charged-particle therapy was associated with significantly greater overall survival and locoregional control at 5 years and at longest follow-up, as well as disease-free survival at 5 years.
A subgroup analysis comparing proton-beam therapy vs intensity-modulated radiation therapy showed significantly greater 5-year disease-free survival (RR = 1.44, P = .045) and locoregional control at longest follow-up (RR = 1.26, P = .011) with proton-beam therapy.
The investigators concluded, “Compared with photon therapy, charged particle therapy could be associated with better outcomes for patients with malignant diseases of the nasal cavity and paranasal sinuses. Prospective studies emphasising collection of patient-reported and functional outcomes are strongly encouraged.”
Samir H. Patel, MD, of the Mayo Clinic, Scottsdale, Arizona, is the corresponding author for The Lancet Oncology article.
The study was funded by the Mayo Foundation for Medical Education and Research. For full disclosures of the study authors, visit www.thelancet.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
