MANAGEMENT OF UNRESECTABLE MALIGNANT-TUMORS AT THE SKULL BASE USING CONCOMITANT CHEMOTHERAPY AND RADIOTHERAPY WITH ACCELERATED FRACTIONATION

Between January 1988 and June 1992, 20 patients with unresectable mali gnant tumors at the skull base were treated. Eleven had T4 lesions of the paranasal sinus/cavity complex, and 9 had T4 nasopharynx cancer. A ll patients had stage IV disease by the American Joint Committee on St aging Criteria. The histology was squamous cell cancer in 15 patients and other minor salivary gland histologies in 5. There was brain and/o r dural invasion in 11 patients and orbital invasion in 9. All patient s received radiation therapy with accelerated fractionation to a total of 70 Gy in 6 weeks. Concomitant cisplatin (100 Mg/M2) was given on d ays 1 and 22 of radiation. Seven patients received mitomycin C (7.5 Mg /M2) on days 1 and 22, plus adjuvant chemotherapy with cisplatin and v inblastine. Median follow-up was 11 (range: 1 to 43) months. At 2 year s, local progression-free survival was 94%, distant metastases-free su rvival was 57%, and overall survival was 80%. Complications occurred i n 20% and caused the death of 1 patient. Treatment of this group of pa tients with aggressive chemotherapy and radiation therapy produced exc ellent local control in our early experience, but longer follow-up is needed. There is a high rate of distant failure. Future strategies are outlined.