Impact of salvage surgery for recurrent sinonasal cancers with skull base and intracranial involvement

Abstract

OBJECTIVE Patients with recurrent sinonasal cancers (RSNCs) often present with extensive involvement of the skull base and exhibit high rates of subsequent recurrence and death after therapy. The impact of salvage surgery and margin status on progression-free survival (PFS) and overall survival (OS) has yet to be demonstrated. The goal of this study was to determine whether skull base resection with negative margins has an impact on outcomes in the recurrent setting. METHODS A retrospective chart review of 47 patients who underwent surgery for RSNC with skull base invasion between November 1993 and June 2020 was conducted. The following variables were extracted from the clinical records: patient demographic characteristics (age and sex), tumor pathology, dural and orbital invasion, and prior radiation exposure and induction chemotherapy. Metastatic disease status, surgical approach, margin status, and history of postoperative chemotherapy and/or postoperative radiation therapy were noted. The primary and secondary outcomes were PFS and OS, respectively. RESULTS The cohort included 30 males (63.8%) and 17 females (36.2%), with a mean ± SD age of 54.8 ± 14.4 years. Thirty-five (74.5%) patients showed disease progression, and 29 (61.7%) patients died during the study period. The mean ± SD patient follow-up period was 61.8 ± 64.4 months. Dural invasion was associated with increased risk of death (HR 2.62, 95% CI 1.13–6.08). High-risk histopathology (HR 3.14, 95% CI 1.10–8.95) and induction chemotherapy (HR 2.32, 95% CI 1.07–5.06) were associated with increased odds of disease progression. When compared to patients with positive margins or gross-total resection with unknown margin status, those with negative margins had decreased odds of disease progression (HR 0.30, 95% CI 0.14–0.63) and death (HR 0.38, 95% CI 0.17–0.85). CONCLUSIONS RSNCs show high rates of subsequent disease progression and mortality. This study demonstrated that negative margins may be associated with improved PFS and OS in carefully selected patients who have undergone salvage surgery for RSNC.

Assessment of dural invasion in complex cases operated on by collaborative efforts of neurosurgery and otolaryngology for pathologies associated with the frontal sinus

“…In a study conducted by Schur and colleagues in 2022, evaluating sinonasal cancers with skull base involvement and intracranial extension, dural invasion was detected in 48.9% of cases, and it was found to be directly proportional to disease progression and mortality 20 . It was also noted that minor and major complications may be higher in such cases.…”

Clinical considerations for open versus endoscopic approaches in skull base surgery

“…Surgical salvage for recurrent tumors or those with previous treatment failure often require bold treatment models. In such patients, achieving negative margin status is of critical importance [30,31 ▪ ]. Compared with patients with gross tumor resections and unknown margin status, patients with negative margins have decreased disease progression and reduced rates of death [31 ▪ ].…”

“…In such patients, achieving negative margin status is of critical importance [30,31 ▪ ]. Compared with patients with gross tumor resections and unknown margin status, patients with negative margins have decreased disease progression and reduced rates of death [31 ▪ ]. Whenever faced with this challenging circumstance, the surgeon should have a candid conversation with the patient regarding goals of treatment.…”