Isolated Leptomeningeal Progression from Sinonasal Carcinomas: Implications for Staging Workup and Treatment

Abstract

1995-May 2015. Patients with melanoma, sarcoma, lymphoma, and adenoid cystic carcinoma were excluded. Disease extent, stage, treatments, and margin status were recorded. Between-group differences in disease-free survival (DFS), overall survival (OS), and freedom from local progression (FFLP) were evaluated using Kaplan-Meier estimation and log-rank test. Multivariate analysis was performed using Cox Proportional Hazards models. Results: A total of 103 patients were treated for cancers of the nasal cavity (68) and maxillary (22), ethmoid (8), sphenoid (4), and frontal (1) sinuses. Eighty had surgery AE adjuvant therapy. Of 18 patients treated non-operatively, 7 completed induction chemotherapy and (chemo)radiation, one had chemotherapy, and 10 had (chemo)radiation. Fifty-four patients had squamous cell carcinoma (SCC), 33 esthesioneuroblastoma (ENB), 6 sinonasal undifferentiated carcinoma (SNUC), 5 sinonasal neuroendocrine carcinoma (SNEC), and 5 adenocarcinoma or adenosquamous carcinoma. Sixty-six percent (39/59) of patients with SCC or adenocarcinoma had T4 disease. Intracranial extension was identified in 47% (47/103) patients. Surgical margins were positive in 55% (44/80) of resections, but gross total resections (GTR) were achieved in 86% (73/85). At a median follow-up of 5.6 years (0.1-17 years), 33 patients recurred and 34 expired. We observed 19 local, 6 regional, and 18 distant recurrences. At 3 years, DFS, OS, and FFLP were 58%, 69% and 62% in the entire cohort, respectively. Among resected patients, positive margins were associated with worse 3-year DFS (47% vs 79%, P<.001), OS (56% vs 91%, PZ.005), and FFLP (50% vs 82%, PZ.004). In non-operated patients, 3-year DFS, OS and FFLP were very similar: 47%, 56%, and 53%, respectively. For patients with SCC, those treated non-operatively had similar DFS (HR 0.94, PZ.9), OS (HR 1.1, PZ.8), and FFLP (HR 1.2, PZ.78) to those with positive margins. All ENBs were resected and, compared to SCC, were associated with better DFS (PZ.06), OS (PZ.01), and FFLP (PZ.02). In the surgical group, there were 4 intracranial infections and 1 stroke. In the non-operative group, 1 patient died from stroke during induction therapy. Conclusion: Excellent outcomes were achieved after complete resections with negative margins. For patients with SCC, upfront necessity for nonoperative treatment yields outcomes similar to surgery with inability to clear margins, which is not remediated by adjuvant therapy.

Carbon ion radiation therapy for sinonasal malignancies: Promising results from 2282 cases from the real world

“…Moreover, 12 studies on PRT (with 508 patients) and 11 studies on photon-based IMRT (with 329 patients) that have been published since 2014 were accrued to our analysis. [11][12][13][14][15][16][17][18]24,28,[30][31][32][33][34][35][36] With this surge of publications on CIRT and PRT in the management of SNM in the past several years, we consider that an update that directly compares the effectiveness of CIRT, PRT, and photon-based IMRT is feasible and necessary.…”

“…We excluded studies if they met one of the following criteria: (a) review, comment, or other nonoriginal study; (b) sample size less than five patients; (c) patient sample only included lymphoma; (d) survival data of interest not extractable (note 22 : Mohr et al reported inconsistent and illogical survival data in the abstract and different parts of the result section in 2015 and thus were excluded due to unreliable data); (e) median follow‐up time <6 months; (f) overlapped population (note: Dagan et al published two articles 23,24 and one poster 25 with overlapped study population between 2016 and 2019; we display their basic information in Table 1 but only included the article published in 2019 and the survival data not reported in the article published in 2019; we dealt with the other three articles published by Zenda et al 26‐28 between 2010 and 2014 in the same way). When patients in the study received IMRT and other conventional radiotherapy such as 2DRT or 3D‐CRT, we excluded the study if the survival of the IMRT part was not extractable.…”

“…We excluded studies if they met one of the following criteria: 23,24 and one poster 25 with overlapped study population between 2016 and 2019; we display their basic information in Table 1 but only included the article published in 2019 and the survival data not reported in the article published in 2019; we dealt with the other three articles published by Zenda et al [26][27][28] between 2010 and 2014 in the same way).…”

“…Forty-four (44) eligible studies (7 carbon ion, [11][12][13][14][15][16] 16 proton, 17,18,24,28,[30][31][32][33][34][35][36][37][38][39][40][41] and 21 IMRT [5][6][7][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] ) including the unpublished online data from our hospital 20 were identified from the database (see recurrent patients in each group, respectively. We also calculated the distribution of different histological types and primary sites.…”

Long-term Outcomes from Proton Therapy for Sinonasal Cancers

“…Additionally, we recommend thorough staging for systemic progression before radiotherapy, including evaluation of the leptomeninges with spine MRI and/or craniospinal fluid sampling in cases of high-grade neuroendocrine histology and intracranial invasion. We previously described this unique pattern of progression [27], and, given overall poor prognosis, such patients may be better served with systemic therapy alone or palliative care, avoiding the unnecessary toxicity of aggressive head and neck radiotherapy. Lastly, the ever-changing landscape of histologic subtypes in sinonasal cancers can inform or confuse our treatment decisions.…”