Feasibility of reirradiation of recurrent sinonasal carcinoma in the periorbital region using hypofractionated image-guided intensity-modulated radiation therapy.

Abstract

Recurrent periorbital tumors pose management challenges because they are often unresectable and chemorefractory. Proximity to critical structures renders reirradiation difficult. With image-guided intensity-modulated radiation therapy (IG-IMRT), real-time corrections to patient setup are possible, enabling significant shrinkage of planning target volume margins and safe dose escalation with hypofractionation. Here, we present our experience with hypofractionated IG-IMRT in a patient with multiply recurrent sinonasal carcinomas in the periorbital region. The patient is a 67-year-old woman with sinonasal carcinoma, treated with surgery and 2 prior courses of high-dose radiotherapy. She developed a second tumor recurrence in the right lateral orbit, which was reirradiated using hypofractionated IG-IMRT (24 Gy in 3 fractions). Near-complete resolution of her ocular symptoms was observed at 4 months. Progress scans demonstrated a decrease in size of the orbital lesion. Preliminary results of reirradiation using hypofractionated IG-IMRT suggest that it is safe and effective.