Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

Orlandi, Ester; Cavalieri, Stefano; Granata, Roberta; Nicolai, Piero; Castelnuovo, Paolo; Piazza, Cesare; Schreiber, Alberto; Turri‐Zanoni, Mario; Quattrone, Pasquale; Miceli, Rosalba; Infante, Gabriele; Sessa, Fausto; Facco, Carla; Calareso, Giuseppina; Iacovelli, Nicola Alessandro; Mattavelli, Davide; Paderno, Alberto; Resteghini, Carlo; Locati, Laura D.; Licitra, Lisa; Bossi, Paolo

doi:10.1002/lary.28202

Cited by 32 publications

(35 citation statements)

References 46 publications

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“…Additionally, we observed that for SNM patients treated with SS, SCC histology had a poor long‐term OS outcome, representing a highly aggressive neoplasm. Locally advanced SNM treated with a multimodal approach has a high propensity for recurrence, with SS providing an opportunity for longer OS 20 . However, as suggested by our current study results, PS may be the best option for improved OS outcomes over SS, whenever surgical resection is an option.…”

Section: Discussionmentioning

confidence: 62%

“…Therefore, in the setting of residual disease, salvage surgery would be indicated for definitive treatment 2,5,10,11,19 . Although the OS benefit of salvage surgery has been documented for patients with advanced SNM experiencing recurrence following upfront surgical or nonsurgical therapy, 10,11,16,20 there are limited data comparing the OS of different surgical sequences for SNM. Therefore, this study used a large‐population national database to compare the clinical outcomes of primary surgery (PS), followed by adjuvant nonsurgical therapy versus upfront nonsurgical therapy, followed by salvage surgery (SS) for SNM based upon stage, histology, and primary site.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

et al. 2020

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Objectives/Hypothesis There exists a lack of consensus on the optimal sequence of treatment for many sinonasal malignancies (SNMs). This study compares the overall survival (OS) outcomes for primary surgery (PS) versus salvage surgery (SS) in SNM patients across stage, histology, and primary site. Study Design Retrospective database review. Methods The National Cancer Database was queried for all SNM cases treated with multimodal surgical and nonsurgical therapy between 2004 and 2015. Logistic regression identified predictors of SS. Cox proportional hazards models evaluated predictors of mortality, and Kaplan‐Meier log‐rank test assessed OS outcomes. Results Our SNM cohort consisted of 3,011 patients (PS = 2,804; SS = 207). SS patients had significantly longer postoperative hospital stays (P = .009) and increased rates of 30‐day (P < .001) and 90‐day mortality (P < .001) compared to PS. On multivariate logistic regression, predictors of undergoing SS included sinonasal undifferentiated carcinoma histology (odds ratio = 2.72; 95% confidence interval [CI]: 1.16‐6.66; P = .024). On multivariate Cox proportional hazards analyses among SS patients, late‐stage disease (hazard ratio [HR] = 4.80; 95% CI: 1.46‐15.8; P = .01) and positive surgical margins (HR = 2.31; 95% CI: 1.29‐4.13; P = .005) portended significantly worse OS. In the propensity score–matched cohort controlling for stage and histology, PS had significantly improved OS compared to SS (P = .007). Compared to SS, PS also had improved OS in subgroup analyses for patients with late‐stage disease (P = .026) and squamous cell carcinoma histology (P = .006). Conclusions In our SMN cohort, PS resulted in improved OS outcomes compared to SS independent of stage and histology. Consideration may be given to primary surgical resection for SMN whenever feasible, though a targeted, individualized approach is warranted. Level of Evidence 3 Laryngoscope, 131:E710–E718, 2021

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

et al. 2020

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“…Tumours affecting patients included in the analysis are heterogeneous, so the therapeutic alternatives varied, being cancer-specific: patients with ACC often undergo a watchful waiting approach or receive systemic chemotherapy, even with disappointing results, only in case of rapidly progressing disease 23 ; patients with SDC can be treated with androgen deprivation therapy 24 or with chemotherapy 25 ; patients with MTC benefit from tyrosine kinase inhibitors, especially when bearing RET alterations 26 ; radioactive iodine-refractory DTC can be effectively treated with antiangiogenic lenvatinib 27 ; retrospective case series of TACE in both MTC 28 and DTC 29 have been published; recurrent/metastatic NPC responds to platinum-based palliative chemotherapy 30 ; and metastatic sinonasal cancer has a dismal prognosis, especially when not responding to systemic therapies. 31 In this case series, the choice of treating patients with extrahepatic metastases with liver-directed therapy was made when liver disease was the only predominant progressing site. In case of concurrent pretreatment hepatic and extrahepatic progression, the decision to deliver a local liver approach was deemed to have an impact on patient prognosis.…”

Section: Discussionmentioning

confidence: 99%

Local therapies for liver metastases of rare head and neck cancers: A monoinstitutional case series

Bergamini

Cavalieri

Cascella

et al. 2020

Tumori

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Introduction: Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are established procedures for treating hepatocellular cancer and selected malignancies with liver metastasis. The aim of this study is to describe a monoinstitutional case series of local approaches in patients with liver metastases from rare head and neck cancers (HNCs). Methods: This is a retrospective series of adult patients with HNC treated with liver locoregional approaches (TACE or RFA) at our institution from 2007 to 2018. In case of chemoembolization, the preferred chemotherapeutic drug was doxorubicin. Response according to RECIST (Response Evaluation Criteria in Solid Tumors) was assessed with contrast-enhanced computed tomography scans. Results: Thirty-four patients were treated (20 men, median age 58 years) with TACE (27), transarterial embolization (2), or RFA (7). Primary tumours were salivary gland (21), thyroid (6), nasopharyngeal (5), and sinonasal cancers (2). Seventeen patients (50%) had a single metastatic liver nodule; 70% of the remaining 17 patients had at least three liver metastases. The median diameter of the metastatic liver mass undergoing treatment was 39 mm (range 11–100 mm). Median follow-up was 27.6 months. Response rate was 35% (3% complete, 32% partial response). Median progression-free survival and overall survival were 6.9 and 19.6 months, respectively. Treatment-related adverse events occurred in 59% of patients (21% grade ⩾ 3; no grade 5). Discussion: This retrospective case series demonstrates that locoregional radiologic approaches for rare HNCs with liver metastases are feasible. These procedures deserve further prospective studies before being considered safe and active in these malignancies where the availability of effective systemic treatments is lacking.

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“…The prognosis of patients with sinonasal carcinomas, despite progress in therapy modalities and regimes, remains poor. Tumor histology, T and N stage, and age are factors that influence therapy outcome [ 5 , 6 ]. Five-year overall survival ranges from 30–80% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Five-year overall survival ranges from 30–80% [ 2 ]. The median OS time is given with 27.6–98.6 months [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors

Klymenko

Buchberger

Wollenberg

et al. 2021

Cancers

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Purpose: We report the outcome of a mono-institutional retrospective study of sinonasal carcinoma with the primary focus on GTV (gross tumor volume) and the effect of radiotherapy. Methods: 53 patients with sinonasal carcinoma and that of the nasal cavity, paranasal sinus or both except lymphoma were included. All patients were treated between 1999 and 2017. For tumor volume delineation, all pre-therapeutic images were fused to the planning CT (computed tomography). Results: The median follow-up was 17 months [0.3–60], the median age 60 years, 35 males and 18 females were included. Squamous cell carcinoma (SCC) (60.4%) was the predominant histology, followed by adenocarcinoma (15.1%). The mean composite OS (overall survival) time was 33.3 ± 3.5 months. There was no significant difference in the 5 y composite OS between tumor localization or radiotherapy setting. The simultaneous integrated boost concept showed a trend towards improving five-year composite OS compared to the sequential boost concept. The only factor with a significant impact on the 5 y composite OS rate was the pre-therapeutic GTV (cutoff 75 cm3; p = 0.033). The GTV ≥ 100 cm3 has no effect on the 5 y composite OS rate for SCC. Conclusions: The pre-therapeutic GTV is a prognostic factor for five-year composite OS for the entire group of patients with sinonasal tumors, influencing the outcome after completion of all treatment strategies. The GTV seems to not influence five-year composite OS in SCC. For this rare tumor entity, an intensive, multidisciplinary discussion is essential to finding the best treatment option for the patient.

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Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

Cited by 32 publications

References 46 publications

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

Local therapies for liver metastases of rare head and neck cancers: A monoinstitutional case series

Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors

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