The Role of Regional Disease and Patterns of Treatment Failure in Primary Sinonasal Malignancies

Abstract

Background The question how to treat the clinically negative neck in sinonasal malignancies is controversial. Objectives To investigate patterns of treatment failure and to assess outcome measures in patients with primary sinonasal malignancies. Methods Retrospective cohort study of patients treated for primary malignant sinonasal malignancies. Results Lymph node (LN) metastases at initial presentation were present in 8 of 152 patients (5.3%). Ipsi- and contralateral LN levels 1 and 2 were identified as nodal basins at risk. We found a 5-year overall survival (OS) of 75.2% and disease free survival of 61.1%. Among patients with cN0 neck, nodal recurrence free survival was not different between patients with and without elective neck treatment ( P = .23). On logistic regression analysis, we found initial T classification as an independent factor for achievement of complete remission (CR) and OS. Conclusions LN metastases at initial presentation are rare and initial T classification was identified as the most important prognostic factor for OS and CR, emphasizing the need for a thorough initial staging of the primary tumor.

Reappraisal of Grading in Intestinal-Type Sinonasal Adenocarcinoma: Tumor Budding as an Independent Prognostic Parameter

“…Overall survival (78.3%), DSS (78.5%) and DFS (69.9%) at 5 years were similar to previous studies, which reported survival rates between 53 and 83%, 82 and 83 and 62 and 74%, respectively [ 7 , 11 , 12 , 31 – 34 ]. With regard to the pattern of recurrence, local recurrence was confirmed to be by far the most common site of treatment failure [ 12 , 32 , 35 , 36 ]. From a therapeutic point of view, transnasal endoscopic techniques have evolved as standard-of-reference for most sinonasal malignancies, providing excellent outcomes and decreased morbidity, when compared to external approaches [ 11 , 12 , 37 ].…”

Current status of sinonasal cancer survivorship care

“…CT scans can also be helpful in cases when recurrence involving bony structures is suspected 24 . When scans are performed, the neck should be included as regional failure can occur in bilateral levels I and II 25 . This is especially important for high‐risk disease such as mucosal melanomas, which have higher rates of regional failure (33% at 5 years) 26 .…”

“…24 When scans are performed, the neck should be included as regional failure can occur in bilateral levels I and II. 25 This is especially important for high-risk disease such as mucosal melanomas, which have higher rates of regional failure (33% at 5 years). 26 PET/CT has an overall specificity of 96.3% and a positive predictive value for local recurrence of 84%.…”

Reflecting on the Work of the Giants That Come Before You

“…14,15 Sinonasal malignancies continue to plague patients during the pandemic and Sharma et al, discuss the improvements in outcomes as endoscopic resections of sinonasal cancers have become more accepted as an appropriate treatment modality. 16 Meerwein et al, examine whether or not treatment of the nodal drainage basins of the sinonasal cavity affect treatment outcomes and survival 17 , and Wang et al, are examining heat shock proteins as a marker for Juvenile Nasopharyngeal Angiofibromas. 18 Olfactory dysfunction has taken a far more prominent place in the minds of North Americans as many afflicted with Covid-19 have experienced this directly.…”