Definitive Intensity modulate radiotherapy for stage IV sinonasal inverted papilloma

Case presentation: A 34 years-old female complained of nasal obstruction for two years. Video-nasofibroscopy showed a large lobulated and polypoid tumor, of rough surface and firm, occupying the all the lateral wall of the nasal cavity. Nasal and paranasal sinuses computed tomography CT and magnetic resonance image (MRI) scan revealed a hyperdense and hyperintense signal occupying all left nasal cavity, ethmoidal, frontal, sphenoid and maxillary sinuses. The tumor was classified as a Krouse stage IV . The biopsy showed a Schneider papilloma without signs of cell atypia. She refused surgical treatment, being treated by radiation therapy alone with IMRT technique with a total dose of 70 Gy in 35 fractions with a complete response. Currently, the patient is well without symptoms from their disease, or any visual or aesthetical sequels. Discussion: Historically, the standard treatment for SIP has been the surgical resection. The recommendation of radiotherapy for SIP is reserved for the presence of a focus of carcinoma, recurrent tumors, and positive margins. Radiotherapy alone as definitive treatment has been poorly investigated even for unresectable tumors, and, therefore, its role remains controversial. Currently, only 6 case reports are describing the treatment results with RT alone for benign SIP. In fact, among these reports, patients with benign SIP were treated after recurrence or with old radiotherapy techniques (cobalt) using doses < 65 Gy resulting in a poor outcome. Our case is the first to report the feasibility, and the good results achieved with high dose IMRT for a patient with an unresectable disease (Stage IV). Final comments: This case report is the first to show a satisfactory result treating an unresectable SIP with definitive IMRT with a high dose (70 Gy). These findings could stimulate other centers to use new radiation technologies such as IMRT or Image-Guided Radiation Therapy (IGRT) for this condition.