Endoscopic endonasal resection of adenoid cystic carcinoma of the sinonasal tract and skull base

Abstract

Objectives Adenoid cystic carcinoma (ACC) is a locally aggressive salivary gland malignancy prone to perineural invasion and local recurrences. In the literature, few data exist to guide treatment when this tumor involves the paranasal sinuses and skull base. We report our experience in the management of sinonasal adenoid cystic carcinoma through an endoscopic endonasal approach. Methods Retrospective analysis of patients affected by sinonasal ACC treated through an endoscopic endonasal approach from 1997 to 2015, managed at the Universities of Varese and Brescia, Italy. Results Thirty‐four patients were included in the analysis. The ethmoid sinus (55.9%), nasal septum (17.7%), maxillary sinus (11.7%), and sphenoid sinus (5.9%) were the primary tumor sites encountered. Twenty patients (58.8%) presented with T3 or T4, without any systemic spreading. Twenty‐nine patients underwent endoscopic transnasal resection, whereas the involvement of the anterior skull base in five cases required a transnasal endoscopic craniectomy. Overall, 20 of 34 (58.8%) patients received some form of adjuvant radiotherapy. The follow‐up ranged from 12 to 202 months (mean of 73.2 months). The 5‐year overall, disease‐specific, and recurrence‐free survival rates were 86.5% ± 7.39%, 86.5% ± 7.39%, and 71.8% ± 8.67%, respectively. Conclusions The endoscopic approach is safe and effective for selected sinonasal ACC, reducing the comorbidities of the external approaches while producing similar oncological results. High T‐stage, grade III histology, positive surgical margins, and perineural infiltration all have an important negative prognostic value. Level of Evidence 4 Laryngoscope, 129:1071–1077, 2019

Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients

“…The ways that tumors of the HN tend to invade surrounding tissues through nerves and vessels has raised particular interest, especially in view of the fact that cancers exhibiting PNI and/or LVI are associated with poor outcomes (with special reference to ACC) [18,[31][32][33][34][35][36][37]. Moreover, the pattern of neural and vascular invasion is known to be associated with histology, as different sinonasal cancers display PNI and LVI with heterogeneous frequency [38].…”

Collision Occurrence of Sinonasal Carcinosarcoma and Pituitary Adenoma: A Case Report and Literature Review.

“…Endonasal endoscopy plays a critical role in the surgical treatment of sinonasal malignancies, including those with skull base invasion [3,7,8] . The extended endoscopic endonasal approach can provide a wide, clear operative eld in the skull base and the intrasellar and suprasellar zones.…”

Surgical Management of Sinonasal Cancers: A Comprehensive Review

“…Adenoid cystic carcinomas are minor salivary gland tumors, representing 5-7% of sinonasal cancers [2,84,99]. They predominate in the maxillary sinus and are characterized by an important propensity to perineural invasion, which means that they are regularly discovered with an extension to the orbit or the skull base, despite a slow evolution [100].…”

“…The 5-year overall survival is 63-86%, but 30-35% of patients have a recurrence, and the risk of distant metastasis is important. As a result, the 10-year overall survival of these patients continues to decline to 32-67% [99][100][101][102]. Surgery remains the gold standard of treatment when possible, and obtaining microscopically clear resection margins is associated with a significant improvement in overall survival [99,102].…”