Management of orbital invasion in sinonasal squamous cell carcinoma: 15 years’ experience

Abstract

Background This study was intended to review our management strategy for sinonasal squamous cell carcinomas (SNSCCs) with orbital invasion and to explore the role of radiotherapy in orbital preservation. Methods We retrospectively analyzed 93 SNSCC patients with orbital invasion who underwent radiotherapy with or without surgery over the past 15 years. The degree of orbital invasion was classified into 3 grades. Results Eighty‐eight patients presented with T4 tumors and 36 had grade III orbital invasion. Seventy‐two patients received surgery plus radiation and 67 received platinum‐based chemotherapy. The median follow‐up for surviving patients was 60 months. Five‐year overall survival (OS) for the whole group was 57.4%. The patients treated with surgery plus radiation had a 5‐year survival rate of 62.2% and orbital preservation was feasible in 90.3% of cases. Twenty‐one patients with SNSCCs that extended into the extraocular muscles or eye globe also underwent orbital preservation. Five‐year locoregional relapse‐free survival (LRFS) was 69.5% for patients treated with orbital preservation and 57.1% for those treated with orbital exenteration, indicating no statistical difference. Five‐year survival, 5‐year progression‐free survival (PFS), and 5‐year distant metastasis‐free survival (DMFS) were similar between groups. Grade III orbital invasion was independently associated with shorter OS, LRFS, PFS, and DMFS. Conclusion Orbital invasion in grade III was associated with the worst survival outcomes. Invasion of either the extraocular muscles or eye globe is not a contraindication for eye‐sparing surgery. Preoperative chemoradiation continues to offer hope to patients with a strong desire to preserve their eyes.

Prognostic Factors and Outcomes of De Novo Sinonasal Squamous Cell Carcinoma: A Systematic Review and Meta‐analysis

“…Among the 28 noncomparative studies, the average MINORS score was 12 (range, 10-14 OS. 4,[6][7][8]10,11,[14][15][16][17][18] The weighted mean overall 5-year OS in this review was 54.5% (range, 18%-75%). Five-year OS data available on all patients undergoing surgery, open and endoscopic surgery, no surgery, radiation, surgery alone, surgery and RT, CT, and CT and RT are reported in Table 3.…”

“…Eight studies provided 5-year OS rates of both surgery and no surgery, with 5-year OS rates of 56.7% and 47.4%, respectively. 17,18,29,45,47,48,51,54 Direct meta-analysis demonstrated patients with surgery were more likely to be alive at 5 years compared to those who did not receive surgery (OR, 2.26; 95% CI, 1.48-3.47; P < .001), with the observed survival difference occurring in the absence of study heterogeneity ( I 2 = 0) ( Figure 3 ). Figure 2 shows the funnel plot with a roughly asymmetrical distribution, signaling the presence of publication bias among the 8 studies included in the meta-analysis.…”

Proton beam therapy of periorbital sinonasal squamous cell carcinoma: Two case reports and review of literature

“…Flaps, such as temporoparietal, galeal, free gracilis and free vastus lateralis musculocutaneous flap, are available for the reconstruction of defects; however, they should be employed with special diligence, due to the known comorbidities and postoperative complications[ 20 , 21 ]. In the recent publications, there is a trend of eye-sparing surgery without previously assumed survival disadvantages, especially in combination with adjuvant RT[ 22 - 25 ].…”

Conservative management of orbital involvement in malignant tumors: is the paradigm evolving? A critical review

“…In case of orbital invasion, progression-free survival was anyway 0% [17]. Some authors describe the possibility to spare the orbit, in case of SCC, even in case of extraocular muscles or eyeball involvement [18]. Pre op RT has been advocated in case of poorly differentiated and locally advanced tumors.…”