Radiotherapy as nose preservation treatment strategy for cancer of the nasal vestibule: The Dutch experience

M.D. Czerwinski*, P.P. Jansen, E.M. Zwijnenburg, A. Al-Mamgani, M.R. Vergeer, J.A. Langendijk, F.W.R. Wesseling, J.H.A.M. Kaanders, C.G. Verhoef

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background and purpose: Primary radiotherapy is often preferred for early-stage cancer of the nasal vestibule (CNV), combining high disease control with preservation of nasal anatomy. However, due to practice variation and an absence of comparative trials, no consensus exists on preference for brachytherapy (BT) or external beam radiotherapy (EBRT). We compared these modalities in terms of disease control, nose preservation rates and toxicity. Materials and methods: Medical records of 225 patients with T1-T2 squamous cell carcinoma of the nasal vestibule treated with 3D image-guided primary radiotherapy between Jan 2010 and Dec 2016 in 6 Dutch institutions were reviewed retrospectively. Results: 153 of 225 patients were treated with BT, 65 with EBRT and 7 with other modalities. Median follow-up was 46 months. Overall 3-year local control (LC) and regional control (RC) were 87% and 89%. Five-year disease-specific survival (DSS) and overall survival (OS) were 94% and 82%. Three-year survival with preserved nose (SPN) was 76%. BT provided higher 3-year LC (95% vs 71%, p < 0.01) and SPN compared with EBRT (82% vs 61%, p < 0.01). Multivariable and propensity-score-matched cohort analyses confirmed better outcomes after BT. No difference was seen in DSS or OS. Five-year incidence of CTCAE 5.0 grade >2 toxicity was higher after BT (20% vs 3%, p = 0.03) and consisted mostly of radiation ulcers. 50% of all late toxicity recovered. Conclusion: In this largest-to-date multicenter analysis of T1-T2 CNV, BT achieved superior LC and SPN compared with EBRT. Grade 1-2 radiation ulcers occurred more frequently after brachytherapy, but were transient in half the cases. Considering these results, BT can be recommended as first-line treatment for T1-T2 CNV. (c) 2021 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology 164 (2021) 20-26 This is an open access article under the CC BY license (
Original languageEnglish
Pages (from-to)20-26
Number of pages7
JournalRadiotherapy and Oncology
Publication statusPublished - 1 Nov 2021


  • Radiotherapy
  • Brachytherapy
  • Head and neck cancer
  • HEAD

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