Treatment‐related morbidity in patients treated for sinonasal malignancy

Abstract

Background: Sinonasal malignancies are a rare, heterogeneous group of tumors that o en present at an advanced stage and require multimodal therapy. The presence of high-grade toxicity and sinonasal complications a er treatment can negatively impact quality of life. In this study we aim to describe pos reatment morbidity in patients with sinonasal malignancy. Methods:A retrospective analysis of all patients treated for sinonasal malignancy was conducted from 2005 to 2018 at a tertiary referral institution. A total of 129 patients met the inclusion criteria. Primary outcomes were treatment details, pathology, pos reatment complications, and radiation toxicity. Fisher's exact test, chi-square test, and Student t test were used for statistical analysis.Results: Mean age was 58.4 (median, 61; range, 19-94) years. A er diagnosis, 24 patients had surgery alone, 46 had surgery with radiation alone, 47 had surgery with chemoradiation, and 14 received definitive chemoradiation. Overall, 10.4% (n = 12) of patients had postoperative complications, and 21.0% (n = 22) had high-grade (grade 3-5) radiation toxicity. A er radiation, 20% (n = 21) of patients had chronic sinusitis requiring functional endoscopic sinus surgery and 20% (n = 21) had symptomatic nasal obstruction requiring operative debridement. Conclusion:Sinonasal complications, including nasal obstruction and chronic sinusitis, occur frequently a er definitive treatment of sinonasal malignancy and should be addressed when considering quality of life in survivors. These complications occur more frequently in patients who undergo chemoradiation as opposed to surgery alone. C 2020 ARS-AAOA, LLC.

Quality of life in sinonasal tumors: an up-to-date review

“…A prospective national study has been initiated with the aim of investigating cerebral toxicity after radiotherapy for SNM following Sharma et al , (2020)'s study which showed significant late neurotoxicity with macroscopic and cognitive impairment present on both hippocampi, both frontal lobes and the right temporal lobe [60 ▪▪ ]. High grade radiation toxicity was also found in Patel et al (2020)'s study with a subset of patients requiring endoscopic sinus surgery post radiation due to chronic sinusitis and another group needing operative debridement due to symptomatic nasal obstruction [61].…”

Current status of sinonasal cancer survivorship care

“…SNC patients experience acute worsening of sinonasal symptoms was measured using the SNOT‐22 questionnaire in the first few months of treatment followed by recovery after approximately 2 years; however, this does not return to baseline 44 . At least 20% of irradiated patients had post‐radiation sinusitis requiring a functional endoscopic sinus surgery (ESS) 87 . While post‐radiation ESS is safe and alleviates sinonasal symptoms, it may not reduce nasal crusting.…”

“…44 At least 20% of irradiated patients had post-radiation sinusitis requiring a functional endoscopic sinus surgery (ESS). 87 While post-radiation ESS is safe and alleviates sinonasal symptoms, it may not reduce nasal crusting. Insufficient evidence exists to confirm whether pre-radiation functional ESS is beneficial to patients, although some surgeons advocate for opening the sinuses during advanced sinonasal or skullbase surgery.…”

Radiation oncology for the rhinologist

“…1). This exposure to low to moderate levels of radiation can potentially lead to both acute and chronic adverse effects [17,18]. These chronic toxicities, such as ocular and neurologic injuries,…”