Definitive-intent (chemo)radiotherapy for sinonasal undifferentiated carcinoma

Abstract

Objective: The current study aimed to investigate the value of definitive-intent (chemo)radiotherapy in treating sinonasal undifferentiated carcinoma (SNUC) in a single institution. Methods: The medical records of twenty-one patients with SNUC treated with definitive-intent (chemo)radiotherapy between 2011 and 2021 in one single institution were retrospectively reviewed. We analyzed the treatment efficiency and long-term survivals. Results: A total of twenty-one patients were included in this cohort, twelve patients presented with T4 stage at diagnosis, and six in T1/T2, three in T3 stage. Nine patients (42.9%, 9/21) showed cervical lymph node metastases. All the patients were scheduled to receive definitive (chemo)radiotherapy and five patients had been performed surgery for residual tumor after (chemo)radiotherapy. 66.7% (14/21) of patients had a complete response after the completion of treatment, 23.8% (5/21) of partial response, one of stable disease, and one of progressed disease. The 3 year overall survival (OS) of the entire group were 86.2%, and the 3 year progress free survival (PFS) were 66.3%, respectively. 52.4% of the patients (11/21) presented orbit invasion, compared with patients without orbit invasion, the patients who had orbit invasion were not found to have significantly poor 3 year OS (87.5% vs 83.3%, p = 0.38) and PFS (75.0% vs 55.3%, p = 0.59). Conclusions: Definitive-intent (chemo)radiotherapy could be the preferred treatment for patients with advanced SNUC, and salvage surgery should be performed for the lesions showing stable disease, progressed disease, or residual tumor. Advances in knowledge: The value of definitive chemoradiotherapy in treating sinonasal undifferentiated carcinoma.

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.…”

“…The 3-year OS in this study was 86.25% and progression-free survival was 66.3%. Notably 11 of 21 (52.4%) of patients in this study had orbital invasion and were all successfully treated nonsurgically [18 ▪ ].…”

“…They were both treated with induction chemotherapy (TPF) followed by CCRT with complete remission for 44 months. Wang et al [18 ▪ ] also recently published a series in which 16 out of 21 patients were treated with induction chemotherapy followed by CCRT. Fourteen of these patients had a response to induction chemotherapy with two having stable disease.…”

Progress and emerging strategies to preserve function in the treatment of sinonasal cancer

“…In addition to the issue of patient selection, the earlier data involved radiation techniques that were less precise. In contrast, more recent reports have emerged supporting the efficacy of concurrent CRT as a first line treatment for SNC 33 . Previous concerns over toxicity risks have been circumvented using new modifications of RT making CRT protocols more precise to minimize toxicity related to surrounding vital structures.…”

“…In contrast, more recent reports have emerged supporting the efficacy of concurrent CRT as a first line treatment for SNC. 33 Previous concerns over toxicity risks have been circumvented using new modifications of RT making CRT protocols more precise to minimize toxicity related to surrounding vital structures. Also, there is evidence to indicate that tumor invasion of bone does not appear to significantly signify refractory disease.…”