Adenoid Cystic Carcinoma of the Paranasal Sinuses

Abstract

Adenoid cystic carcinoma of the paranasal sinuses is a rare neoplasm whose propensity for perineural spread frequently results in positive surgical margins at the skull base. Radiation therapy (RT) may be used to treat unresectable tumors or as an adjuvant for positive surgical margins after attempted resection. A retrospective review of the experience at the University of Michigan Medical Center was undertaken to study the factors influencing survival and to compare the efficacy of RT alone versus as an adjuvant treatment to surgical resection. All patients selected for review (n = 17) had a histologically confirmed diagnosis of adenoid cystic carcinoma arising from the paranasal sinuses with an average follow-up of 6 years. The choice of treatment modality was based upon the resectability of the tumor by clinical and radiologic parameters. This was therefore not a randomized study and there was a clear bias against the radiation only group, which contained the more advanced and locally aggressive tumors. The 6-year survival for the combined surgery + RT group was 73% compared with 50% for the radiation only group (p = NS). The overall local recurrence rate was 76% and the rate of distant metastases was 18%. Of the 10 patients who underwent surgical resection eight (80%) had positive surgical margins at the skull base.

Sinonasal Adenoid Cystic Carcinoma

“…This also echoes the results of the largest reported study of IPD conducted by Kim et al 73 Despite the ability for postoperative radiation to increase survival in SNACC, there has been no statistical difference reported between the surgery cohort and surgery with postoperative radiation cohort. 52,74 In this analysis, we found a similar survival percentage in the combination (surgery and radiotherapy) treatment group compared with surgery alone, 68.4% vs 63.2%. Two case series reported that the combination therapy cohort had greater survival than the radiotherapy-only cohort, although this was not found to be statistically significant possibly due to small sample size.…”

A national series of 244 sinonasal cancers in Finland in 1990–2004

“…The longest duration of symptoms and the low risk of regional metastases ( Table 2) might reXect the less malignant behaviour of adenoid cystic carcinoma compared with other types of sinonasal cancer. The better prognosis of adenoid cystic carcinoma has also been noticed in previous studies [14]. However, Götte et al [2] speculated that the better shortterm survival is somewhat misleading because of the tendency of late distant and regional metastases to occur in adenoid cystic carcinoma.…”

Sinonasal Malignancy: What’s New?

“…Adenoid cystic carcinomas show similar 5-year survival rates ranging from 73 to 89% [116]; the data concerning the adenoid cystic carcinomas, however, are misleading: the 5-year survival in adenoid cystic carcinomas has very little in common with cure in this slow-growing carcinoma with perineural spread. The disease-specific survival at 15 years diminishes to around 40% [86], the rate of local recurrence is greater than 70%, and the rate of distant metastases is around 20% in adenoid cystic carcinomas [86].…”