Sinonasal undifferentiated carcinoma: Institutional trend toward induction chemotherapy followed by definitive chemoradiation

Abstract

Background: Recent reports have investigated the nascent role of induction chemotherapy for sinonasal undifferentiated carcinoma (SNUC). The goal of this study was to ascertain trends in treatment pattern changes for SNUC at a single institution and design a treatment algorithm utilized at our institution. Methods: Retrospective chart analysis of 21 cases of SNUC from 2010 to 2018. Results: Of 21 patients in this cohort, 18 (85.7%) presented with T4 disease, 7 (33.3%) presented with nodal disease, and 3 (14.3%) presented with distant metastasis. Since 2016, patients have been managed by induction chemotherapy followed by concurrent chemoradiation. To this point, patients treated with TPF induction chemotherapy followed by concurrent chemoradiation show no evidence of disease; however, the average follow up time is 16.8 months. Conclusions: The multimodality treatment for SNUC continues to evolve, as highlighted by this study, toward increased use of induction chemotherapy followed by chemoradiotherapy.

Modern treatment of sinonasal undifferentiated carcinoma

“…Regardless, it is the authors’ opinion that definitive CRT should be favoured in the chemo-responsive group, with an improved OS and organ preservation compared with patients who go on to receive surgery. This trend to CRT after induction chemotherapy has been reported by London et al [16] and Wang et al [18 ▪ ], with similar good results. It is postulated that the addition of surgery between induction chemotherapy and adjuvant CRT delays definitive treatment with chemoradiation.…”

“…In another series by London et al [16] all but one patient who had induction chemotherapy followed by CCRT remained disease-free. In this series, the predominant induction chemotherapy regimen was docetaxel, cisplatin and fluorouracil (TPF).…”

“…In this series, the predominant induction chemotherapy regimen was docetaxel, cisplatin and fluorouracil (TPF). However, this study was limited by a small sample size and a short follow-up period of 16.8 months (range 6–39 months) [16]. London et al [16] further proposed a treatment algorithm wherein debulking and optic nerve decompression may be considered prior to induction chemotherapy should vision loss be present.…”

“…Also, the concept of chemoselection suggests that induction chemotherapy may be used to select patients into different treatment arms. A favourable response to induction chemotherapy suggests chemosensitivity and radiosensitivity and therefore a favourable response with concurrent chemoradiotherapy (CCRT), thereby guiding treatment [2,14,16]. A suggested workflow is highlighted in Fig.…”

“…Where there is a poor response, reassessment of histopathology may be considered, as mimics such as NUT gene tumours may be less chemosensitive. Surgical resection is then favoured for SNUC that is not chemoresponsive [2,16].…”