Proton re-irradiation of Sinonasal Esthesioneuroblastoma: a Case Report

Author(s) :

Konstantin Gordon1,2, Igor Gulidov1, Danil Gogolin1, Olga Lepilina2, Olga Golovanova3, Alexey Semenov1, Sergey Dujenko4, Kira Medvedeva1,
Sergey Koryakin4, Sergey Ivanov5, Andrey Kaprin6

1 Department of Proton Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russia

2 Department of Histology, Cytology, and Embryology, Medical Institution, People’s Friendship University of Russia, Moscow, Russia

3 Department of Dosimetry, A. Tsyb Medical Radiological Research Center, Obninsk, Russia

4 Department of Radiophysics, A. Tsyb Medical Radiological Research Center, Obninsk, Russia

5 A. Tsyb Medical Radiological Research Center, Obninsk, Russia

6 National Medical Research Radiological Center, Moscow, Russia

Corresponding author: Konstantin Gordon, Email:

Published: Journal of Medical and Radiation Oncology 1 (2021) 75-81, , , - DOI: 10.53011/JMRO.2021.01.08

Open Access

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March 22, 2021 0 Comments


Head and neck (H&N) cancers are in the 7-8th place among all types of cancer. Despite novel approaches in cancer treatment, most of the patients have a high risk of loco-regional recurrence.

Esthesioneuroblastoma (ENB) is a very rare H&N neoplasm, accounting for only 3-6% of all intranasal tumors. These tumors usually are presented with locally advanced stages and required radiotherapy as a part of the comprehensive treatment. Loco-regional failures represent a challenge, and re-irradiation can be effective for some groups of patients. We present a case of re-irradiation with protons of sinonasal tumor in a 49-years old patient with recurrent ENB, involving visual structures. We achieved a 5-year positive local control after the proton therapy (PT), without significant toxicity. The case shows an example of re-irradiation as an essential area for PT application, given the need to maximize the treatment’s efficacy and minimize the risk of severe toxicity.

Fig. 1. Diagnostic MR-imaging before PT in 2016 (A), VGTV=110.8 cm3, and after 5 years, in 2021 (B), VGTV=93.9 cm3.
Fig. 2 Dose distribution of the proton therapy plan (Intensity-modulation PT, JSC Protomtm TPS).

Table 1. Approximate cumulative BED to the OARs (a/b = 3)

Optic nerve R (Dmax) Optic nerve L (Dmax) Chiasma



Temporal lobe R


Temporal lobe L




Brain stem (Dmax) Cochlea R (Dmean) Cochlea L
120 120 120 68 26 20 120 56 56
78.6 85.5 72 6 2.6 3 92.6 32.6 23.6
Total BED 198.6 205.5 192 72 28.6 23 212.6 88.6 79.6
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