Sinonasal Malignancies and Charged Particle Radiation Treatment: A Systematic Literature Review

Table 5

Results of studies focusing on toxicity.

Reference	Toxicity	Median time (months, range)	Grade	Dmax to affected OARs, Gy (RBE) (median, range)	Risk factors
Jensen, et al., 2011 [45]	7/29	na	^1G3 mucositis: 5; ^1G3 dysphagia: 2	na	na
Demizu et al., 2009 [46]	Carbon: 1/10; Proton: 4/42^2	C: 52; P: 34.5 (26–39)	Counting fingers or more severe	ON: 129^3; ON: 118^3, (61–126)	^4UA: Age > 60 years; DM, Dmax>110 Gy (RBE); ^4MA: DM
Hasegawa et al., 2006 [47]	7/14^5	24 (10–41)	Complete visual loss	ON: 57.6, (57.6–64)	^4UA: MG, CMT, anemia, DM, TD, Dmax to ON, D10-50,; MA: D20 > 60 Gy (RBE)
Weber et al., 2006 [48]	13/36; 5-years ≥G2: 20.7%±7.8	31.5 (6.4–91)	^6G1: 5; G2: 6; G3: 2 (CA, NLB)	ON: 54.7, (47.8–80); OC: 52.1, (26.2–56.4)	GTV Dose; OC: D90 and D50; ON: D10; Younger Age
Miyawaki et al., 2009 [49]	C: 2/5; P: 3/23	C: 27.5 (19–36); P: 31 (6–49)	^7C: G1: 1, G3: 1; ^7P: G1, G2, G3: 1	C, Dmin: 27.5^3 (102.4–110.6); P, Dmin: 117.1^3 (59.4–117.1)	^4Carbon ions, Dose ≥80 Gy (RBE)^3,; Volumes > 83, 90, 100 Gy (RBE)^3

¹CTCAE versus 4.0, ²One patient experienced bilateral vision loss, ³Doses are expressed in biologically equivalent dose (BED) at α/β = 3, ⁴Data refer to a wider group of patients with head and neck malignancies, ⁵Two patients had bilateral visual loss, ⁶Dry-eye syndrome and epiphora were evaluated with CTCAE v.2.0, all the others with LENT/SOMA, ⁷CTCAE v. 3.0, OARs: organs at risk, C: carbon ions, P: protons, na: not applicable, ON: optic nerve, OC: optic chiasm, DM: diabetes mellitus, MG: male gender, TD: tumor dose, CMT: chemotherapy, UA: univariate analysis, MA: multivariate analysis, CA: cataract, NLB: nasolacrimal duct blockage, D_{10, 20, 50, 90}: dose to the 10%–20%–50%–90% of the organ considered.