Prognostic value of surgical margins during endoscopic resection of paranasal sinus malignancy

Manjunath, L.; Derousseau, Taylor; Batra, Pete S.

doi:10.1002/alr.21463

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…A recurrent head and neck malignancy is associated with a generally poor prognosis with a median survival of only 6 to 9 months, and a 2‐year DFS of 36.4% after salvage surgery (early‐stage laryngeal cancer patients excluded) . Patients with recurrent oral cavity, pharynx, and sinonasal malignancies have a 2‐year DFS of 36.2%, 24.6%, and 42%, respectively, after salvage surgery . This study showed a 2‐year DFS of 28% of all tumor locations together.…”

Section: Discussionmentioning

confidence: 64%

Adjuvant photodynamic therapy in head and neck cancer after tumor‐positive resection margins

et al. 2017

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Section: Discussionmentioning

confidence: 64%

Adjuvant photodynamic therapy in head and neck cancer after tumor‐positive resection margins

et al. 2017

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“…In our cohort, patients with negative surgical margins had increased survival compared with patients who had positive margin, which coincides with other published reports. 17,[19][20][21] This highlights the importance of complete surgical resection with clear margins and may also underscore the benefit of postoperative RT in sinonasal malignancies. In those patients who had positive margins, we did find that patients treated with surgery alone had an increased risk of mortality compared with those who received surgery and adjuvant RT.…”

Section: Discussionmentioning

confidence: 92%

Multi-modality Treatment and Survival in Sinonasal Minor Salivary Gland Tumors

et al. 2019

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Objectives The aim of this study was to analyze the effect of the multimodality treatment on survival in sinonasal minor salivary gland tumors. Methods Adult clinical American Joint Committee on Cancer (AJCC) tumor (T) 1-4a staged cases of sinonasal minor salivary gland tumors were isolated from the National Cancer Database (2004–2014). Multivariate regressions were performed to analyze the effect of multimodality treatment. A subset analysis was also performed in patients with positive margins following surgical management. Results We identified 556 cases, of which 293 (52.7%) patients were treated with surgery and radiotherapy (RT), 160 (28.8%) were treated with surgery alone, and 52 (9.4%) were treated with surgery and chemoradiotherapy (CRT). No patients were treated with chemotherapy alone. With surgery and CRT as a reference, the only treatment modality associated with decreased survival was RT alone (hazard ratio [HR]: 3.213 [95% confidence interval (CI): 1.578–6.543]; p = 0.001). Within a subset analysis of patients with positive margins, surgery was associated with decreased survival (HR: 2.021 [95% CI: 1.401–3.925]; p = 0.038), but not triple modality therapy (HR: 1.700 [95% CI: 0.798–3.662]) when compared with surgery with RT. Conclusion The most common treatment was surgery and RT, consistent with National Comprehensive Cancer Network (NCCN) guidelines which recommends chemotherapy (CT) only in the most concerning cases. However, we found no difference in survival among most treatment modalities when compared with triple modality therapy, with the exception of RT alone. Although margins were prognostic within these cancers, we found no evidence that adjuvant CRT provides any survival benefit over surgery and RT, though surgery alone was associated with decreased survival.

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“…12,16,28 Prior studies have demonstrated that failure to achieve local control for SNMM may increase the risk of distant metastasis and death. 29,30 With recent FDA approval and increasing use of several targeted immunotherapy agents for metastatic melanoma, treatment paradigms for sinonasal mucosal melanoma have begun to shift, with several clinical trials investigating their effectiveness in this disease entity. This is the first study in the literature to specifically examine the role of targeted immunotherapy in SNMM, giving attention to local and distant response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Sinonasal Mucosal Melanoma in Patients Treated with Systemic Immunotherapy

Chao

Kuan

Tong

et al. 2020

J Neurol Surg B Skull Base

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Objectives Surgical resection is widely accepted as a critical component for definitive treatment of sinonasal mucosal melanoma. Systemic immunotherapy, including multiple newer agents, has been used to treat metastatic or unresectable disease. In this study, we examine its efficacy in locoregional control when used in conjunction with surgical resection for primary mucosal lesions. Design Present study is a retrospective review of all patients at a tertiary academic medical center with primary sinonasal mucosal melanoma and distant metastatic disease. Results A total of four patients were identified. In all cases, patients were treated with a combination of surgical resection of the primary tumor and systemic immunotherapy. Three patients were initially treated with surgery at the primary site followed by immunotherapy for distant metastases. Response to immunotherapy at the sites of primary and metastatic disease was seen in two patients. All four patients developed progression or recurrence at the primary site following initiation of immunotherapy for which they underwent surgical resection. One patient remains in follow-up without evidence of disease 20 months after initial treatment; three succumbed to the disease at 135, 37, and 16 months after initial treatment. Conclusion Surgical resection for local control plays a critically important role in the treatment of sinonasal mucosal melanoma regardless of the presence of metastases and whether immunotherapy will be given. This case series suggests that, though immunotherapy may demonstrate efficacy in managing distant disease, surgery should remain the first-line treatment for the primary site.

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Prognostic value of surgical margins during endoscopic resection of paranasal sinus malignancy

Cited by 9 publications

References 17 publications

Adjuvant photodynamic therapy in head and neck cancer after tumor‐positive resection margins

Adjuvant photodynamic therapy in head and neck cancer after tumor‐positive resection margins

Multi-modality Treatment and Survival in Sinonasal Minor Salivary Gland Tumors

Surgical Treatment of Sinonasal Mucosal Melanoma in Patients Treated with Systemic Immunotherapy

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