Induction Chemotherapy Response as a Guide for Treatment Optimization in Sinonasal Undifferentiated Carcinoma

Abstract

PURPOSE Multimodal therapy is a well-established approach for the treatment of sinonasal undifferentiated carcinoma (SNUC); however, the optimal sequence of the various treatments modalities is yet to be determined. This study aimed to assess the role of induction chemotherapy (IC) in guiding definitive therapy in patients with SNUC. METHODS Ninety-five previously untreated patients diagnosed with SNUC and treated between 2001 and 2018 at The University of Texas MD Anderson Cancer Center were included in the analysis. Patients were treated with curative intent and received IC before definitive locoregional therapy. The primary end point was disease-specific survival (DSS). Secondary end points included overall and disease-free survival, disease recurrence, and organ preservation. RESULTS A total of 95 treatment-naïve patients were included in the analysis. For the entire cohort, the 5-years DSS probability was 59% (95% CI, 53% to 66%). In patients who had partial or complete response to IC, the 5-year DSS probabilities were 81% (95% CI, 69% to 88%) after treatment with definitive concurrent chemoradiotherapy (CRT) after IC and 54% (95% CI, 44% to 61%) after definitive surgery and postoperative radiotherapy or CRT after IC (log-rank P = .001). In patients who did not experience at least a partial response to IC, the 5-year DSS probabilities were 0% (95% CI, 0% to 4%) in patients who were treated with concurrent CRT after IC and 39% (95% CI, 30% to 46%) in patients who were treated with surgery plus radiotherapy or CRT (adjusted hazard ratio of 5.68 [95% CI, 2.89 to 9.36]). CONCLUSION In patients who achieve a favorable response to IC, definitive CRT results in improved survival compared with those who undergo definitive surgery. In patients who do not achieve a favorable response to IC, surgery when feasible seems to provide a better chance of disease control and improved survival.

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

“…In this regard, the incorporation of induction chemotherapy (IC) into the treatment strategy with the aim to reduce distant metastasis and possibly impact on locoregional control has shown promising results despite having been obtained from heterogeneous series and within small studies. Favorable response to IC proved to be a strong positive prognosticator …”

“…In our series, the response to IC confirmed to be a strong positive prognosticator. This finding agrees with those reported in other retrospective studies . Therefore, it is time that research moves toward the identification of baseline molecular or radiological (radiomics) disease features, which could profile patients receiving the highest benefit from IC.…”

“…This is not in line with the literature data, in which trimodality seems to be associated with better outcome in locoregional advanced cases. However, one should always consider the biases of treatment selection, which prompted a nonsurgical approach in diseases obtaining a favorable response to IC, thus bearing a better prognosis as recently reported by a retrospective U.S. series of SNUC . In this regard, the feasibility of nonsurgical strategies in selected cases obtaining response to IC deserves to be explored in prospective series, including with specific aims such as orbital‐preservation strategies …”

“…Current treatment approaches to sinonasal tumors include craniofacial resection, endoscopic surgery, and radiation therapy (RT) (including intensity‐modulated RT [IMRT] techniques) . However, survival benefits with all the above‐mentioned approaches remain poor; therefore, for the management of sinonasal cancers the sequencing and combinations of multimodal treatments have been gaining importance and relevance .…”

“…6 Current treatment approaches to sinonasal tumors include craniofacial resection, endoscopic surgery, and radiation therapy (RT) (including intensity-modulated RT [IMRT] techniques). [12][13][14][15][16][17][18][19] However, survival benefits with all the above-mentioned approaches remain poor; therefore, for the management of sinonasal cancers the sequencing and combinations of multimodal treatments have been gaining importance and relevance. 18,19 In this regard, the incorporation of induction chemotherapy (IC) into the treatment strategy with the aim to reduce distant metastasis and possibly impact on locoregional control has shown promising results despite having been obtained from heterogeneous series and within small studies.…”