Clinical and Biological Prognostic Factors in 179 Cases with Sinonasal Carcinoma Treated in the Italian Piedmont Region

Abstract

Objectives: In spite of aggressive surgery and high-dose radiotherapy, the long-term survival of patients with sinonasal cancer remains disappointing. In this paper, we report data from 179 consecutive cases treated in the Italian Piedmont region between 1996 and 2000 according to a fixed protocol. Methods: Clinical and pathological data and the following biological parameters were analyzed: microvessel density and growth fraction by CD31 and Ki-67 positivity, respectively, and immunohistochemical expression of vascular endothelial growth factor (VEGF). Results: The median follow-up period was 75 months (range 45–108 months). Median overall survival was 26 months; 2- and 5-year overall survival rates were 52 and 36%, respectively. Patients with T1-T2 adenocarcinoma and squamous cell cancers (SCC) had better median survival than those with other lesions (p < 0.05). Patients treated with surgery with or without radiotherapy had better survival (p < 0.01), while chemotherapy had a marginally favorable effect (p = 0.09). The type of surgery and radiotherapy dose had no impact on survival; in contrast, there was a strong association between Ki-67 expression and microvessel density and overall survival (p < 0.05 and p = 0.039, respectively), while VEGF-C was a prognostic factor in SCC patients only (p < 0.05). Conclusions: In sinonasal cancer, tumor stage and histology have a clear impact on survival; surgery with or without radiotherapy represents the main choice of treatment for such tumors. The efficacy of neoadjuvant and concomitant chemoradiotherapy needs to be further investigated. The proliferative index and angiogenesis show a major role in the natural history of this cancer.

Intensity-Modulated Radiotherapy for Sinonasal Cancer: Improved Outcome Compared to Conventional Radiotherapy

“…Recently, the incorporation of adjuvant or concomitant chemotherapy in the treatment of sinonasal cancer, as in other head and neck cancers, has produced encouraging results and would now be considered for certain indications, especially in patients with squamous cell carcinoma (37,38). However, the use of chemotherapy for adenocarcinoma patients (the overall majority in our series) is much more controversial and needs to be investigated further (39).…”

Effect of local extension sites on survival in locally advanced maxillary sinus cancer

“…In order to reduce the complications associated with radical resection, trimodality therapy, consisting of partial maxillectomy, intra-arterial chemotherapy, and radiotherapy, has also been used for the treatment of maxillary sinus cancer in many institutions in Japan. 10,11 Therefore, the eligibility criteria in this study were limited to T4 disease and SCC. [4][5][6] However, CRT does not necessarily lead to satisfactory treatment outcome in cases of maxillary sinus cancer.…”

Sinonasal Malignancies and Charged Particle Radiation Treatment: A Systematic Literature Review

“…No clear evidence exists for a routine use of chemotherapy, which is administered generally in a case-by-case scenario [17, 18]. Despite the therapeutic efforts, results are not completely satisfactory, with overall survival rates at 5 years ranging from 50% to 67% [19, 20] for combined treatment and from 15% to 38% when radiation therapy is given as the sole treatment [10, 21]. Furthermore, side effects associated with the treatment can be significant [22, 23].…”