Recurrence Patterns and Efficacy of Surveillance Modalities for Sinonasal Malignancies

Abstract

Objective There is limited information regarding the recurrence patterns and efficacy of surveillance modalities in patients with sinonasal malignancies. Methods A retrospective study was conducted between the years 2001–2018 at a tertiary care center. Included were all patients with sinonasal malignancies treated in our institution. Data regarding recurrence and survival were analyzed. Results Eighty-one patients were included. Multimodal treatment was administered to the majority of patients. 24 (35.3%) patients recurred with a median time of 17 months (range, 4–180). Although the majority of recurrences occurred within the first 5 years (83.3%), 4 (16.6%) recurred later on (5−15 years). Recurrences were local in 83.3%, regional in 20.8% and distant in 16.6%. All local recurrences occurred within the radiation treatment field and all patients with distant failure had mucosal melanoma. The majority of recurrences (70.6%) were diagnosed clinically or endoscopically, mainly in patients with SCC during the first 2 years of follow up. MRI or PET-CT were crucial in detecting extra-sinus and distant failures. Salvage surgery was feasible in the majority of patients (58.3%). Overall, 5 years survival (OS) rate was 60.9%. Conclusions Frequent clinic visits with nasal endoscopy combined with frequent imaging studies should be routinely practiced as part of a long-term surveillance plan. Longer follow up duration should be considered in these patients.

Current status of sinonasal cancer survivorship care

“…The National Comprehensive Cancer Network (NCCN) guidelines for head and neck cancer surveillance includes sinonasal malignancies 31 . The average time to recurrence of SNC can be longer than that of other head and neck mucosal cancers (17–33 months compared to 1–12 months) 18,29,32 . Thus, more intensive surveillance of SNCs is recommended for the first 3 years (Table 1).…”

“…31 The average time to recurrence of SNC can be longer than that of other head and neck mucosal cancers (17-33 months compared to 1-12 months). 18,29,32 Thus, more intensive surveillance of SNCs is recommended for the first 3 years (Table 1). Moreover, follow-up visits scheduled every 2-3 months for the first year, every 3-4 months for the second year, every 6 months for the third to fifth years, and annually until the tenth year have been recommended.…”

Contemporary surveillance of sinonasal malignancy in adults

“…SNUCs are often locally recurrent and frequently metastasize, resulting in significant morbidity and mortality. Mucosal melanoma has a high recurrence rate with a tendency for distant failure (38%-57%) and demonstrates high FDG avidity, making PET/CT particularly useful [19,53,54] . FDG PET/CT is also recommended in patients with NUT carcinoma, given the particularly high risk for metastatic disease.…”

The Lifetime Pursuit of Solving Complex Questions

“…Finally, we have 3 papers that strive to improve the overall quality of care and standardization of treatment. Tzelnick et al 15 retrospectively analyze their sinonasal malignancy patients to help define a post-primary treatment care plan. They discovered that although 35% recurred with a median range of 17 months, there is a wide range, where up to 16% of recurrences were found to occur 5 to 15 years post treatment.…”