Role of induction chemotherapy in sinonasal malignancies: a systematic review

Khoury, Tawfiq; Jang, David W.; Carrau, Ricardo L.; Ready, Neal; Barak, Ian; Hachem, Ralph Abi

doi:10.1002/alr.22229

Cited by 35 publications

(38 citation statements)

References 30 publications

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“…Current treatment approaches to sinonasal tumors include craniofacial resection, endoscopic surgery, and radiation therapy (RT) (including intensity‐modulated RT [IMRT] techniques) . However, survival benefits with all the above‐mentioned approaches remain poor; therefore, for the management of sinonasal cancers the sequencing and combinations of multimodal treatments have been gaining importance and relevance .…”

Section: Introductioncontrasting

confidence: 91%

“…17,35,36 More recently, heavy particles (protons and carbon ions) therapies have gained popularity, thus potentially allowing a dose escalation with an increase of the therapeutic ratio and survival. 18,19 This strategy, as well as its positioning in the clinical approach to sinonasal cancer patients, needs further consideration.…”

Section: Discussionmentioning

confidence: 99%

“…6 Current treatment approaches to sinonasal tumors include craniofacial resection, endoscopic surgery, and radiation therapy (RT) (including intensity-modulated RT [IMRT] techniques). [12][13][14][15][16][17][18][19] However, survival benefits with all the above-mentioned approaches remain poor; therefore, for the management of sinonasal cancers the sequencing and combinations of multimodal treatments have been gaining importance and relevance. 18,19 In this regard, the incorporation of induction chemotherapy (IC) into the treatment strategy with the aim to reduce distant metastasis and possibly impact on locoregional control has shown promising results despite having been obtained from heterogeneous series and within small studies.…”

Section: Introductionmentioning

confidence: 99%

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Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

et al. 2019

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Objective Outcomes of locally advanced epithelial sinonasal cancers remain unsatisfactory; moreover, only limited and heterogeneous data exist on prognostic factors. Methods We reviewed all consecutive patients with American Joint Committee Cancer stage III to IV epithelial sinonasal cancers treated with platinum‐based induction chemotherapy (IC) followed by locoregional treatment between 1996 and 2015. Results We identified 69 patients treated with a multimodal approach (IC, surgery, radiotherapy). Overall, 44 patients recurred (64%). Of those, 19 patients received salvage surgery, but only four remained disease‐free. Median overall survival (OS) was 62.5 months. Sinonasal neuroendocrine and small cell histotypes (P = 0.0085), neuroendocrine differentiation (P = 0.006), and lack of response to IC (P = 0.03) were associated with worse OS. In patients who recurred, median OS was 13 months since recurrence. Survival was longer in patients submitted to salvage surgery (44%) than in those receiving chemotherapy alone at recurrence (29.5 vs. 4.6 months). Patients with a clinical benefit after palliative chemotherapy had a longer median OS than those with disease progression (29.2 vs. 4.4 months; P < 0.0001). Conclusion Globally, the prognosis of locally advanced epithelial sinonasal cancers is dismal, with worse outcomes for neuroendocrine lesions. In the recurrent setting, feasibility of salvage surgery and clinical benefit from palliative chemotherapy are associated with longer OS. A multimodal treatment strategy with IC seems to offer improved OS when compared with other retrospective series not employing such a therapeutic tool. Level of Evidence 4 Laryngoscope, 130:857–865, 2020

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Section: Introductioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

et al. 2019

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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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“…Surgery plays an important role in the management of advanced sinonasal cancer [32,33], with non-surgical strategies being currently employed mostly in the neoadjuvant or adjuvant setting [34][35][36]. Achieving clear margins is paramount and is the key surgeon-controllable variable that can significantly affect patient outcome [37][38][39][40].…”

Section: Current Standard Of Carementioning

confidence: 99%

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

et al. 2019

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To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. Materials and methods: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using realtime tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. Results: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). Conclusion: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting-with rigorous assessment of oncological outcomeswould be the proposed next step.

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Role of induction chemotherapy in sinonasal malignancies: a systematic review

Cited by 35 publications

References 30 publications

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

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

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

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