Response to induction chemotherapy in sinonasal malignancies: A single‐institutional experience

Nyirjesy, Sarah; Fenberg, Rachel; Heller, Margaret; Judd, Ryan T.; Li, Michael M; Koch, Brandon; Bonomi, Marcelo; Carrau, Ricardo L.; VanKoevering, Kyle K.

doi:10.1002/hed.27357

Cited by 5 publications

(3 citation statements)

References 39 publications

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“…Nyiriesy et al looked at multiple sinonasal pathologies but performed a secondary analysis of SNSCC comparing those who were treated with and without IC [38]. As expected, those treated with IC were significantly more likely to have orbital, skull base, or dural involvement as well as a higher T stage.…”

Section: Induction Chemotherapy In Sinonasal Squamous Cell Carcinomamentioning

confidence: 96%

Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma and Sinonasal Undifferentiated Carcinoma: A Comprehensive Review

Melder

Geltzeiler

2023

Cancers

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Sinonasal squamous cell carcinoma (SNSCC) and sinonasal undifferentiated carcinoma (SNUC) are two of the most common, high-grade malignancies of the sinonasal cavity. The standard of care for resectable lesions per the National Comprehensive Cancer Network (NCCN) guidelines includes surgical resection with negative margins plus adjuvant radiation therapy. However, surgery for locally advanced disease with both orbital and intracranial involvement is associated with significant morbidity and poor overall survival. Over the last decade, induction chemotherapy (IC) has emerged as part of a multimodal treatment strategy to optimize locoregional disease control and minimize substantial surgical morbidity such as orbital exenteration without compromising rates of overall survival. The response to IC both guides additional therapy and helps prognosticate a patient’s disease. This narrative review examines the data surrounding the management of patients with SNSCC and SNUC. The pros and cons of upfront surgical management plus adjuvant therapy will be explored, and the case for IC will be presented. The IC-specific regimens and treatment paradigms for SNSCC and SNUC will each be explored in detail. Organ preservation, treatment morbidity, and survival data will be presented, and evidence-based recommendations will be presented for the management of these patients.

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Section: Induction Chemotherapy In Sinonasal Squamous Cell Carcinomamentioning

confidence: 96%

Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma and Sinonasal Undifferentiated Carcinoma: A Comprehensive Review

Melder

Geltzeiler

2023

Cancers

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“…1 These tumors tend to be aggressive and are usually diagnosed late, making treatment challenging, with oncologic outcomes for SNMs not significantly improving over the past 30 years. 2 Current treatment is guided by histology, with most SNMs benefiting from multimodal therapy and surgical resection. Obtaining negative margins during resection is critical to improving patient survival.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, previous studies have suggested that IC response could be used as a guide for SNM patient treatment and survival. 2,12 However, the use of IC is relatively novel in SNMs, with a paucity of literature on the effects of IC on orbital preservation and orbital function. In this study, we performed a systematic review of studies reporting on IC use in SNMs with orbital invasion.…”

Section: Introductionmentioning

confidence: 99%

The role of induction chemotherapy for orbital invasion in sinonasal malignancies: A systematic review

Tang,

Calcaterra,

Harris

et al. 2024

Int Forum Allergy Rhinol

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BackgroundSinonasal malignancies (SNMs) frequently present with orbital invasion. Orbital exenteration (OE) can lead to significant morbidity. Induction chemotherapy (IC) is a promising treatment alternative that may allow for orbit preserving (OP) treatments without compromising patient survival. This systematic review was conducted to synthesize the published data on SNM patients with orbital invasion who underwent IC, including tumor response, orbital outcomes, and survival.MethodsThe study protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Databases Embase, Cochrane, Medline, and Scopus, from inception to July 17, 2023, were searched.ResultsNineteen studies were included, encompassing 305 SNM patients with orbital invasion treated with IC. Fourteen studies reported an overall IC response rate (positive response defined as complete or partial tumor volume reduction) of 77.2%. Among included studies, OE rates after IC ranged from 0 to 40%. Three studies reported a high rate of posttreatment functional orbital preservation (89.8–96.0%). Five studies specifically reported that 62.5% (60 out of 96) of patients were downgraded from planned OE to OP treatment following IC. Three studies reported a significant overall survival (OS) improvement in IC responders versus IC nonresponders. Following IC, 5‐year OS ranged from 44.2 to 55.5%. Patients with olfactory neuroblastoma demonstrated the highest IC response rate and lowest OE rate (100 and 0%, respectively) versus those with sinonasal undifferentiated carcinomas (68.4 and 0%) or squamous cell carcinomas (76.7 and 16%).ConclusionsFor select patients, IC may allow for OP in locally advanced SNMs with orbital involvement.

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Surgical resection and overall survival in cT4b sinonasal non‐squamous cell carcinoma

Patel,

Haleem,

Revercomb

et al. 2024

Laryngoscope Investig Oto

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ObjectiveSurgical resection is associated with higher overall survival (OS) than definitive radiotherapy (RT) or chemoradiotherapy (CRT) in cT4b sinonasal squamous cell carcinoma (SCC). Our study investigates the survival benefit of surgical resection in cT4b sinonasal non‐SCC.MethodsThe 2004 to 2019 National Cancer Database was queried for patients with cT4b sinonasal non‐SCC undergoing definitive treatment with (1) surgical resection + additional therapy (RT, chemotherapy, or both), (2) RT alone, or (3) CRT. Surgical resection + additional therapy and definitive RT/CRT were compared with Kaplan–Meier and multivariable Cox regression models.ResultsOf 629 patients satisfying inclusion criteria, 513 (81.6%) underwent surgical resection + additional therapy and 116 (18.4%) underwent definitive RT/CRT. The most frequent histologic types were undifferentiated carcinoma (23.7%), adenoid cystic carcinoma (22.6%), and adenocarcinoma (20.7%). Few patients presented with clinical nodal metastasis (15.7%). There were 4 (0.8%) mortalities within 90 days of surgical resection. Patients undergoing surgical resection with positive surgical margins had higher 5‐year OS than those undergoing definitive RT/CRT (56.3% vs. 39.4%, p = .039) and similar 5‐year OS as those with negative margins (56.3% vs. 63.9%, p = .059). Patients undergoing neoadjuvant chemotherapy had similar 5‐year OS as those undergoing definitive RT/CRT (60.9% vs. 39.5%, p = .053). Age at diagnosis, tumor diameter, and surgical resection + additional therapy (aHR 0.64, 95% CI 0.45–0.91) were associated with OS (p < .05).ConclusionSurgical resection + additional therapy was associated with higher OS than definitive RT/CRT in cT4b sinonasal non‐SCC. Surgical resection may benefit select patient with cT4b sinonasal non‐SCC.Level of Evidence4.

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Response to induction chemotherapy in sinonasal malignancies: A single‐institutional experience

Cited by 5 publications

References 39 publications

Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma and Sinonasal Undifferentiated Carcinoma: A Comprehensive Review

Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma and Sinonasal Undifferentiated Carcinoma: A Comprehensive Review

The role of induction chemotherapy for orbital invasion in sinonasal malignancies: A systematic review

Surgical resection and overall survival in cT4b sinonasal non‐squamous cell carcinoma

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