Advances in the management of paranasal sinus tumors

  • Michael E. Johns
  • Michael J. Kaplan
Part of the Cancer Treatment and Research book series (CTAR, volume 22)


Cancer of the paranasal sinuses is rare, but because of a historically dismal prognosis and morbidity, these tumors deserve great attention. Advances necessary to improve the management of these tumors include: earlier diagnosis, better local control, and the development of new and better therapeutic modalities. Unfortunately, the natural history of the more common malignant tumors in this anatomic area confound these goals. Diagnosis is frequently delayed because early symptoms are lacking, misleading or ignored. When symptoms do occur, they frequently mimic benign disease such as allergy or a ‘persistent cold’. Although locally advanced, cervical or distant metastatic spread is present at the time of diagnosis in only 5–15% of cases. Thus, local control is a realistic goal Limiting factors, however, include extension of tumor to vital structures at the cribriform plate, ptery-gomaxillary space, orbital apex, sphenoid, and nasopharynx. The major challenge to the head and neck surgeon is to improve the chances of cure and yet provide functional and cosmetic reconstruction. This chapter will review the current status and recent advances in the recognition and delineation of disease extent, surgical techniques used to achieve local control and rehabilitation, and investigational therapy.


Paranasal Sinus Maxillary Sinus Frontal Sinus Bone Flap Ethmoid Sinus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gray H: In: Warwick R, Williams PL (eds) Gray’s Anatomy, 35th edn. London, Longman, 1973.Google Scholar
  2. 2.
    Montgomery WW: Surgery of the Upper Respiratory System, 2nd edn. Philadelphia, Lea and Febiger, 1979.Google Scholar
  3. 3.
    Boone MLM, Harle TS, Higholt HW: Paranasal sinuses and nasal cavity. In: Fletcher GH, Jing B-S (eds) The Head and Neck. Chicago, Year Book Medical Publishers, Inc, 1968, pp 235–313.Google Scholar
  4. 4.
    Lederman M: Tumors of the upper jaw. Natural history and treatment. J Laryngol Otol 84: 369–401, 1970.PubMedGoogle Scholar
  5. 5.
    Lewis JS, Castro EB: Cancer of the nasal cavity on paranasal sinuses. J Laryngol Otol 86: 255–262, 1972.PubMedGoogle Scholar
  6. 6.
    Jackson RT, Fitz-Hugh GS, Constable WC: Malignant neoplasms of the nasal cavities and paranasal sinuses: (A retrospective study). Laryngoscope 87: 726–736, 1977.PubMedGoogle Scholar
  7. 7.
    Robins PE, Powell, DJ, Stansbie JM: Review: Carcinoma of the nasal cavity and paranasal sinuses: Incidence and presentation of different histological types. Clin Otolaryngol 4: 431–456, 1979.Google Scholar
  8. 8.
    Batsakis, JG: Tumors of the Head and Neck: Clinical and Pathological Consideration, 2nd edn. Baltimore, Williams and Wilkins, 1979.Google Scholar
  9. 9.
    Sisson GA, Becker SP: Cancer of the nasal cavity and paranasal sinuses. In: Suen JY, Myers EN (eds) Cancer of the Head and Neck. New York, Churchill Livingston, 1981, pp 242–279.Google Scholar
  10. 10.
    Haagensen CD, Feimd CR, Herter FP, Slanetz CA Jr., Weinberg JA: The Lymphatics in Cancer. Philadelphia, W.B. Saunders, 1972.Google Scholar
  11. 11.
    Bleehen NM: Ethmoid sinus cancer. JAMA 219: 346–347, 1972.PubMedGoogle Scholar
  12. 12.
    Cheng VST, Wang CC: Carcinoma of the paranasal sinuses. A study of sixty-six cases. Cancer 40: 3038–3041, 1977.PubMedGoogle Scholar
  13. 13.
    Staging of cancer of head and neck sites and of melanomas, 1980. Chicago, American Joint Committee on Cancer, 1980.Google Scholar
  14. 14.
    Harrison DFN: Critical look at the classification of maxillary sinus carcinomata. Ann Otol Rhinol Laryngol, 87: 3–9, 1978.PubMedGoogle Scholar
  15. 15.
    Harrison DFN: A critical evaluation of present day attitudes to the treatment of antroethmoidal cancer. J Otolaryngol 11: 148–150, 1982.PubMedGoogle Scholar
  16. 16.
    Petruson B: A form to show extension of tumors in the nose and sinus. Arch Otolaryngol 108: 460–461, 1982.PubMedGoogle Scholar
  17. 17.
    Batsakis JG, Rice DH, Solomon AR: The pathology of head and neck tumors: Squamous and mucous gland carcinomas of the nasal cavity, paranasal sinuses, and larynx, part 6. Head Neck Surg 2: 497–508, 1980.PubMedGoogle Scholar
  18. 18.
    Fu YS, Perzin KH: Nonepithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx. A clinicopathological study. X. Malignant lymphomas. Cancer 43: 611–621, 1979.PubMedGoogle Scholar
  19. 19.
    Gottlieb TH, Meriwether WD: Lymphosarcoma of paranasal sinuses. Arch Otol 93: 199–202, 1971.Google Scholar
  20. 20.
    Wang CC: Primary malignant lymphoma of the oral cavity and paranasal sinuses. Radiology 100: 151–153, 1971.PubMedGoogle Scholar
  21. 21.
    Goepfert H, Lindberg RD, Sinkovics JG, Ayala AG: Soft tissue sarcoma of the head and neck after puberty. Treatment by surgery on postoperative radiation therapy. Arch Otolaryngol 103: 365–368, 1977.PubMedGoogle Scholar
  22. 22.
    Lund V: Malignant melanoma of the nasal cavity and paranasal sinuses. J Laryngol Otol 96: 347–355, 1982.PubMedGoogle Scholar
  23. 23.
    Nahum AM, Bailey BJ: Malignant tumors metastatic to the nose and paranasal sinuses: Case report and review of the literature. Laryngoscope 73: 942–953, 1963.PubMedGoogle Scholar
  24. 24.
    Bernstein JM, Montgomery WW, Balogh K: Metastatic tumors to the maxilla, nose, and paranasal sinus. Laryngoscope, 76: 621–650, 1966.PubMedGoogle Scholar
  25. 25.
    Chaudhry AP, Haar JG, Koul A, Nickerson PA: Olfactory neuroblastoma (esthesioneuroblastoma). A light and ultrastructural study of two cases. Cancer 44: 564–579, 1979.PubMedGoogle Scholar
  26. 26.
    Elkon D, Hightower SI, Lim ML, Cantrell RW, Constable WC: Esthesioneuroblastoma. Cancer 44: 1987–1094, 1979.Google Scholar
  27. 27.
    Trojanowski JQ, Lee V, Pillsbury N, Lee S: Neuronal origin of human esthesioneuroblastoma demonstrated with anti-neurofilament monoclonal antibodies. N Engl J Med 307: 159–161, 1982.PubMedGoogle Scholar
  28. 28.
    Gown AM: Neuronal origin of human esthesioneuroblastoma. Letter to the editor. N Engl J Med 307: 1457, 1982.Google Scholar
  29. 29.
    Silva E, Batsakis JG: Neuronal origin of human esthesioneuroblastoma. Letter to the editor. N Engl J Med 307: 1457–1458, 1982.Google Scholar
  30. 30.
    Cantrell RW, Ghorayeb BV, Fitz-Hugh GS: Esthesioneuroblastoma: Diagnosis and treatment. Ann Otol Rhinol Laryngol 86: 760–765, 1977.PubMedGoogle Scholar
  31. 31.
    Oberman HA, Rice DH: Olfactory neuroblastomas. A clinicopathologic study. Cancer 38: 2494–2502, 1976.PubMedGoogle Scholar
  32. 32.
    Roush GC: Epidemiology of cancer of the nose and paranasal sinuses: Current concepts. Head Neck Surg 2: 3–33, 1979.PubMedGoogle Scholar
  33. 33.
    Acheson ED, Cowdell RH, Hadfield E, Macbeth RG: Nasal cancer in woodworkers in the furniture industry. Br Med J 2: 587–596, 1968.PubMedGoogle Scholar
  34. 34.
    Engzell U: Occupational etiology and nasal cancer. An internordic project. Acta Otolaryngol (Suppl) 360: 126–128, 1979.Google Scholar
  35. 35.
    Acheson ED, Cowdell RH, Jolles B: Nasal cancer in the Northhampton boot and shoe industry. Br Med J 1: 385–393, 1975.Google Scholar
  36. 36.
    Acheson ED: Nasal cancer in the furniture and boot and shoe manufacturing industries. Prev Med 5: 295–315, 1976.PubMedGoogle Scholar
  37. 37.
    Schechter GL, Ogura JH: Maxillary sinus malignancy. Laryngoscope 82: 796–806, 1972.PubMedGoogle Scholar
  38. 38.
    Weymuller EA, Reardon EJ, Nash D: A comparison of treatment modalities in carcinoma of the maxillary antrum. Arch Otolaryngol 106: 625–629, 1980.PubMedGoogle Scholar
  39. 39.
    Mancuso AA, Hanafee WN: Paranasal sinuses –normal anatomy, methodology, and pathology. In: Computed Tomography of the Head and Neck. Baltimore, Williams and Wilkins, 1982, pp 203–243.Google Scholar
  40. 40.
    Schindler E, Reck R: Value and limits of computer-assisted tomography. Head Neck Surg 2: 287–292, 1980.PubMedGoogle Scholar
  41. 41.
    Som PM, Shugar JMA: The significance of bone expansion associated with the diagnosis of malignant tumors of paranasal sinuses. Radiology 136: 97–100, 1980.PubMedGoogle Scholar
  42. 42.
    Dubois PJ, Schultz JC, Perrin RL, Dastur KJ: Tomography in expansile lesions of the nasal and paranasal sinuses. Radiology 125: 149–158, 1977.PubMedGoogle Scholar
  43. 43.
    Som PM: The role of CT in the diagnosis of carcinoma of the paranasal sinuses and nasopharynx. J Otolaryngol 11: 340–348, 1982.PubMedGoogle Scholar
  44. 44.
    De St Jeor, Konradh, Hanafee WN: Tomography of paranasal sinus disease undetected by routine views. Appl Radio 9: 73–80, 1980.Google Scholar
  45. 45.
    Jeans WD, Gilani S, Bullimore J: The effect of CT scanning on staging of tumors of the paranasal sinuses. Clin Radiol 33: 173–179, 1982.PubMedGoogle Scholar
  46. 46.
    Thomsen J, Gyldensted C, Lester J: Computer tomography of cerebellopontine angle lesions. Arch Otolaryngol 103: 65–69, 1977.PubMedGoogle Scholar
  47. 47.
    Jing BS, Goepfert H, Close LG: Computerized tomography of paranasal sinus neoplasms. Laryngoscope 88: 1485–1503, 1978.PubMedGoogle Scholar
  48. 48.
    Robin PE, Powell DJ: Diagnostic errors in cancers of the nasal cavity and paranasal sinuses. The essential role of surgery. Arch Otolaryngol 107: 138–140, 1981.PubMedGoogle Scholar
  49. 49.
    Kaufman L, Crooks LE, Margulis A: Nuclear Magnetic Resonance Imaging in Medicine. New York, Igaku-Shoin, 1981.Google Scholar
  50. 50.
    Partain CL, James AE Jr, Rollo FD, Price RR: Nuclear Magnetic Resonance (NMR) Imaging. Philadelphia, WB Saunders Company, 1983.Google Scholar
  51. 51.
    Damadian R: Tumor detection by nuclear magnetic resonance. Science 171: 1151–1153, 1971.PubMedGoogle Scholar
  52. 52.
    Lauterbur PC: Image formation by induced local interactions: example employing nuclear magnetic resonance. Nature 242: 190–191, 1973.Google Scholar
  53. 53.
    Pykett IL, Newhouse JH, Buonanno FS, et al.: Nuclear magnetic resonance Principle of nuclear magnetic resonance imaging. Radiology 143: 157–168, 1982.PubMedGoogle Scholar
  54. 54.
    James AE Jr, Partain CL, Holland GN, et al: Nuclear magnetic resonance imaging: The current state. AJR 138: 201–210, 1981.Google Scholar
  55. 55.
    Hounsfield GN: Computed medical imaging. Nobel lecture, December 8, 1979. J Comput Assist Tomogr 4: 665–674, 1980.PubMedGoogle Scholar
  56. 56.
    Eichel BS: The medical and surgical approach in management of the unilateral opacified antrum. Laryngoscope 87: 737–750, 1977.PubMedGoogle Scholar
  57. 57.
    Eichel BS: Criteria for selection of patients undergoing paranasal sinus surgery. Candidate’s thesis to the American Laryngological, Rhinological and Otological Society, Inc., 1976.Google Scholar
  58. 58.
    Marx JL: NMR opens a new window into the body. The uses of nuclear magnetic resonance for medical diagnosis hovers on the brink of practical applications. Science 210: 302–305, 1980.PubMedGoogle Scholar
  59. 59.
    Bydder GM, Steiner RE, Young IR, et al: Clinical NMR imaging of the brain: 140 cases. AJR 139: 215–236, 1982.PubMedGoogle Scholar
  60. 60.
    Harrison DFN: Problem in surgical management of neoplasms arising in the paranasal sinuses. J laryngol Otol 90: 69–74, 1976.PubMedGoogle Scholar
  61. 61.
    Ohngren LG: Malignant tumors of the maxillo-ethmoidal region: A clinical study with special reference to the treatment with electrocautery and irradiation. ACTA Otolaryngol (Suppl) 19: 1–476, 1933.Google Scholar
  62. 62.
    Ellingwood KE, Million RR: Cancer of the nasal cavity and ethmoid/sphenoid sinuses. Cancer 43: 1517–1526, 1979.PubMedGoogle Scholar
  63. 63.
    Robin PE, Powell DJ: Treatment of carcinoma of the nasal cavity and paranasal sinuses. Clin Otolaryngol 6: 401–414, 1981.PubMedGoogle Scholar
  64. 64.
    Som ML: Surgical management of carcinoma of the maxilla. Arch Otolaryngol 99: 270–273, 1974.PubMedGoogle Scholar
  65. 65.
    Jesse RH, Goepfert H, Lindberg RD: Carcinoma of the sinuses: A review of treatment. In: Chambers RG, Jansen de Limpeus AMP, Jaques DA, Routledge RT (eds) Cancer of the Head and Neck. Amsterdam, Excerpta Medica; New York, American Elsevier Publ Co, 1975, pp 153–159.Google Scholar
  66. 66.
    Sisson GA: Symposium. III. Treatment of malignancies of paranasal sinuses: Discussion and summary. Laryngoscope 80: 945–953, 1970.PubMedGoogle Scholar
  67. 67.
    Yu-Hua H, Gui-Yi T, Yu-Qin Q, et al.: Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of maxillary sinus. Lat J Radiation Oncol Biol Phys 8: 1045–1049, 1982.Google Scholar
  68. 68.
    Ahmad K, Cordoba RB, Fayos JV: Squamous cell carcinoma of the maxillary sinus. Arch Otolaryngol 107: 48–51, 1981.PubMedGoogle Scholar
  69. 69.
    Larson DL, Christ JE, Jesse RH: Preservation of the orbital contents in cancer of the maxillary sinus. Arch Otolaryngol 108: 370–372, 1982.PubMedGoogle Scholar
  70. 70.
    Adkins WY Jr: Maxillectomy with preservation of orbital function. Surg Forum 27: 548–550, 1976.PubMedGoogle Scholar
  71. 71.
    Ketcham AS, Chretien PB, Van Buren TM, Hoye RC, Beazley RM, Herdt JR: The ethmoid sinuses: A re-evaluation of surgical resection. Am J Surg 126: 469–476, 1973.PubMedGoogle Scholar
  72. 72.
    Smith RR, Klopp CT, Williams JM: Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer 7: 991–994, 1954.PubMedGoogle Scholar
  73. 73.
    Malecki J: New trends in frontal sinus surgery. Acta Otolaryngol 50: 137–140, 1959.PubMedGoogle Scholar
  74. 74.
    Ketcham AS, Wilkins RH, Van Buren JM, Smith RR: A combined intracranial facial approach to the paranasal sinuses. Am J Surg 106: 698–703, 1963.PubMedGoogle Scholar
  75. 75.
    Shah JP, Galicich JH: Craniofacial resection for malignant tumors of ethmoid and anterior skull base. Arch Otolaryngol 103: 514–517, 1977.PubMedGoogle Scholar
  76. 76.
    Schramm VL, Myers EN, Maroon JC: Anterior skull base surgery for benign and malignant disease. Laryngoscope 89: 1077–1091, 1979.PubMedGoogle Scholar
  77. 77.
    Johns ME, Winn HR, McLean WC, Cantrell RW: Pericranial flap for the closure of defects of craniofacial resections. Laryngoscope 91: 952–958, 1981.PubMedGoogle Scholar
  78. 78.
    Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB: The supraorbital approach: Technical note. Neurosurgery 11: 537–542, 1982.PubMedGoogle Scholar
  79. 79.
    Bridger GP, Shaheen OH: Radical surgery for ethmoid cancer. J Laryngol Otol 82: 817–824, 1968.PubMedGoogle Scholar
  80. 80.
    Sisson GA, Bytell DE, Becker SP, Ruge D: Carcinoma of the paranasal sinuses and cranial-facial resection. J Laryngol Otol 90: 59–68, 1976.PubMedGoogle Scholar
  81. 81.
    Schuller D: Personal communication.Google Scholar
  82. 82.
    Winn HR, Dacey RG, Jane JA: Intracranial subarachnoid pressure recording: Experience with 650 patients. Surg Neurol 8: 41–47, 1977.PubMedGoogle Scholar
  83. 83.
    Bridger GP: Radical surgery for ethmoid cancer. Arch Otolaryngol 106: 630–634, 1980.PubMedGoogle Scholar
  84. 84.
    Terz J J, Young HF, Lawrence W Jr: Combined craniofacial resection for locally advanced carcinoma of the head and neck. II. Carcinoma of the paranasal sinuses. Am J Surg 140: 618–624, 1980.PubMedGoogle Scholar
  85. 85.
    Jafek BW, Nahum AM, Butler RM: Surgical treatment of juvenile nasopharyngeal angiofibroma. Laryngoscope 83: 707–720, 1973.PubMedGoogle Scholar
  86. 86.
    Krekorian EA, Katu RH: Surgical management of nasopharyngeal angiofibroma with intracranial extension. Laryngoscope 87: 154–164, 1977.PubMedGoogle Scholar
  87. 87.
    Standefer J, Holt GR, Brown WE, Gates GA: Combined intracranial and extracranial excision of nasopharyngeal angiofibroma. Laryngoscope, in press.Google Scholar
  88. 88.
    Terz J J, Alksne JF, Lawrence W Jr: Craniofacial resection for tumors invading the pterygoid fossa. Am J Surg 118: 732–740, 1969.PubMedGoogle Scholar
  89. 89.
    Windeyer BW: Malignant tumors of the upper jaw. Br J Radiol 16: 362–366, 1943.Google Scholar
  90. 90.
    Larsson LG, Mortensson G: Maxillary antrial cancers. JAMA, 219: 342–345, 1972.PubMedGoogle Scholar
  91. 91.
    Goepfert H, Jesse RH, Lindberg RD: Arterial indusions and radiation therapy in the treatment of advanced cancer of the nasal cavity and paranasal sinuses. Am J Surg 126: 464–468, 1973.PubMedGoogle Scholar
  92. 92.
    Moseley HS, Thomas LR, Sverts EC, Stevens KR, Ireland KM: Advanced squamous cell carcinoma of the maxillary sinus. Results of combined regional infusion chemotherapy, radiation therapy and surgery. Am J Surg 141: 522–525, 1981.PubMedGoogle Scholar
  93. 93.
    Arbit E, Sundareson N, Galicich JH, Shab J: Craniofacial resection following chemotherapy. Surg Neurol 13: 395–399, 1980.PubMedGoogle Scholar
  94. 94.
    Wade PM, Smith RE, Johns ME: Response of esthesioneuroblastoma to chemotherapy. Report of five cases and review of the literature. Arch Otolaryngol, in press.Google Scholar
  95. 95.
    Crabtree HG, Cramer W: The action of radium on cancer cells. II. Some factors determining the susceptibility of cancer cells to radium. Proc R Soc Lond (Biol) 113: 238–250, 1933.Google Scholar
  96. 96.
    Stratford IJ: Mechanisms of hypoxic cell radiosensitization and the development of new sensitizers. Int J Radiat Oncology Biol Phys 8: 391–398, 1982.Google Scholar
  97. 97.
    Piro AJ, Taylor CC, Bell JA: Interaction between radiation and drug damage in mammalian cells. II. The effect of Actinomycin D on the repair of sub-lethal damage in plateau phase cells. Cancer 37: 2697–2702, 1976.PubMedGoogle Scholar
  98. 98.
    Ben-Hur E, Elkind MM, Bronk BV: Thermally enhanced radio-response of cultured Chinese hamster cells: Inhibition of repair of sublethal damage and enhancement of lethal damage. Radiat Res 58: 38–51, 1974.PubMedGoogle Scholar
  99. 99.
    Bump EA, Brown JM: The use of drugs which deplete intracellular glutathione as radio- sensitizers of hypoxic tumor cells in vivo. Int J Radiat Oncol Biol Phys 8: 439–442, 1982.PubMedGoogle Scholar
  100. 100.
    Varnes ME, Biaglow JE, Koch CJ, Hall EJ: Depletion of non-protein thiols of hypoxic cells by misonidazole and metronidazole. In: Brady LW (ed) Radiation Sensitizers. New York, Masson, 1980, pp 121–124.Google Scholar
  101. 101.
    Douple EB, Richmond RC: Platinum complexes as radiosensitizers of hypoxic mammalian cells. Br J Cancer 37 (Suppl III): 98–102, 1978.Google Scholar
  102. 102.
    Stratford IJ, Williamson C, Adams GE: Combination studies with misonidazole and a cis-platinum complex: Cytotoxicity and radiosensitization in vitro. Br J Cancer 41: 517–523, 1980.PubMedGoogle Scholar
  103. 103.
    Fazekas JT: The value of adjuvant misonidazole in the definitive irradiation of advanced head and neck squamous cancer. An RTOG pilot study (#78–02). Int J Radiat Oncol Biol Phys 5 (Suppl 2): 186–187, 1979.Google Scholar
  104. 104.
    Sealy R, Williams A, Cridland S, Stratford M, Minchinton A, Hallet C: A report on misonidazole in a randomized trial in locally advanced head and neck cancer. Int J Radiat Oncol Biol Phys 8: 339–342, 1982.PubMedGoogle Scholar
  105. 105.
    Hall ET: Radiobiology for the Radiologist. Hagerstown, Maryland, Harper and Row, 1978.Google Scholar
  106. 106.
    Hall EJ: The particles compared. Int J Radiat Oncol Biol Phys 8: 2137–2140, 1982.PubMedGoogle Scholar
  107. 107.
    Gragoudas ES, Goitein M, Koehler A, et al.: Proton irradation of choroidal melanomas. Arch Ophthalmol 96:1583–1591, 1978.Google Scholar
  108. 108.
    Tobias CA, Blackely EA, Alpen EK, et al.: Molecular and cellular radiobiology of heavy ions. Int J Radiant Oncol Biol Phys 8:2109–2120, 1982.Google Scholar
  109. 109.
    Catterall M, Sutherland I, Bewley DK: First results of a randomized clinical trial of fast neutrons compared with X or gamma rays in treatment of advanced tumors of the head and neck. Br Med J 2: 653–656, 1975.PubMedGoogle Scholar
  110. 110.
    Catterall M, Bewley DK: Fast Neutrons in the Treatment of cancer. London, Academic Press; New York, Grune and Stratton, 1979.Google Scholar
  111. 111.
    Duncan W, Arnott SJ, Orr J A, Kerr GR: The Edinburgh experience of fast neutron therapy. Int J Radiat Oncol Biol Phys 8: 2155–2157, 1982.PubMedGoogle Scholar
  112. 112.
    Cohen L: Absence of a demonstrable gain factor for neutron beam therapy of epidermoid carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 8: 2173–2176, 1982.PubMedGoogle Scholar
  113. 113.
    Griffin TW, Laramore GE, Hussey DH, Hendrickson FR, Rodriquez-Antunez A: Fast neutron beam radiation therapy in the United States. Int J Radiat Oncol Biol Phys 8: 2165–2168.Google Scholar

Copyright information

© Martinus Nijhoff Publishers, Boston 1984

Authors and Affiliations

  • Michael E. Johns
  • Michael J. Kaplan

There are no affiliations available

Personalised recommendations