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Case report
peer-reviewed

Combination Intensity Modulated Proton Therapy and Passive Scatter Boost for Rapidly Progressing Nasal Cavity Squamous Cell Carcinoma



Abstract

Cancers of the nasal cavity and septum are associated with poor prognosis and are usually treated with surgery followed by post-operative radiotherapy with or without concurrent chemotherapy. Definitive radiotherapy is used in cases where the tumor is unresectable, patient is unfit for surgery, and/or the patient declines surgical intervention. Here, we present a case of a patient, who for non-medical reasons, opted to have non-surgical management of his rapidly progressing nasal cavity tumor. He was successfully treated with concurrent chemoradiotherapy utilizing a combination of intensity modulated proton therapy (IMPT) with passive scatter boost to reduce dose to the adjacent critical neural structures. Post-treatment clinical examination and imaging demonstrated complete clinical and metabolic response at the primary site and neck. This case highlights the use of IMPT and passive scatter boost in combination to achieve delivery of therapeutic dose to nasal cavity tumor and neck whilst limiting dose to numerous adjacent organs-at-risk.



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Case report
peer-reviewed

Combination Intensity Modulated Proton Therapy and Passive Scatter Boost for Rapidly Progressing Nasal Cavity Squamous Cell Carcinoma


Author Information

Sweet Ping Ng Corresponding Author

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Ethan B. Ludmir

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Manuel A. Oyervides

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Richard Y. Wu

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Steve Frank

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

G Brandon Gunn

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. The University of Texas MD Anderson Cancer Center issued approval PCR05-0207. Informed consent obtained. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Combination Intensity Modulated Proton Therapy and Passive Scatter Boost for Rapidly Progressing Nasal Cavity Squamous Cell Carcinoma


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Case report
peer-reviewed

Combination Intensity Modulated Proton Therapy and Passive Scatter Boost for Rapidly Progressing Nasal Cavity Squamous Cell Carcinoma

Sweet Ping Ng">Sweet Ping Ng , Ethan B. Ludmir">Ethan B. Ludmir, Manuel A. Oyervides">Manuel A. Oyervides, Richard Y. Wu">Richard Y. Wu, Steve Frank">Steve Frank, G Brandon Gunn">G Brandon Gunn

  • Author Information
    Sweet Ping Ng Corresponding Author

    Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

    Ethan B. Ludmir

    Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

    Manuel A. Oyervides

    Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

    Richard Y. Wu

    Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

    Steve Frank

    Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

    G Brandon Gunn

    Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. The University of Texas MD Anderson Cancer Center issued approval PCR05-0207. Informed consent obtained. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 14, 2017

    DOI

    10.7759/cureus.1685

    Cite this article as:

    Ng S, Ludmir E B, Oyervides M A, et al. (September 14, 2017) Combination Intensity Modulated Proton Therapy and Passive Scatter Boost for Rapidly Progressing Nasal Cavity Squamous Cell Carcinoma. Cureus 9(9): e1685. doi:10.7759/cureus.1685

    Publication history

    Received by Cureus: August 08, 2017
    Peer review began: August 17, 2017
    Peer review concluded: September 07, 2017
    Published: September 14, 2017

    Copyright

    © Copyright 2017
    Ng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Cancers of the nasal cavity and septum are associated with poor prognosis and are usually treated with surgery followed by post-operative radiotherapy with or without concurrent chemotherapy. Definitive radiotherapy is used in cases where the tumor is unresectable, patient is unfit for surgery, and/or the patient declines surgical intervention. Here, we present a case of a patient, who for non-medical reasons, opted to have non-surgical management of his rapidly progressing nasal cavity tumor. He was successfully treated with concurrent chemoradiotherapy utilizing a combination of intensity modulated proton therapy (IMPT) with passive scatter boost to reduce dose to the adjacent critical neural structures. Post-treatment clinical examination and imaging demonstrated complete clinical and metabolic response at the primary site and neck. This case highlights the use of IMPT and passive scatter boost in combination to achieve delivery of therapeutic dose to nasal cavity tumor and neck whilst limiting dose to numerous adjacent organs-at-risk.



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Sweet Ping Ng

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

For correspondence:
spng@mdanderson.org

Ethan B. Ludmir

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Manuel A. Oyervides

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Richard Y. Wu

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Steve Frank, M.D., Professor

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

G Brandon Gunn

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Sweet Ping Ng

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

For correspondence:
spng@mdanderson.org

Ethan B. Ludmir

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Manuel A. Oyervides

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Richard Y. Wu

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

Steve Frank, M.D., Professor

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

G Brandon Gunn

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center