Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature

Abstract

The optimal treatment of sinonasal undifferentiated carcinoma (SNUC) remains unclear. We report our results on the outcome and toxicity of patients with SNUC treated by a combined modality and attempt to define the optimal treatment strategies by reviewing the literature. Between 1996 and 2010, 21 consecutive patients with SNUC were treated by any combination of surgery, chemotherapy and radiotherapy. End points were local control (LC), regional control (RC), disease-free (DFS), cause-specific (CSS) overall survival (OS), and late toxicity. Organ preservation was defined as visual preservation without orbital exenteration. After median follow-up of 54 months, the 5-year actuarial rates of LC, RC, DFS, CSS, and OS were 80, 90, 64, 74, and 74 % respectively. On multivariate analysis, T-stage and multimodality treatment approach correlated significantly with LC. Elective nodal irradiation was given to 42 % of high-risk node-negative patients. None of them developed regional failure. The overall 5-year incidence of grade ≥2 late toxicity was 30 %. Treatment-related blindness was significantly decreased in patients treated with intensity-modulated radiotherapy (IMRT), compared to 2D and 3D-conformal radiotherapy (3DCRT), with organ preservation rates of 86 and 14 % respectively (p = 0.006). We concluded that combined-modality treatment with three, or at least two, modalities resulted in good LC, but with high overall rate of late toxicity. However, the incidence of late toxicity and permanent visual impairment were decreased over time by the introduction of IMRT. Because of the improvement in therapeutic ratio achieved by using IMRT, this highly conformal radiation technique should be the standard of care in patients with SNUC.

Incidence and Survival Patterns of Sinonasal Undifferentiated Carcinoma in the United States

“…3,4,8,11,15 To better understand the epidemiological patterns of SNUC, we evaluated 318 cases of SNUC between 1973 and 2010 from the Surveillance Epidemiology and End Results (SEER) program database. For the purpose of this study, the SEER database draws from multiple institutions and regions to offer the benefit of a much larger sample size than previously reported.…”

An Atypical Etiology of Anosmia

“…However, current series show an overall survival between 40 and 75% [11][12][13][14]. Neck metastases in advanced local disease is a poor prognostic sign [8].…”

“…Invasive growth can lead to manifestations such as proptosis, cranial nerve palsies and visual disturbances. In spite of the frequent locally advanced disease at presentation, at this time only 5-13% of patients have nodal metastasis [8][9][10][11][12][13].…”

“…Current information available does not demonstrate a clear advantage of preoperative over postoperative adjuvant therapy. Other options such as proton beam radiation therapy need further investigation [6,8,12,15].…”

Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach

“…The overall prognosis is poor, but with aggressive multimodality therapy, including primary surgical resection, 5-year survival rates or 35-63% are achieved, but with a median overall survival of about 2 years. [46][47][48][49]53,60,[62][63][64][65][66] Local recurrence is common, but nodal metastases are relatively uncommon, although distant metastases are frequent.…”