Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach

Background: examine presentation and outcomes of sinonasal squamous cell carcinoma (SCC). Methods: A retrospective study utilizing the National Cancer Database, 2004 to 2015. The study population included adult patients diagnosed with primary sinonasal SCC. Results: A total of 537 patients were included. The mean age of the study population was 62.6 ± 12.7 years. The median follow-up time was 35.6 months (interquartile range: 8.6-55.9). The histological variants identified are: (i) 66.7% keratinizing SCC, (ii) 21.6% non-keratinizing SCC, (iii) 8.0% papillary SCC, and (iv) 3.7% spindle cell carcinoma. Stage at presentation was: (i) 33.3% T1-2, N0, (ii) 31.8% T3-4a, N0, (iii) 13.8% T1-4a, N+, (iv) 17.0% T4b,N0-3, (v) 4.1% M1. Human papilloma virus (HPV) status was available for 96 patients and tested positive in 24 (25.0%) patients. By histological variants, 5-year survival was lowest for spindle cell carcinoma (40.0%), and highest for papillary SCC (70.1%). HPV negative tumors had a 5-year survival of 26.4%, while HPV positive tumors had a 5-year survival of 57.1% ( P = <.001). Of the 255 patients with T1-4a, N0-3, M0 who had surgery of the primary site, 31 (12.2%) patients underwent endoscopic approach. The risk of positive postsurgical margins was not significantly different comparing endoscopic to open approach (23.8% vs 24.1%, P >.99). Conclusions: Sinonasal SCC could present at advanced stages in two-thirds of the population and exhibit a variety of histological subtypes. Like other sites of head and neck, HPV positive tumors are associated with a favorable prognosis. Endoscopic approach is comparable to open approach in terms of post-surgical margins.

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“…20 Other studies have shown that delays in beginning adjuvant radiotherapy after surgery lead to increased mortality. 21,22…”

Section: Discussionmentioning

confidence: 99%

Sinonasal Squamous Cell Carcinoma Presentation and Outcome: A National Perspective

Al‐Qurayshi

Smith

Walsh

2020

Ann Otol Rhinol Laryngol

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“…The debate on whether endoscopic or open surgery should be selected has been slowly progressing towards consensus. There is evidence that endoscopic transnasal surgery provides a shorter hospital stay [ 83 ] and surgery-to-radiation time [ 84 ]. The belief that complications rate was higher for open surgery was instead recently tempered by a meta-analysis [ 85 ].…”

Section: Treatmentmentioning

confidence: 99%

“…Timely co-ordination between surgeons and radiation oncologists is strongly recommended when a patient affected by SNSCC has to undergo a multimodal treatment. In fact, it has been recently demonstrated that surgery-to-radiation interval should be kept within 61 days to avoid outcomes worsening [ 84 ].…”

Section: Treatmentmentioning

confidence: 99%

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Ferrari

Taboni

Carobbio

et al. 2021

Cancers

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Sinonasal squamous cell carcinoma is a rare tumor affecting the nasal cavity and paranasal sinuses. Several aspects of this disease, ranging from epidemiology to biology, pathology, diagnosis, staging, treatment, and post-treatment surveillance are controversial, and consensus on how to manage this sinonasal cancer is lacking. A narrative literature review was performed to summarize the current evidence and provide the reader with available data supporting the decision-making process in patients affected by sinonasal squamous cell carcinoma, alongside the authors’ personal opinion on the unsolved issues of this tumor. The review has highlighted several advances in molecular definition of epithelial cancers of the sinonasal tract. Surgery represents the pivot of treatment and is performed through an endoscopic transnasal approach whenever feasible. Open surgery is required for a large proportion of cases. Reconstruction of the defect follows principles of skull base and cranio-maxillo-facial reconstruction. Chemotherapy is given as neoadjuvant treatment or concomitantly to radiotherapy. Photon-based radiation therapy has a crucial role in the adjuvant setting. Particle therapy is providing promising results. Management of the neck should be planned based on the presence of clinically appreciable metastases, primary tumor extension, and need for recipient vessels. Biotherapy and immunotherapy are still underexplored therapeutical modalities.

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“…For example, some authors suggest that radiotherapy should be performed 3 months after surgery to allow healing after craniofacial resection [48]. Endoscopic surgery, therefore, reduces this time, reducing the delay to 15 days between diagnosis and radiotherapy compared to craniectomy surgery, in a series of 168 patients matched on the National Cancer DataBase (NCDB) [49]. Different studies comparing the oncological results between the transfacial and endoscopic approaches have shown similar results in terms of survival [46,[50][51][52].…”

Section: Oncological Resultsmentioning

confidence: 99%

Surgical Management of Sinonasal Cancers: A Comprehensive Review

Chatelet

Simon

Bedarida

et al. 2021

Cancers

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Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, specific criteria related to the tumor (tumor extensions, tumor pathology), the patient, or the surgeon himself. The aims of this review are (i) to provide a complete overview of the surgical techniques available for the management of sinonasal malignant tumors, with a special focus on recent developments in the field of transnasal endoscopic surgery; (ii) to summarize the criteria that lead to the choice of one technique over another. In particular, the oncological outcomes, the morbidity of the different techniques, and the specificities of each histologic subtype will be discussed based on a comprehensive literature review.

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Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach

Cited by 17 publications

References 34 publications

Sinonasal Squamous Cell Carcinoma Presentation and Outcome: A National Perspective

Sinonasal Squamous Cell Carcinoma Presentation and Outcome: A National Perspective

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

Surgical Management of Sinonasal Cancers: A Comprehensive Review

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