Determinants of Patient Refusal of Postoperative Radiation Therapy in Sinonasal Squamous Cell Carcinoma

Abstract

Objectives Although adjuvant radiotherapy may be indicated in patients with sinonasal squamous cell carcinoma (SNSCC) following primary surgery, some patients choose to forgo recommended post-operative radiation (PORT). This study aimed to elucidate factors associated with patient refusal of recommended PORT in SNSCC and examine overall survival. Methods Retrospective analysis of patients with SNSCC treated with primary surgery from the National Cancer Database diagnosed between 2004 and 2016. A multivariable logistic regression model was created to determine the association between clinical or demographic covariates and likelihood of PORT refusal. Unadjusted Kaplan-Meier estimates, log-rank tests, and a multivariable Cox proportional hazard model were used to assess overall survival. Results 2231 patients were included in the final analysis, of which 1456 (65.3%) were male and 73 (3.3%) refused recommended PORT. Patients older than 74 years old were more likely to refuse PORT than those younger than 54 (OR 3.43, 95% CI: 1.84-6.62). Median survival among the entire cohort, those that received recommended PORT, and those that refused PORT was 83.0 months (95% CI: 74.6-97.1), 83.0 months (95% CI: 74.9-98.2), and 63.6 months (95% CI: 37.3-101.4). Refusal of PORT was not associated with overall survival (HR 0.99, 95% CI: 0.69-1.42). Conclusions PORT refusal in patients with SNSCC is rare and was found to be associated with several patient factors. The decision to forgo PORT is not independently associated with overall survival in this cohort. Further study is required to determine the clinical implications of these findings as the treatment decisions are complex.

Postoperative Radiation Therapy Refusal in Major Salivary Gland Cancers

“…To our knowledge, this study is the first national analysis to examine factors predictive of PORT refusal in MSGC patients. Previous studies have examined factors associated with radiation refusal in other head and neck cancers, including HPV‐positive oropharyngeal squamous cell carcinomas 5,11,12,24,25 . Of note, our finding that 4.5% of MSGC patients refused recommended PORT was similar to, but slightly higher than, the rate of PORT refusal seen in all head and neck cancers (4.0%) and HPV + oropharyngeal squamous cell carcinoma (3.7%) 11,12 …”

“…Previous studies have examined factors associated with radiation refusal in other head and neck cancers, including HPV-positive oropharyngeal squamous cell carcinomas. 5,11,12,24,25 Of note, our finding that 4.5% of MSGC patients refused recommended PORT was similar to, but slightly higher than, the rate of PORT refusal seen in all head and neck cancers (4.0%) and HPV + oropharyngeal squamous cell carcinoma (3.7%). 11,12 Refusal of recommended treatment, including surgery, radiation, and/or chemotherapy, in head and neck cancer patients has previously been associated with a variety of factors, including low socioeconomic status, African-American and Asian race, advanced age, and earlier pathologic staging, among other variables.…”

Endoscopic Repair of Anterior Skull Base Cerebrospinal Fluid Leaks is Successful in Frail Patients

“…These findings corroborate previous work demonstrating that endoscopic approaches for sinonasal malignancy and suprasellar pathology do not have higher rates of complications in the frail population. 11,12 Interestingly, this finding does appear unique to the endoscopic approach. In patients with lateral skull base CSF leaks undergoing repair via open middle cranial fossa craniotomies, Curry et al found that frail patients (as measured by the MFI-5) had an extended length of hospital stay.…”

“…Previously, patients with sinonasal squamous cell carcinoma undergoing surgical treatment were retrospectively queried and no association between patient frailty and 30-day medical or surgical complications or readmission was found. 11 Furthermore, equivalent outcomes were seen irrespective of patient comorbidities and resultant frailty in patients undergoing endoscopic treatment of suprasellar pathologies. 12 Given that endoscopic CSF leak repair has rapidly become the standard of care and the fact that many patients have significant comorbidities (e.g., obesity in the case of idiopathic intracranial hypertension), our goal was to evaluate the effect of frailty upon outcomes of endoscopic CSF leak repair for non-tumor etiologies at two tertiary referral centers.…”

Impact of Frailty on Postoperative Outcomes in Extended Endonasal Skull Base Surgery for Suprasellar Pathologies

“…Frailty as a metric has also been examined in skull base surgery 7 . and otolaryngology, 8‐10 and also explored in the context of endoscopic skull base surgery, though prior work has largely focused on pituitary surgery 11,12 . Frailty metrics have also recently been used as screening tools to help predict adverse postoperative outcomes and are increasingly recognized as important in quality improvement and outcomes assessment 13 …”