Sinonasal squamous cell carcinoma without clinical lymph node involvement

Castelnau-Marchand, P.; Lévy, Antonin; Moya‐Plana, Antoine; Mirghani, Haïtham; Campo, Eleonor Rivin del; Janot, F.; Kolb, F.; Ferrand, François‐Régis; Temam, Stéphane; Blanchard, Pierre; Tao, Yungan

doi:10.1007/s00066-016-0997-5

Cited by 15 publications

(23 citation statements)

References 27 publications

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“…8,10,11 For SNSCC, however, no consensus exists as to surgical management of the clinically N0 neck. [12][13][14] Given the clinical equipoise regarding END in the setting of high recurrence rates and associated mortality of SNSCC, there is a critical need for further investigation into the potential impact of END on survival in patients with clinically node-negative disease. Using the National Cancer Database (NCDB), we explored the survival impact of END in surgical patients with locally advanced, clinically node-negative SNSCC.…”

Section: Introductionmentioning

confidence: 99%

“…Several anatomic sites, including oral cavity, oropharynx, and hypopharynx have clear indications for elective neck dissection (END) reflecting studies demonstrating that prophylactic removal of lymph nodes which may harbor occult metastases prolongs OS and reduces recurrence 8,10,11 . For SNSCC, however, no consensus exists as to surgical management of the clinically N0 neck 12‐14 . Given the clinical equipoise regarding END in the setting of high recurrence rates and associated mortality of SNSCC, there is a critical need for further investigation into the potential impact of END on survival in patients with clinically node‐negative disease.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: In locally advanced sinonasal squamous cell carcinoma (SNSCC), management of the clinically node-negative (cN0) neck is variable and elective neck dissection (END) remains controversial. Methods: Patients with surgically treated T3/T4 cN0 M0 SNSCC were identified using the NCDB. Overall survival (OS) was assessed by Cox proportional hazard analysis in propensity score-matched cohorts. Factors associated with END were evaluated with logistic regression. Results: Two hundred twenty patients underwent END (19.6%). END did not correlated with OS in propensity score-matched cohorts (HR 0.971, 95% CI 0.677-1.392), a maxillary sinus tumor subgroup (HR 1.089, 95% CI 0.742-1.599), or by radiation status [radiation: (HR 0.802, 95% CI 0.584-1.102); no radiation: (HR 0.852, 95% CI 0.502-1.445)]. The occult metastasis rate in the END cohort was 12.7%. Conclusion: END did not significantly improve OS in this study. Further information on disease-free survival is necessary to determine its role in advanced-stage SNSCC.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…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]. Castelnau-Marchand et al [17] investigated 87 patients with neck negative SNSCC including 15% (n=17) early stages carcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…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]. Castelnau-Marchand et al [17] investigated 87 patients with neck negative SNSCC including 15% (n=17) early stages carcinomas. Treatment of neck was performed in 87 N0 (T1-T4) patients with no difference in overall survival but a signi cant difference in locoregional control [17].…”

Section: Discussionmentioning

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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“…Notwithstanding, the accurate assessment of elective nodal treatment in clinically N0 neck is fastidious, with an estimated risk for occult disease of 10%-20% or more. Notably, in tumor stage III-IV of SNSCC, elective neck irradiation should be intended in absence of selective neck dissection[ 27 ]. In a retrospective review, Peck et al[ 28 ] identified the histologic types of SNM as the most impacting factors in predicting regional metastases, whereas the invasion of adjacent structures like dura, infratemporal fossa, palate and facial soft tissue was associated with increased occurrence of regional metastases.…”

Section: Discussionmentioning

confidence: 99%

Proton beam therapy of periorbital sinonasal squamous cell carcinoma: Two case reports and review of literature

Lin¹

2020

WJCO

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BACKGROUND Sinonasal malignancies are rare but demanding due to complex anatomy, usually late diagnosis, and inconsistent therapy strategy based on multimodality approaches. Squamous cell carcinoma (SCC) is the most common histology, with poorer prognosis. In the setting of orbital invasion, an orbital exenteration may be required. However, in case of primary rejection of disfiguring surgery or unresectable disease, proton beam therapy (PBT) should be largely considered, allowing for better sparing of neighboring critical structures and improved outcomes by dose escalation. CASE SUMMARY A 62-year-old male presented with a recurrent SCC in the nasal septum abutting frontal skull base and bilateral orbits at 7 mo after primary partial nasal amputation. Because of refusal of face-deforming surgery and considerable adverse effects of conventional radiotherapy, the patient underwent a PBT by hyperfractionated accelerated scheme, resulting in complete response and moderate toxicities. After 2 years, a nasal reconstruction was implemented with satisfactory appearance and recurrence-freedom to date. Another patient with an initially extended sinonasal SCC, invading right orbit and facial soft tissue, declined an orbital exenteration and was treated with a normofractionated PBT to the gross tumor and elective cervical lymphatics. The follow-up showed a continuous tumor remission with reasonable late toxicities, such as cataract and telangiectasia on the right. Despite T4a stage and disapproval of concurrent chemotherapy owing to individual choice, both patients still achieved outstanding treatment outcomes with PBT alone. CONCLUSION PBT enabled orbit preservation and excellent tumor control without severe adverse effects on both presented patients with locally advanced sinonasal SCC.

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Sinonasal squamous cell carcinoma without clinical lymph node involvement

Abstract: SND may detect occult cervical positive nodes, allowing selective postoperative RT. ENI (ipsilateral level II, ±Ib and III or bilateral) needs to be proposed in selected patients, especially when SND has not been performed.

Cited by 15 publications

References 27 publications

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

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

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

Proton beam therapy of periorbital sinonasal squamous cell carcinoma: Two case reports and review of literature

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