Decreasing recurrence and increasing survival rates in patients of ethmoid or sphenoid intestinal-type adenocarcinomas

Abstract

Background: Ethmoid or sphenoid intestinal-type adenocarcinomas (ITACs) form a distinct subtype of sinonasal adenocarcinomas that occur less than 1 case/100,000/yr. They have obvious exposure relationship to hardwood or leather dusts, infrequent metastasis, but a relatively high local-recurrence rate. They locate at sinuses close to vital structures listed as high-risk areas in surgeries. Even in expert hands, a craniofacial resection is associated with non-negligible mortality and morbidity. Management of these tumors, first or recurrent, needs to weigh these consequences versus the survival, regional-recurrence, and distant-recurrence rates. Due to the rareness of ethmoid or sphenoid ITACs, accurate overall survival and local- or regional-recurrence rates across diverse treatments are unclear. The aim of this study is to report the overall statistics of this cancer and the relationship between enrollment year versus age, recurrence, and survival. Methods: Systemic review and meta-analysis with 1126 cases across various treatments in the literature. Results: Here, we show that patients of ethmoid or sphenoid ITACs had overall local-, regional-, and distant-recurrence rates of 32.2%, 2.2%, and 10.3%, respectively, with a 5-year overall survival rate of 66.2%. The results present a significant correlation between age, local-recurrent rate, or overall survival rate versus enrollment year. Conclusion: This suggests that recent patients of ethmoid or sphenoid ITACs may present at an older mean age, have a lower local-recurrence rate, and have a better 5-year survival rate than before. There was a shifting trend of treating ethmoid ITACs from external approach to endoscopic resection. Clinicians may want to weigh mortality and morbidity rates of external surgeries and these data to share or decide a solution.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Data available to date show that there is a low incidence of EGFR , K‐RAS , and BRAF mutations and a high rate of increase in the number of EGFR copies. This genetic fingerprint seems to support the potential for anti‐ EGFR drugs 1145,1154 . Current evidence for use of anti‐ EGFR drugs is limited, but several clinical trials are ongoing for patients with metastatic disease 1157,1160 .…”

“…Systemic staging (e.g., total body CT, PET/CT) should be conducted once per year for the duration of the follow‐up as ITAC patients may develop distant metastatic disease 1146 . With such a surveillance protocol, earlier detection of recurrences increases the possibility to cure patients who experience relapses 1144,1154 . Globally, the recurrence rate after definitive treatment ranges from 17.6% to 49.6% 1155 .…”