Nasal Cavity Squamous Cell Carcinoma: Factors Associated With Treatment Outcomes and Potential Organ Preservation

Abstract

Background Squamous cell carcinoma of the nasal cavity (NCSCC) is a rare, challenging malignancy. Surgical resection of this tumor can cause significant facial deformity, and indications for adjuvant or organ preservation therapies are not well-described. Objective To examine the impact of treatment regimen on survival outcomes in NCSCC and to compare surgical to non-surgical based therapies. Methods The National Cancer Database was queried for NCSCC from 2004 to 2014. Patient demographics, tumor characteristics, and treatment regimen were compared for the entire cohort. Multivariable Cox proportional hazards regression was performed for statistical analysis of treatment regimen and surgical margins on overall survival (OS) for early and late-stage disease. Results A total of 1883 NCSCC patients were identified. The OS for the cohort was 83 months, and median age at diagnosis was 65 years. NCSCC patients who underwent surgery followed by adjuvant radiation therapy (RT) had a better OS compared to definitive RT (HR: 0.58, P < .001). In early stage NCSCC (T1/T2, N0), there was no significant difference in OS between patients treated with surgery only or surgery with adjuvant RT compared to definitive RT. In advanced stage NCSCC, surgery with adjuvant RT had a better OS compared to definitive chemoradiation. Having positive margins was shown to predict a worse OS when compared to negative margins in surgical patients despite adjuvant RT or chemoradiation. Conclusions NCSCC appears to be best treated with surgery followed by adjuvant RT in advanced-stage disease whereas in early-stage disease, surgery does not improve OS compared to definitive RT.

Radiation oncology for the rhinologist

“…In a retrospective analysis of 1883 patients in the United States National Cancer Database, Issa reported a similar OS between upfront surgery followed by adjuvant radiotherapy and definitive chemoradiotherapy in patients with T1/2 and node negative disease (2023). For patients with T3/4 or node positive disease, upfront surgery followed by adjuvant radiotherapy yielded better OS compared to definitive chemoradiotherapy ( P < 0.001) [50]. In early stage (T1/2) nasal cavity cancer, brachytherapy is an effective tool with one study demonstrating 3 years local control (LC) exceeding 95% [52].…”

“…For cancers of the external nose, surgical resection often requires the need for extensive reconstruction or prosthesis, which may lead to poor cosmesis [49]. This has led to interest in nonsurgical approaches in the treatment of external nose cancers, with promising early results from several single-institutional studies [50][51][52]. In a recent study examining nonoperative approach in the treatment of nasal cancers, Mimica et al [51 examined 11 patients treated with definitive radiotherapy with or without concurrent chemotherapy, and found 2year rhinectomy-free and 2-year OS of 88% and 100%, respectively].…”

Advancing Rhinology Through Research

“…Among the important take-homes from this research, is the data indicating that surgical treatment is associated with better survival benefit. Similarly, Issa et al 9 also used the NCD to evaluate the impact of treatment regimen in survival across different stages of sinonasal squamous cell carcinoma. Palmeiri et al 10 took a similar conceptual approach when evaluating the role of antibiotic prophylaxis and risk factors for post-operative intracranial infections after endoscopic skull base surgery in pediatric patients.…”