Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus

Noronha, Vanita; Patil, Vijay; Joshi, Amit; Krishna, M. Hari; Dhumal, Sachin; Juvekar, Shashikant; Pai, Prathamesh; Chatturvedi, Pankaj; Chaukar, Devendra; Agarwal, Jai Prakash; Ghosh, Sibasish; Murthy, Vedang; D’Cruz, Anil; Prabhash, Kumar

doi:10.1155/2014/487872

Cited by 23 publications

(31 citation statements)

References 22 publications

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“…One possibility is to shrink these tumors prior to surgical intervention with an induction therapy. Indeed, the literature, although not definitive, suggests that induction chemotherapy in sinonasal tumors may mitigate the risk of positive margins, increase organ preservation, and increase survival . Encouragingly, patient factors such as race and insurance status did not affect margin rates in SNCC, although they have been associated with quality‐of‐care measures and survival in head and neck cancers .…”

Section: Discussionmentioning

confidence: 99%

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Torabi

Spock²,

Cardoso

et al. 2019

The Laryngoscope

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Objectives: To identify factors associated with positive margins following surgical management of sinonasal squamous cell carcinoma (SNSCC), especially with regard to endoscopic treatment.Methods: In a retrospective analysis of adult patients with clinically staged tumor (T)1 to T4a SNSCC within the National Cancer Database (NCDB) from 2004 to 2014, factors were associated with positive margins using multivariable binary logistic regression. Cases from 2010 to 2014 had surgical approach (open vs. endoscopic) available and were analyzed in a subgroup to assess the association of surgical approach with margin status. The association of margin status with overall survival (OS) and additional therapy administration was also assessed.Results: We identified 2,968 cases, of which 807 (27.2%) had positive margins. On multivariable analysis, factors associated with positive margins included higher T stage (T4a vs. T1: odds ratio [OR] 2.768 [95% CI 2.143-3.577]), less differentiated tumors (poorly differentiated vs. well differentiated: OR 1.403 [95% CI 1.060-1.856]), and tumors in the ethmoid sinus (vs. nasal cavity; OR 1.889 [95% CI 1.305-2.734]). Cases treated at higher volume facilities (HVFs) were associated with a lower likelihood of positive margins (OR 0.716 [95% CI 0.582-0.881]). Positive margins were associated with decreased OS (hazard ratio 1.672 [95% CI 1.464-1.908]) and an increased rate of additional therapy (OR 1.966 [95% confidence interval 1.597-2.421]). An endoscopic approach was not associated with an increased likelihood of obtaining positive margins (vs. open; OR 1.151 [0.903-1.651]).Conclusion: Positive margins were less likely when performed at HVFs and more likely in the ethmoid sinus than other subsites. Importantly, there was no association between positive margins and surgical approach. Endoscopic surgery may offer a safe, less invasive alternative to open surgery for select patients.

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Section: Discussionmentioning

confidence: 99%

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Torabi

Spock²,

Cardoso

et al. 2019

The Laryngoscope

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“…3,[12][13][14][15][16] The optimal sequencing of chemotherapy and radiotherapy for patients with sinonasal carcinoma remains controversial. 17 Small reports have shown a benefit for induction chemotherapy, 8,[18][19][20][21][22] and numerous institutional and multiinstitutional series have shown a benefit for adjuvant therapy. [3][4][5][6]8,23 To our knowledge, definitive concurrent chemoradiotherapy has been less studied in this disease, with a few series demonstrating low survival outcomes and in-field failures with biologically equivalent doses <65 grays.…”

Section: Introductionmentioning

confidence: 99%

A comprehensive comparative analysis of treatment modalities for sinonasal malignancies

Robin

Jones

Gordon

et al. 2017

Cancer

137

170

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BACKGROUND: Sinonasal malignancies are a rare and heterogeneous group of tumors for which there is a paucity of robust data with which to guide management decisions. The authors used the National Cancer Data Base to better understand the presenting characteristics of these tumors and to compare outcomes by treatment modality. METHODS: The National Cancer Data Base was queried for sinonasal malignancies diagnosed between 2004 and 2012. Overall survival was assessed using multivariate analyses and propensity score matching. RESULTS: A total of 11,160 patients were identified for the initial analysis. The majority were male, aged 40 to 69 years, with tumors of the nasal cavity or maxillary sinus. Squamous cell histology was most common. The majority of patients presented with advanced tumor stage but without locoregional lymph node or distant metastases. Treatment modalities were compared for squamous cell carcinomas. In multivariate analysis, compared with surgery alone, patients who received adjuvant radiotherapy (hazard ratio [HR], 0.658 [P<.001]), adjuvant chemoradiotherapy (HR, 0.696 [P=.002]), or neoadjuvant therapy (HR, 0.656 [P = .007]) had improved overall survival. Patients who received radiotherapy alone (HR, 1.294 [P=.001]) or chemotherapy alone (HR, 1.834 [P<.001]) had worse outcomes. These findings were validated in propensity score matching. It is important to note that neoadjuvant chemoradiotherapy was associated with achieving a negative surgical margin (odds ratio, 2.641 [P=.045]). CONCLUSIONS: Surgery is the mainstay of therapy for patients with sinonasal malignancies, but multimodality therapy is associated with improved overall survival.

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“…As a result, two drug combination of platinum and taxane or a modified dose reduced TPF regimen is been administered in certain centers in India. [34567] These regimens are likely to be associated with inferior outcomes than the standard TPF regimen. Mucositis and diarrhea, two common toxicities associated with this regimen, are either not seen or are seen at a considerably lower frequency when two drug regimen of platinum and taxane is administered.…”

Section: Introductionmentioning

confidence: 99%

Dihydropyrimidine dehydrogenase mutation in neoadjuvant chemotherapy in head and neck cancers: Myth or reality?

Patil

Noronha

Joshi

et al. 2016

South Asian J Cancer

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Purpose:The docetaxel, 5-fluorouracil (5-FU), and cisplatin (TPF) regimen in India is associated with high percentages of Grade 3–4 toxicity. This analysis was planned to evaluate the incidence of dihydropyrimidine dehydrogenase (DPD) mutation in patients with severe gastrointestinal toxicity, to assess whether the mutation could be predicted by a set of clinical criteria and whether it has any impact on postneoadjuvant chemotherapy response.Methods:All consecutive patients who received TPF regimen in head and neck cancers between January 2015 and April 2015 were selected. Patients who had predefined set of toxicities in Cycle 1 were selected for DPD mutation testing. Depending on the results, C2 doses were modified. Postcompletion of two cycles, patients underwent radiological response assessment. Descriptive statistics has been performed. The normally distributed continuous variables were compared by unpaired Student's t-test, whereas variables which were not normally distributed by Wilcoxon sum rank test. For noncontinuous variables, comparison was performed by Fisher's exact test.Results:Out of 34 patients, who received TPF, 12 were selected for DPD testing, and 11 (32.4%, 95% confidence interval [95% CI]: 19.1–49.3%) had DPD mutation. The predictive accuracy of the criteria for the tested DPD mutations was 81.3% (95% CI: 62.1–100%). Of the 11 DPD mutation positive patients, except for one patient, all others received the second cycle of TPF. The dose adjustments done in 5-FU were 50% dose reduction in 9 patients and no dose reduction in one patient. The response rate in DPD mutated patients was 27.3% (3/11) and that in DPD nonmutated/nontested was 39.1% (9/23) (P = 0.70).Conclusion:In this small study, it seems that the incidence of DPD mutation is more common in Indian then it's in the Caucasian population. Clinical toxicity criteria can accurately predict for DPD mutation. Postdose adjustments of 5-FU from C2 onward, TPF can safely be delivered in the majority of patients with DPD heterozygous mutations without decrement in efficacy.

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Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus

Cited by 23 publications

References 22 publications

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

A comprehensive comparative analysis of treatment modalities for sinonasal malignancies

Dihydropyrimidine dehydrogenase mutation in neoadjuvant chemotherapy in head and neck cancers: Myth or reality?

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