# OSIRIS-Nose: Organ Sparing Using Interventional Radiotherapy (Brachytherapy) for Invasive Squamous Cell Cancer of the Nasal Vestibule

## TL;DR

A new treatment combining surgery and brachytherapy preserves the nose in patients with nasal vestibule cancer, avoiding disfigurement and maintaining good outcomes.

## Contribution

The OSIRIS approach introduces a novel organ-preserving treatment for SCCNV using HDR-IRT with surgery, offering an alternative to radical surgery.

## Key findings

- 51 patients treated with HDR-IRT and surgery had a 90% nose preservation rate at 5 years.
- Local tumor control was 84% with acceptable toxicity and 84.3% satisfactory cosmetic outcomes at 3 years.
- The treatment achieved high disease control with minimal disfigurement and functional impairment.

## Abstract

Squamous cell carcinoma of the nasal vestibule is a rare tumor commonly treated with radical surgery that may result in permanent functional impairment and facial disfigurement. Developing effective organ-preserving treatment strategies is therefore of major clinical importance. This study evaluates a combined approach integrating conservative surgery with high-dose-rate brachytherapy (HDR-IRT), enabling precise radiation delivery directly to the tumor region. In a cohort of 51 patients, this strategy achieved high rates of local tumor control and long-term nose preservation, while maintaining acceptable toxicity and favorable cosmetic outcomes. These results support HDR-IRT-based organ-preserving treatment as a clinically effective alternative to radical surgery, with the potential to improve both oncologic outcomes and patient quality of life in this rare disease.

Background/Objectives: Squamous cell carcinoma of the nasal vestibule (SCCNV) represents a rare malignancy traditionally managed by radical surgical resection, frequently at the cost of substantial functional impairment and disfiguring aesthetic consequences. This study investigates an organ-preserving therapeutic strategy integrating high-dose-rate interventional radiotherapy (HDR-IRT; brachytherapy) with organ-preserving surgery. Material and Methods: A retrospective analysis of patients with primary SCCNV treated using HDR-IRT between 2008 and 2022, excluding recurrent disease and cutaneous squamous cell carcinomas. Interstitial HDR-IRT catheters were implanted intraoperatively, with radiation delivered twice daily to a target volume encompassing the tumor and a 10–15 mm safety margin. Results: Fifty-one patients were included, with a median age of 71 years. The median total dose was 40 Gy. Gross total resection was performed in 7 patients, and subtotal resection in 44. The median follow-up was 35 months. The 5-year nose preservation rate was 90%, with local control at 84%, regional failure-free survival at 94%, and overall survival at 82%. In total, 49 acute toxicity events were documented, including two grade 3 events, while 35 chronic toxicity events were reported, including one grade 3 event. At 3 years, 84.3% of cosmetic outcomes were rated as satisfactory, 9.8% as acceptable, and 5.9% as unsatisfactory. Conclusions: The OSIRIS approach, combining HDR-IRT with organ-preserving surgery, is an effective treatment for SCCNV, offering high organ preservation and favorable long-term disease control, with manageable toxicity and positive cosmetic outcomes.