| Eligibility |
Inclusion Criteria:
- Age greater than or equal to 18 years.
- Histopathologically confirmed diagnosis of one the following cancer types:
- Squamous cell carcinoma
- Esthesioneuroblastoma
- Adenoid cystic carcinoma
- Adenocarcinoma
- Paranasal sinus/nasal cavity malignancy is considered unresectable with negative
margins surgery or resection would be considered excessively morbid. This could
include lesions with:
- Carotid involvement
- Cavernous sinus invasion
- Brain invasion
- Orbital apex
- Intraconal space
- Pterygoid musculature involvement
- Invasion of the clivus
- Resection of at least 80% of the volume of the tumor is feasible. Resectability will
be determined by the surgeon and radiologist after discussion among the
multidisciplinary team. For patients who have had surgery at an outside institution,
the same parameters will be thoroughly screened to ensure the patient met the same
inclusion criteria and resection standards.
- Patients must be a candidate for surgery (as per treating surgeon) and be able to
tolerate proton radiation and chemotherapy (as per treating radiation oncologist and
medical oncologist).
- Karnofsky performance statue >/= 70
- The subject has organ and marrow function and laboratory values rendering safe
administration of Cisplatin:
- The ANC >/= 1000/mm3 without colony stimulating factor support
- Platelets >/= 100,000/mm3
- Hemoglobin >/= 9 g/dL
- Bilirubin </= 1.5 mg/dL the ULM. For subjects with Gilbert's disease, bilirubin
</= 3.0 mg/dL
- Serum albumin >/= 2.8 g/dl
- Creatinine clearance (CrCl) >/= 60 mL/min. For creatinine clearance estimation,
the Cockcroft and Gault equation should be used:
- Male: CrCl (mL/min) = (140 = age) x wt (kg) / (serum creatinine x 72)
- Female: Multiply above result by 0.85
- ALT and AST </= 3.0 ULN
- Serum phosphorus, calcium, magnesium and potassium >/= LLN
- No evidence of intercurrent infection
- Negative pregnancy test for women of childbearing potential (<51 years of age) as per
institutional policy.
- Patients with distant metastatic disease may not be included.
- Patient must be able to read and write in English.
- Patients who intitially meet the histopathological inclusion criteria but surgical
pathology report shows Sinonasal Undifferentiated Carcinoma.
Exclusion Criteria:
- Tumor is deemed to be resectable with negative margins by conventional surgical
standards.
- Patients not able to receive standard-dose cisplatin based on the judgement of the
treating medical oncologist.
- Patients with chronic kidney disease (GFR <60), uncontrolled hypertension, congestive
heart failure, pre-existing bone marrow dysfunction, or cytopenias.
° Congestive heart failure (CHF): New York Heart Association (NYHA) Class II-IV at the
time of screening
- Concurrent uncontrolled hypertension defined as sustained blood pressure > 150 mm Hg
systolic or > 100 mm Hg diastolic despite optimal antihypertensive treatment within 7
days of the first dose of study treatment; If severe hearing impairment is measured or
if significant neuropathy is reported at baseline the treating physician will discuss
the risks for further permanent hearing loss and neuropathy with the patient.
- Patients not able to have a MRI (due to pacemaker, claustrophobia, etc.).
- Inability to return to MSKCC for frequent scheduled hydration sessions
post-chemotherapy.
- Inability to comply with requirements for cisplatin administration anti-emetic
regimens post-treatment.
- Patients not able or unwilling to travel for proton therapy.
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