Craniofacial resection for malignant paranasal sinus tumors: Report of an International Collaborative Study

Ganly, Ian; Patel, Snehal G.; Singh, Bhuvanesh; Kraus, Dennis H.; Bridger, Patrick G.; Cantù, G.; Cheesman, A. D.; De, Geraldo; Donald, Paul J.; Fliss, Dan M.; Gullane, Patrick; Janecka, Ivo P.; Kamata, Shin Etsu; Kowalski, Luiz Paulo; Levine, Paul A.; Santos, Luiz Roberto Medina dos; Pradhan, Sangram K.; Schramm, Victor L.; Snyderman, Carl H.; Wei, William I.; Shah, Jatin P.

doi:10.1002/hed.20165

Cited by 254 publications

(270 citation statements)

References 20 publications

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“…In ethmoid adenocarcinoma, despite the improvements in surgical and anesthetic techniques, survival data with CFR approach remain disappointing [1]. Our survival rates results confirm this suspicion with no great difference to other studies that currently perform CFR, whose overall survival rates at 5 and 10 years goes from 36% to 57% and 28% to 53%, respectively [7,[11][12][13][14][15]. Our good survival results also suggest that for well selected cases and with the appropriate use of adjuvant therapy, endoscopic resection of sinonasal cancer results in acceptable oncologic outcomes.…”

Section: Discussionsupporting

confidence: 71%

Sinonasal Adenocarcinoma—Experience of an Oncology Center

Bernardo¹,

Ferreira²,

Silva³

et al. 2013

IJOHNS

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Introduction and Objectives: Sinonasal tumours represent only 3% of all head and neck cancers. Adenocarcinoma is the second most frequent histopathology type. Hardwood exposure has been considered a risk factor. Sinonasal adenocarcinoma grows silently which leads to a late diagnosis and low survival rates. The aim of this study was to present our experience in the management of the patients with sinonasal adenocarcinoma. Method: Retrospective medical records review of patients with sinonasal adenocarcinomas (1974 to 2009). Results: From 301 patients with sinonasal tumors, 67 had histology of adenocarcinoma. Patient average age was 60.1 ± 11.1 years (30 -84 years). 83.6% were man. 65.7% had history of working with wood. 70.1% of the patients had advance disease. The most common treatment strategy was external surgery (lateral rhinotomy (47.8%), sublabial (17.9%) or cranio-facial resection (6%)) or endoscopic approaches with postoperative radiotherapy. The 3 and 5 years overall survival rate were 60% and 49%, respectively. Conclusions: Our group study showed similar epidemiologic characteristics than other series. We confirmed sinonasal adenocarcinomas tendency to late diagnosis and wood dust exposure relation. In our experience, the limited surgical treatment (without craniofacial resection) and postoperative radiotherapy has good survival rates results, similar to other departments who consider the craniofacial resection as the standard treatment.

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Section: Discussionsupporting

confidence: 71%

Sinonasal Adenocarcinoma—Experience of an Oncology Center

Bernardo¹,

Ferreira²,

Silva³

et al. 2013

IJOHNS

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“…The same classification system was used previously for other nonepithelial skull base neoplasms, such as melanomas and soft tissue sarcomas. 18,19,[21][22][23] Staging for 121 patients (83%) was based on reported data and available information on orbital and intracranial extension (see Table 3). …”

Section: Primary Tumormentioning

confidence: 99%

“…The use of CFR and other surgical approaches to the anterior skull base (ie, the subcranial approach) has been documented for a variety of malignant and benign tumors. 19,20 However, because of the rarity of these neoplasms, little is known about the surgical results and clinical outcomes of patients undergoing CFR specifically for SBS. All of the reports on anterior SBS are based on cohorts of patients with head and neck sarcoma who received varying treatment regimens; therefore, identification of independent prognostic predictors using multivariate analysis has not been possible.…”

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confidence: 99%

Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Gil

Patel

Singh

et al. 2007

Cancer

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BACKGROUND. Single‐institutional studies lack sufficient power to assess the role of surgery and radiotherapy in the management of sarcomas involving the anterior skull base. For this study, an international collaborative study group analyzed a large cohort of patients who underwent surgery for the treatment of skull base tumors. METHODS. A subset of 146 patients who had a histologic diagnosis of skull base sarcoma (SBS) formed the basis of this report. Most patients were aged ≥21 years (77%) and had stage IV disease (56%). Adjuvant radiotherapy was received by 35% of patients, and chemotherapy was received by 10% of patients. RESULTS. Orbital involvement was encountered in 53% of patients, involvement of the orbital wall was encountered in 46% of patients, and intracranial extension was encountered in 28% of patients. Positive microscopic margins were reported in 43% of patients (51 of 118 patients). Treatment‐related complications were reported in 27% of patients, and postoperative mortality was reported in 1.4% of patients. With a median follow‐up of 34 months, the 5‐year overall, disease‐specific, and recurrence‐free survival rates were 62%, 64%, and 57%, respectively. Tumor grade and adjuvant radiotherapy were not significant predictors of survival. Prior radiotherapy, intraorbital extension, positive margins, and postoperative complications were significant predictors of reduced disease‐specific survival on univariate analysis. The presence of positive/close margins, however, was the only independent predictor of poor overall, recurrence‐free, and disease‐specific survival on multivariate analysis (relative risk, 2.4; P = .006). The 5‐year disease‐specific survival rate was 77%, 43%, and 36% for patients with negative, close, and positive margins, respectively. CONCLUSIONS. The current results indicated that wide craniofacial resection with negative margins is an independent prognostic predictor of better outcome. Patients with positive margins have a high risk for tumor recurrence independent of tumor grade. Cancer 2007. © 2007 American Cancer Society.

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“…To date, the best outcome studies of these tumours are from the International Collaborative Study, which published their results most recently in 2006 (1,3,17,18). In this multicentre case series, in which our institution was included, data from 1307 patients were acquired retrospectively.…”

Section: Resultsmentioning

confidence: 99%

“…The craniofacial resection is a well-established technique for the surgical excision of tumours involving the anterior skull base and paranasal sinuses (3,10,11). This technique incorporates a combination of transfacial and transcranial procedures in order to allow broad exposure of the anterior cranial fossa and subcranial compartment.…”

Section: Craniofacial Resectionmentioning

confidence: 99%

Surgical Approaches to Resection of Anterior Skull Base and Paranasal Sinuses Tumors

Abu‐Ghanem

Fliss

2013

Balkan Med J

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IntroductionTumours involving the anterior skull base and paranasal sinuses are challenging to treat because of their relative rarity, the wide diversity of tumour types represented, and the variability in the extent of involved local structures (1).The route of spread of these tumours is determined by the complex anatomy of the craniomaxillofacial compartments. These tumours may invade laterally into the orbit and middle fossa, inferiorly into the maxillary antrum and palate, posteriorly into the nasopharynx and pterygopalatine fossa (PPF), and superiorly into the cavernous sinus and brain. Surgery remains the important modality of treatment of anterior skull base tumours. Combined craniofacial techniques for the resection of tumours of the anterior skull base were first described by Ketcham et al. (2) in 1963. Since then, anterior skull base surgery has evolved greatly, with a better understanding of the anatomy, pathology, imaging and surgical techniques. The craniofacial approach and the subcranial approach have become the standard of care for the treatment of malignant tumours involving the anterior skull base (3-6) and, because of this and the varied histologic findings, most outcomes data reflect the experience of small patient cohorts. This International Collaborative study examines a large cohort of patients accumulated from multiple institutions experienced in craniofacial surgery, with the aim of reporting benchmark figures for outcomes and identifying patient-related and tumor-related predictors of prognosis after craniofacial resection (CFR. Recent developments in technology have allowed the use of endoscopic endonasal approaches. Nevertheless, several problems still exist, relating to case selection, histology, cost, patient selection, and the experience of the surgeon. This review focuses on the open surgical resection approaches used for anterior skull base tumours, as used in our institution in the last 20 years. AnatomyThe anterior skull base is a complex anatomical compartment. It can be defined as the portion of the skull base adjacent to the anterior cranial fossa. The anterior skull base boundaries include the medial border that is formed by the cribriform plate, making up the roof of the nasal cavity, the lateral border that is formed by the orbital plates of the frontal bone that form the roof of the orbits and ethmoid air cells, and the posterior border that is formed by the planum sphenoidale and lesser wings of the sphenoid (4).The cribiform plate is traversed by multiple olfactory nerves that extend from the olfactory mucosa to the olfactory bulbs. A bony fissure between the lesser and greater sphenoid wings, the superior orbital fissure, gives passage to cranial nerves III, IV, V and VI and to the superior ophthalmic vein. Superior and laterally lies the optic canal bordered by the body of the sphenoid and by the superior and inferior roots of the lesser sphenoid wing, giving passage to the optic nerve, ophthalmic artery, and sympathetic nerves. However, both the superior orbital fi...

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Craniofacial resection for malignant paranasal sinus tumors: Report of an International Collaborative Study

Abstract: CFR for malignant paranasal sinus tumors is a safe surgical treatment with an overall mortality of 4.5% and complication rate of 33%. The status of surgical margins, histologic findings of the primary tumor, and intracranial extent are independent predictors of outcome.

Cited by 254 publications

References 20 publications

Sinonasal Adenocarcinoma—Experience of an Oncology Center

Sinonasal Adenocarcinoma—Experience of an Oncology Center

Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Surgical Approaches to Resection of Anterior Skull Base and Paranasal Sinuses Tumors

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