Elective neck dissection for <scp>T3</scp>/<scp>T4 cN0</scp> sinonasal squamous cell carcinoma

Crawford, Kayva; Jafari, Aria; Qualliotine, Jesse R.; Stuart, Emelia; DeConde, Adam S.; Califano, Joseph A.; Orosco, Ryan K.

doi:10.1002/hed.26418

Cited by 22 publications

(25 citation statements)

References 20 publications

(39 reference statements)

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“…They did not find any statistically significant difference in OS between patients who underwent elective neck dissection and those who did not, with a global prevalence of occult metastases of 12.7%. The reported results were confirmed when the cohort was filtered to consider only maxillary sinus SCCs [135]. Nonetheless, no information about nodal recurrence-free survival was given.…”

Section: Surgery: Neck Dissectionmentioning

confidence: 85%

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Ferrari

Taboni

Carobbio

et al. 2021

Cancers

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Sinonasal squamous cell carcinoma is a rare tumor affecting the nasal cavity and paranasal sinuses. Several aspects of this disease, ranging from epidemiology to biology, pathology, diagnosis, staging, treatment, and post-treatment surveillance are controversial, and consensus on how to manage this sinonasal cancer is lacking. A narrative literature review was performed to summarize the current evidence and provide the reader with available data supporting the decision-making process in patients affected by sinonasal squamous cell carcinoma, alongside the authors’ personal opinion on the unsolved issues of this tumor. The review has highlighted several advances in molecular definition of epithelial cancers of the sinonasal tract. Surgery represents the pivot of treatment and is performed through an endoscopic transnasal approach whenever feasible. Open surgery is required for a large proportion of cases. Reconstruction of the defect follows principles of skull base and cranio-maxillo-facial reconstruction. Chemotherapy is given as neoadjuvant treatment or concomitantly to radiotherapy. Photon-based radiation therapy has a crucial role in the adjuvant setting. Particle therapy is providing promising results. Management of the neck should be planned based on the presence of clinically appreciable metastases, primary tumor extension, and need for recipient vessels. Biotherapy and immunotherapy are still underexplored therapeutical modalities.

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Section: Surgery: Neck Dissectionmentioning

confidence: 85%

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Ferrari

Taboni

Carobbio

et al. 2021

Cancers

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“…No literature is published in these early stages, but overall, for all tumor stages, the rate of occult metastasis ranges from 13.5 -22.2% [13]. Though occult metastasis seems to be rare in T1 and T2 sinonasal SCCs, the regional control was signi cantly better in patients who had received elective neck treatment [12,14,16]. Several studies could underline the fact that END is linked to decreasing regional recurrent disease, but is rather recommended in higher stages [13,17,19].…”

Section: Discussionmentioning

confidence: 99%

“…However, Scurry and Ahn (2,8) supposed that elective nodal treatment can decrease the risk of nodal recurrence to a 4% rate [2,8]. Although the risk of regional recurrences can be reduced by incorporating elective nodal treatment [2,8,11], elective neck dissection (END) failed to demonstrate signi cantly better overall survival in T3-T4 sinonasal SCCs of the nasoethmoidal complex and maxillary sinus [12].…”

Section: Introductionmentioning

confidence: 99%

A New Risk Score Assessment for Neck Management in T1-T2N0 Sinonasal Squamous Cell Carcinoma Patients: A European Head and Neck Cancer Center Survey Study and Evaluation of 58 Patients with Early Stage Sinonasal Carcinoma

Lill¹,

Erović²,

Seemann³

et al. 2021

Preprint

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Purpose The purpose of the present study was to assess whether European head and neck cancer centers perform elective neck dissection (END) in early stage sinonasal squamous cell carcinomas (SCCs) and whether END affects oncological outcome. Methods A questionnaire regarding performance of END in T1 - T2 sinonasal SCCs was sent to 38 head and neck cancer centers in Europe. The results were further correlated and compared with clinical data of 58 patients with T1 (n = 37) and T2 (n = 21) sinonasal SCCs, a risk score and a nomogram were generated. Results Only 5–10 % of respondents are performing END in T1 and 26–32% in T2 sinonasal SCCs. In our cohort regional recurrence was evident in 10 (17.2%) patients, representing a significant worse prognostic factor for cancer specific survival (HR 8.13; p = 0.016). Particularly, regional recurrence was more frequent in T2 tumors and in patients where the primary tumor originated from nasal septum and vestibule. Based on our clinical and questionnaire data a new risk-score was determined to predict necessity for END. The risk-score, including T-classification and tumor site, assigned T1-classification with 0 points, followed by 1 point for T2; tumor site: nasal septum or vestibule with 1 point and tumors from other subsites with 0 points. Based on these factors we further created a nomogram for predicting the risk of regional recurrence. Patients with a high-risk score showed 9.52-fold higher risk for regional and or distant recurrence (HR 9.52; p = 0.002;) and their 5-year CSS was 44.4% compared to 92.8% in patients with moderate or low risk (p = 0.017). Conclusions Our proposed risk-score system in T1-2N0 sinonasal carcinoma is helpful to identify patients who may benefit from END. Although to date END has no value in European head and neck cancer centers for T1-T2 sinonasal SCCs, our study indicates that the neck management in these patients should be reconsidered.

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“…While there is broad consensus on the necessity for treatment of the positive neck, so far no general recommendation about ENT could be made. 8,13,20,22,23,[33][34][35][36][37][38] In our cohort, we performed ENT in 29 of 137 (21.2%) curatively treated patients. The decision in terms of ENT was made on an individual basis at our interdisciplinary tumor board and incorporated the initial T category, the histology of the tumor and clinical characteristics.…”

Section: Main Findingsmentioning

confidence: 99%

“…8,[19][20][21] However, the question how to treat the clinically negative neck is controversial. 8,22,23 In particular it is still debated, whether elective neck treatment (ENT) may prevent nodal metastases in the further course of disease. 20,24 The aim of this study on the primary sinonasal malignancies was (1) to investigate patterns of treatment failure, (2) to study incidence and distribution of LN metastases, (3) to assess outcome measures, and (4) to identify prognosticators of outcome.…”

Section: Introductionmentioning

confidence: 99%

The Role of Regional Disease and Patterns of Treatment Failure in Primary Sinonasal Malignancies

Meerwein

Balermpas

Vital

et al. 2021

Am J Rhinol�Allergy

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Background The question how to treat the clinically negative neck in sinonasal malignancies is controversial. Objectives To investigate patterns of treatment failure and to assess outcome measures in patients with primary sinonasal malignancies. Methods Retrospective cohort study of patients treated for primary malignant sinonasal malignancies. Results Lymph node (LN) metastases at initial presentation were present in 8 of 152 patients (5.3%). Ipsi- and contralateral LN levels 1 and 2 were identified as nodal basins at risk. We found a 5-year overall survival (OS) of 75.2% and disease free survival of 61.1%. Among patients with cN0 neck, nodal recurrence free survival was not different between patients with and without elective neck treatment ( P = .23). On logistic regression analysis, we found initial T classification as an independent factor for achievement of complete remission (CR) and OS. Conclusions LN metastases at initial presentation are rare and initial T classification was identified as the most important prognostic factor for OS and CR, emphasizing the need for a thorough initial staging of the primary tumor.

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Elective neck dissection for T3/T4 cN0 sinonasal squamous cell carcinoma

Cited by 22 publications

References 20 publications

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

A New Risk Score Assessment for Neck Management in T1-T2N0 Sinonasal Squamous Cell Carcinoma Patients: A European Head and Neck Cancer Center Survey Study and Evaluation of 58 Patients with Early Stage Sinonasal Carcinoma

The Role of Regional Disease and Patterns of Treatment Failure in Primary Sinonasal Malignancies

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