51
|
Ferrari M, Bossi P, Mattavelli D, Ardighieri L, Nicolai P. Management of sinonasal adenocarcinomas with anterior skull base extension. J Neurooncol 2020; 150:405-417. [PMID: 31897925 DOI: 10.1007/s11060-019-03385-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/27/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sinonasal adenocarcinomas (SNAC) are rare and heterogeneous. Management of SNAC follows a rather standardized and internationally accepted paradigm. Several refinements have been introduced during the last decade. METHODS A narrative review of most updated literature on SNACs has been conducted. RESULTS SNACs are classified as intestinal-type and non-intestinal-type, which are further categorized according to grade. Preoperative work-up should include magnetic resonance imaging (or contrast-enhanced computed tomography as a secondary or complementary choice) and biopsy under general anesthesia, or under local anesthesia in case of a history of exposure to wood and/or leather dust. Positron emission tomography, neck ultrasound, and fine-needle aspiration cytology are indicated in selected cases. Surgery represents the most common upfront modality of treatment and is usually accomplished via a transnasal endoscopic approach. Adjuvant radiation therapy is indicated for high-grade, locally advanced tumors and/or in case of margins involvement. Neoadjuvant chemotherapy with cisplatin, 5-fluorouracil and leucovorin may offer high response rates and long-term control in a subgroup of patients affected by intestinal-type adenocarcinoma, and in particular in those whose tumors harbor a functional p53 protein. Most of the bio- and immune-therapeutic potentials on SNACs still remain theoretical, and no clinical data are currently available. CONCLUSIONS Management of SNAC consists of histological diagnosis, radiological staging, radical surgery, and adjuvant radiation therapy. Neoadjuvant chemotherapy can be indicated in selected cases. The role of biotherapy and immune therapy still needs to be elucidated.
Collapse
Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy. .,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| |
Collapse
|
52
|
Kalinin PL, Fomichev DV, Abdilatipov AA, Chernov IV, Astafieva LI, Kutin MA, Ryzhova MV, Panina TN, Shishkina LV, Nikitin PV, Kurnosov AB. [Primary sellar neuroblastoma (clinical case and literature review)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2020; 84:83-92. [PMID: 32412197 DOI: 10.17116/neiro20208402183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neuroblastoma is a malignancy developing from the embryonic neuroblasts of sympathetic nervous system. Primary sellar neuroblastomas are extremely rare (there are currently only 11 case reports in the literature). Possible development of neuroblastoma in sellar region expands differential diagnosis of local processes due to inclusion of neuroblastoma into the spectrum of suspected tumors. We report a literature review and description of a patient with primary sellar neuroblastoma.
Collapse
Affiliation(s)
- P L Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - M A Kutin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - T N Panina
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - P V Nikitin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | |
Collapse
|
53
|
Zocchi J, Pietrobon G, Campomagnani I, Riggi E, Veronesi G, Borchini R, Pellini R, Volpi L, Bignami M, Castelnuovo P. The role of a post therapeutic surveillance program for sinonasal malignancies: Analysis of 417 patients. Head Neck 2019; 42:963-973. [PMID: 31889395 DOI: 10.1002/hed.26069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 10/08/2019] [Accepted: 12/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Post therapeutic surveillance of head and neck neoplasms is a still debated issue in the current literature: although different works tried to establish frequency, modality, and efficacy of a routine follow-up, little evidence has been produced, in particular considering only sinonasal malignancies. METHODS A retrospective review of patients treated for sinonasal malignancies in a single tertiary center and followed through a regular program of follow-up was carried out. Rate of recurrence, location, timing, diagnosis, and salvage treatment were the main data analyzed. RESULTS Of note, 417 patients were included in the study and 117 experienced at least one relapse. Staging, histological type, and previous treatment represent the main clinical factors to be considered to stratify patient's risk of recurrence. CONCLUSION A regular post therapeutic surveillance can provide an early recurrence detection for patients treated for sinonasal malignancies, offering opportunity for salvage treatment in a high percentage of patients.
Collapse
Affiliation(s)
- Jacopo Zocchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Isotta Campomagnani
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Emilia Riggi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria.,SSD Epidemiology and Screening-CPO, University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria
| | - Rossana Borchini
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Luca Volpi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
54
|
Ferrari M, Daly MJ, Douglas CM, Chan HHL, Qiu J, Deganello A, Taboni S, Thomas CM, Sahovaler A, Jethwa AR, Hasan W, Nicolai P, Gilbert RW, Irish JC. Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study. Oral Oncol 2019; 99:104463. [PMID: 31683173 DOI: 10.1016/j.oraloncology.2019.104463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
Collapse
Affiliation(s)
- Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wael Hasan
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
55
|
Ferella L, Cavallo A, Miceli R, Iacovelli NA, Giandini T, Pignoli E, Calareso G, Bossi P, Resteghini C, Gravina GL, Nicolai P, Castelnuovo P, Piazza C, Licitra L, Fallai C, Orlandi E. Prognostic role of primary tumor, nodal neck, and retropharyngeal GTVs for unresectable sinonasal cancers treated with IMRT and chemotherapy. TUMORI JOURNAL 2019; 106:39-46. [DOI: 10.1177/0300891619868006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: We evaluated the prognostic role of gross tumor volumes (GTVs) of primary tumor and positive lymph nodes on overall survival (OS) and progression-free survival (PFS) in locally advanced unresectable sinonasal cancer (SNC) treated with definitive intensity-modulated radiotherapy (IMRT) with or without chemotherapy. Methods: Primary tumor GTV (GTV-T), pathologic neck nodes GTV (GTV-N), and positive retropharyngeal nodes GTV (GTV-RPN) of 34 patients with epithelial nonglandular SNC receiving IMRT with or without chemotherapy were retrospectively measured. The GTV variables were analyzed in relation with OS and PFS. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test. We also estimated the crude cumulative incidence of locoregional relapses only. The optimal volume cutoff value was determined using an outcome-oriented method among the observed values. Results: GTV-T was significantly associated with decreased OS ( P=0.003) and PFS ( P=0.003). Moreover, patients with disease total volumes (GTV) smaller than 149.44 cm³ had better OS and PFS than patients with higher volumes ( P<0.0001 for both). Neck nodal metastasis impacted on OS and PFS ( P=0.030 and P=0.033, respectively), but GTV-N did not ( P=0.961; P=0.958). Retropharyngeal nodes metastasis was not associated with prognosis (OS: P=0.400; PFS: P=0.104). When GTV-RPN was added to GTV-N (GTV-TN), a relation with PFS ( P=0.041) and a trend toward significance for OS ( P=0.075) were found. Conclusions: Our results show that tumor volume is a powerful predictor of outcome in SNC. This could be useful to identify patients with worse prognosis deserving different treatment strategies.
Collapse
Affiliation(s)
- Letizia Ferella
- Unit of Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Cavallo
- Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Tommaso Giandini
- Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Pignoli
- Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Bossi
- Unit of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Resteghini
- Unit of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Luca Gravina
- Division of Radiotherapy, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Cesare Piazza
- Department of Otolaryngology, Head and Neck Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, University of Milan, Milan, Italy
| | - Lisa Licitra
- Unit of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Carlo Fallai
- Unit of Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ester Orlandi
- Unit of Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Unit of Radiotherapy 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
56
|
Orlandi E, Cavalieri S, Granata R, Nicolai P, Castelnuovo P, Piazza C, Schreiber A, Turri-Zanoni M, Quattrone P, Miceli R, Infante G, Sessa F, Facco C, Calareso G, Iacovelli NA, Mattavelli D, Paderno A, Resteghini C, Locati LD, Licitra L, Bossi P. Locally advanced epithelial sinonasal tumors: The impact of multimodal approach. Laryngoscope 2019; 130:857-865. [PMID: 31369156 DOI: 10.1002/lary.28202] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/04/2019] [Accepted: 07/09/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Outcomes of locally advanced epithelial sinonasal cancers remain unsatisfactory; moreover, only limited and heterogeneous data exist on prognostic factors. METHODS We reviewed all consecutive patients with American Joint Committee Cancer stage III to IV epithelial sinonasal cancers treated with platinum-based induction chemotherapy (IC) followed by locoregional treatment between 1996 and 2015. RESULTS We identified 69 patients treated with a multimodal approach (IC, surgery, radiotherapy). Overall, 44 patients recurred (64%). Of those, 19 patients received salvage surgery, but only four remained disease-free. Median overall survival (OS) was 62.5 months. Sinonasal neuroendocrine and small cell histotypes (P = 0.0085), neuroendocrine differentiation (P = 0.006), and lack of response to IC (P = 0.03) were associated with worse OS. In patients who recurred, median OS was 13 months since recurrence. Survival was longer in patients submitted to salvage surgery (44%) than in those receiving chemotherapy alone at recurrence (29.5 vs. 4.6 months). Patients with a clinical benefit after palliative chemotherapy had a longer median OS than those with disease progression (29.2 vs. 4.4 months; P < 0.0001). CONCLUSION Globally, the prognosis of locally advanced epithelial sinonasal cancers is dismal, with worse outcomes for neuroendocrine lesions. In the recurrent setting, feasibility of salvage surgery and clinical benefit from palliative chemotherapy are associated with longer OS. A multimodal treatment strategy with IC seems to offer improved OS when compared with other retrospective series not employing such a therapeutic tool. LEVEL OF EVIDENCE 4 Laryngoscope, 130:857-865, 2020.
Collapse
Affiliation(s)
- Ester Orlandi
- Radiation Oncology Department, The University of Milan, Milan
| | - Stefano Cavalieri
- the Head and Neck Medical Oncology Department, The University of Milan, Milan
| | - Roberta Granata
- the Head and Neck Medical Oncology Department, The University of Milan, Milan
| | - Piero Nicolai
- the Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia
| | - Paolo Castelnuovo
- the Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Cesare Piazza
- the Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, The University of Milan, Milan
| | - Alberto Schreiber
- the Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia
| | - Mario Turri-Zanoni
- the Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Pasquale Quattrone
- the Department of Pathology and Laboratory Medicine, The University of Milan, Milan
| | - Rosalba Miceli
- the Unit of Clinical Epidemiology and Trial Organization, The University of Milan, Milan
| | - Gabriele Infante
- the Unit of Clinical Epidemiology and Trial Organization, The University of Milan, Milan
| | - Fausto Sessa
- the Department of Pathology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Carla Facco
- the Department of Pathology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | | | | | - Davide Mattavelli
- the Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia
| | - Alberto Paderno
- the Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia
| | - Carlo Resteghini
- the Head and Neck Medical Oncology Department, The University of Milan, Milan
| | | | - Lisa Licitra
- the Head and Neck Medical Oncology Department, The University of Milan, Milan.,Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, the University of Milan, Milan
| | - Paolo Bossi
- the Head and Neck Medical Oncology Department, The University of Milan, Milan.,the University of Brescia, Brescia
| |
Collapse
|
57
|
Quan H, Yan L, Zhang H, Zou L, Yuan W, Wang S. Development and validation of a nomogram for prognosis of sinonasal squamous cell carcinoma. Int Forum Allergy Rhinol 2019; 9:1030-1040. [PMID: 31318493 DOI: 10.1002/alr.22354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/19/2019] [Accepted: 04/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sinonasal squamous cell carcinoma (SNSCC) is a rare malignancy with varied outcomes. The aim of this study was to develop a nomogram for predicting survival of patients with SNSCC. METHODS From the Surveillance, Epidemiology, and End Results database, we identified 1766 patients diagnosed with SNSCC between 2004 and 2015. Patients were randomly separated into a training set and a validation set in 4:1 ratio. An external validation was also performed by a set of 74 SNSCC patients who had been treated in our department. We used the training set to build a nomogram based on stratified multivariable Cox proportional hazard models for predicting overall survival. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index and calibration curve. RESULTS Based on 1412 cases of the training cohort, our Cox regression analysis revealed that age, marital status, primary site, differentiation, T stage, N classification, M stage, and treatment modalities were associated with overall survival. A nomogram was established based on the results of multivariate analysis. The C-index values of the nomogram for predicting survival were superior to those of the tumor-node-metastasis staging system (0.745 vs 0.679 in the training cohort, 0.752 vs 0.656 in the validation set, and 0.678 vs 0.596 in the external validation set). The calibration plots demonstrated good consistency between the predicted and observed results. CONCLUSION We have developed a nomogram to accurately predict the clinical outcomes of SNSCC patients. This model was effective and can help clinicians to improve patient counseling.
Collapse
Affiliation(s)
- Huatao Quan
- Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Li Yan
- Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Haiyan Zhang
- Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Lifen Zou
- Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Wei Yuan
- Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye and ENT Hospital, Fudan University, Shanghai, China
| |
Collapse
|
58
|
Taverna C, Maggiore G, Cannavicci A, Bonomo P, Santucci M, Franchi A. Immunohistochemical profiling of mucins in sinonasal adenocarcinomas. Pathol Res Pract 2019; 215:152439. [DOI: 10.1016/j.prp.2019.152439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 02/03/2023]
|
59
|
Tabano A, Restelli F, Pozzi F, Turri-Zanoni M, Veiceschi P, Cherubino M, Castelnuovo P, Locatelli D. The Helmet-Visor Pericranial Flap as a Viable Option for Anterior Cranial Base Reconstruction in Complex Oncologic Cases. World Neurosurg 2019; 128:506-513. [PMID: 31132485 DOI: 10.1016/j.wneu.2019.05.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe a novel bilaterally pedicled pericranial flap for anterior cranial base reconstruction after removal of complex frontobasal cancers extending to the frontal region, thus precluding the use of standard reconstructive techniques. METHODS In selected oncologic cranial base surgeries, the use of the standard galea frontalis pericranial flap for reconstructive purposes may be precluded by tumor infiltration. In such cases, dura mater reconstruction and exclusion of frontal sinuses from the intracranial space can be performed using a large superficial temporal artery bilaterally pedicled pericranial flap obtained from both temporoparietal regions. Surgical technique, indication, contraindication, complications, and degree of resection are recorded to evaluate the efficacy of this surgical method. RESULTS A 48-year-old man affected by a recurrence of frontobasal squamous cell carcinoma was surgically treated by combined transcranial and endoscopic endonasal resection. A large pericranial flap pedicled bilaterally on the parietal branches of the superficial temporal artery was obtained, transposed anteriorly, carefully watertight sutured to the dural defect, and used to exclude cranialized frontal sinuses as well. The reconstruction was successful, and the patient was discharged home on the tenth postoperative day without any complications and/or development of cerebrospinal fluid leak. Contrast-enhanced magnetic resonance imaging 3 months after surgery was clear from disease with consolidated surgical outcomes. CONCLUSIONS This novel pericranial flap seems to be easily obtained and effective for anterior cranial base reconstruction when the use of a traditional galea frontalis flap is precluded for oncologic reasons and there are concerns for the possible development of contaminations and cerebrospinal fluid leaks.
Collapse
Affiliation(s)
- Antonio Tabano
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesco Restelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Fabio Pozzi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Pierlorenzo Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
60
|
D'Aguanno V, Ralli M, Cerbelli B, Greco A, de Vincentiis M. Liver metastases from maxillary sinus sinonasal undifferentiated carcinoma: A case report. Oncol Lett 2019; 17:5811-5814. [DOI: 10.3892/ol.2019.10251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/13/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vittorio D'Aguanno
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
| | - Bruna Cerbelli
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, I-00186 Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, I-00186 Rome, Italy
| |
Collapse
|
61
|
Turri-Zanoni M, Lambertoni A, Margherini S, Giovannardi M, Ferrari M, Rampinelli V, Schreiber A, Cherubino M, Antognoni P, Locatelli D, Battaglia P, Castelnuovo P, Nicolai P. Multidisciplinary treatment algorithm for the management of sinonasal cancers with orbital invasion: A retrospective study. Head Neck 2019; 41:2777-2788. [PMID: 30932253 DOI: 10.1002/hed.25759] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/19/2019] [Accepted: 03/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sinonasal cancers frequently involve the orbit with resulting controversies on whether to remove or preserve the orbital contents. METHODS Retrospective review of patients with primary sinonasal cancer involving the orbit, treated according to a multidisciplinary protocol tailored to tumor histology and extent of orbital invasion in two tertiary care referral centers over a 20-year period. RESULTS The oncological and functional outcomes of 163 patients were analyzed. The degree of orbital involvement significantly affected both overall (P < .0001) and disease-free (P < .0001) survival. Orbital apex invasion was an independent negative prognostic factor (5-year overall survival, 14.6% ± 7.5%), with dismal prognosis regardless of the treatment adopted. An appropriate use of induction chemotherapy and endoscopic-assisted surgery allowed for orbital preservation in 76.6% of cases; 96% of patients treated using an orbit-sparing approach maintained a functional eye after treatment. CONCLUSION The multimodal treatment algorithm herein proposed was able to maximize orbital preservation rates with acceptable oncological and functional outcomes.
Collapse
Affiliation(s)
- Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Stefano Margherini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, Monzino Hospital, Milan, Italy
| | - Marco Ferrari
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Mario Cherubino
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| |
Collapse
|
62
|
Tirelli G, Capriotti V, Sartori G, Tofanelli M, Marcuzzo AV. Primary Adenoid Cystic Carcinoma of the Frontal Sinus: Case Description of a Previously Unreported Entity and Literature Review. EAR, NOSE & THROAT JOURNAL 2019; 98:E8-E12. [PMID: 30922111 DOI: 10.1177/0145561319837881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sinonasal adenoid cystic carcinoma is a rare malignant epithelial tumor characterized by slow growth, multiple local recurrences, and perineural invasion; surgery followed by radiotherapy provides the best overall survival by means of an endoscopic, craniofacial, or combined approach. We present a previously undescribed case of frontal sinus adenoid cystic carcinoma involving the subcutaneous tissue and the dura mater treated with an open technique, free flap reconstruction, and hadron therapy together with a summary of the state of the art.
Collapse
Affiliation(s)
- Giancarlo Tirelli
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Vincenzo Capriotti
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giovanni Sartori
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Margherita Tofanelli
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| |
Collapse
|
63
|
Mattavelli D, Ferrari M, Bolzoni Villaret A, Schreiber A, Rampinelli V, Turri-Zanoni M, Lancini D, Taglietti V, Accorona R, Doglietto F, Battaglia P, Castelnuovo P, Nicolai P. Transnasal endoscopic surgery in selected nasal-ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes. Head Neck 2019; 41:1854-1862. [PMID: 30636181 DOI: 10.1002/hed.25621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/02/2018] [Accepted: 12/12/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In nasal-ethmoidal malignancies, brain involvement is associated with dismal prognosis. METHOD Patients undergoing endoscopic resection with transnasal craniectomy and subpial dissection (ERTC-SD) for brain-invading nasal-ethmoidal cancer between 2008 and 2016 were included. Complications were analyzed in all patients, whereas oncological outcomes only in patients with pathological brain invasion. The prognostic impact of previous treatments, brain edema, and histology was assessed. Hospitalization ratio was calculated. RESULTS Nineteen patients received ERTC-SD and 11 had pathological-proven brain invasion. Histologies were 6 olfactory neuroblastomas (ONB), 3 neuroendocrine carcinomas, and 2 intestinal-type adenocarcinomas. Mean follow-up was 21.9 months. Three-year overall, local recurrence-free, and distance recurrence-free survivals were 65.5%, 81.8%, and 68.2%, respectively. Overall and distant recurrence-free survivals were significantly better in patients with ONB (P = 0.032 and P = 0.013, respectively). Hospitalization ratio was 4.1%. Complication rate was 10.5%. CONCLUSION In selected nasal-ethmoidal tumors with brain invasion, ERTC-SD can provide good local control, satisfactory survival, and limited morbidity.
Collapse
Affiliation(s)
- Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Bolzoni Villaret
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Valentina Taglietti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology, Humanitas Clinical and Research Center, Milan, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Battaglia
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
64
|
Caballero-García J, Gonzáles-Fernández N, Morales-Hechevarría PP, Aparicio-García C, Sánchez ML, Huanca-Amaru J. A Novel Classification of Brain Invasion in Malignant Ethmoidal Tumors and Management Proposal. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ijohns.2019.85017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
65
|
Abu-Ghanem S, Yafit D, Ghanayem M, Abergel A, Yehuda M, Fliss DM. Utility of first positron emission tomography-computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies. Head Neck 2018; 41:701-706. [PMID: 30521131 DOI: 10.1002/hed.25416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 06/30/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prognostic value of the first posttreatment whole body integrated positron emission tomography-computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined. METHODS We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000-2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved. RESULTS Thirty-eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5-year survival was significantly lower in the first posttreatment PET/CT-positive group (35%) compared to the PET/CT-negative group (93%) (P = .0008). CONCLUSION Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival.
Collapse
Affiliation(s)
- Sara Abu-Ghanem
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Yafit
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mohamad Ghanayem
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Yehuda
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
66
|
Sahnane N, Ottini G, Turri-Zanoni M, Furlan D, Battaglia P, Karligkiotis A, Albeni C, Cerutti R, Mura E, Chiaravalli AM, Castelnuovo P, Sessa F, Facco C. Comprehensive analysis of HPV infection, EGFR exon 20 mutations and LINE1 hypomethylation as risk factors for malignant transformation of sinonasal-inverted papilloma to squamous cell carcinoma. Int J Cancer 2018; 144:1313-1320. [PMID: 30411788 DOI: 10.1002/ijc.31971] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022]
Abstract
Different risk factors are suspected to be involved in malignant transformation of sinonasal papillomas and include HPV infection, tobacco smoking, occupational exposure, EGFR/KRAS mutations and DNA methylation alterations. In our study, 25 inverted sinonasal papillomas (ISPs), 5 oncocytic sinonasal papillomas (OSP) and 35 squamous cell carcinomas (SCCs) from 54 patients were genotyped for 10 genes involved in EGFR signalling. HPV-DNA detection was performed by in-situ hybridisation and LINE-1 methylation was quantitatively determined by bisulphite-pyrosequencing. High-risk HPV was observed only in 13% of ISP-associated SCC and in 8% of de novo-SCC patients. EGFR mutations occurred in 72% of ISPs, 30% of ISP-associated SCCs and 17% of de novo-SCCs. At 5-year follow-up, SCC arose in only 30% (6/20) of patients with EGFR-mutated ISPs compared to 76% (13/17) of patients with EGFR-wild-type ISP (p = 0.0044). LINE-1 hypomethylation significantly increased from papilloma/early stage SCC to advanced stage SCC (p = 0.03) and was associated with occupational exposure (p = 0.01) and worse prognosis (p = 0.09). In conclusion, our results suggest that a small subset of these tumours could be related to HPV infection; EGFR mutations characterise those ISPs with a lower risk of developing into SCC; LINE-1 hypomethylation is associated with occupational exposure and could identify more aggressive nasal SCC.
Collapse
Affiliation(s)
- Nora Sahnane
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Giorgia Ottini
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Daniela Furlan
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Chiara Albeni
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Roberta Cerutti
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Eleonora Mura
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Anna Maria Chiaravalli
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Fausto Sessa
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| | - Carla Facco
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria and ASST Sette-Laghi, Varese, Italy
| |
Collapse
|
67
|
Volpi L, Bignami M, Lepera D, Karligkiotis A, Pistochini A, Ottini G, Grigioni E, Lombardi D, Nicolai P, Castelnuovo P. Endoscopic endonasal resection of adenoid cystic carcinoma of the sinonasal tract and skull base. Laryngoscope 2018; 129:1071-1077. [DOI: 10.1002/lary.27485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Luca Volpi
- Department of Biotechnology and Life Sciences Varese Italy
- Head and Neck Surgery and Forensic Dissection Research Center Varese Italy
| | - Maurizio Bignami
- Department of Biotechnology and Life Sciences Varese Italy
- Head and Neck Surgery and Forensic Dissection Research Center Varese Italy
| | - Davide Lepera
- Department of Biotechnology and Life Sciences Varese Italy
- Head and Neck Surgery and Forensic Dissection Research Center Varese Italy
| | - Apostolos Karligkiotis
- Department of Biotechnology and Life Sciences Varese Italy
- Head and Neck Surgery and Forensic Dissection Research Center Varese Italy
| | - Andrea Pistochini
- Department of Biotechnology and Life Sciences Varese Italy
- Head and Neck Surgery and Forensic Dissection Research Center Varese Italy
| | - Giorgia Ottini
- Department of Biotechnology and Life Sciences, Department of Surgical and Morphological Sciences Varese Italy
| | - Elena Grigioni
- Unit of Pathology, and Department of OncologyUniversity of Insubria‐Varese, ASST Sette Laghi, Ospedale Circolo Macchi Varese Italy
| | - Davide Lombardi
- Department of OtorhinolaryngologyUniversity of Brescia Brescia Italy
| | - Piero Nicolai
- Department of OtorhinolaryngologyUniversity of Brescia Brescia Italy
| | | |
Collapse
|
68
|
Fu T, Chin CJ, Xu W, Che J, Huang SH, Monteiro E, Alghonaim Y, Ringash J, Witterick IJ. Impact of neoadjuvant radiation on margins for non-squamous cell carcinoma sinonasal malignancies. Laryngoscope 2018; 128:2796-2803. [DOI: 10.1002/lary.27316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/22/2018] [Accepted: 05/07/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Terence Fu
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
| | - Christopher J. Chin
- Division of Otolaryngology- Head and Neck Surgery, Department of Surgery; Dalhousie Medicine New Brunswick; St. John New Brunswick
| | - Wei Xu
- Dalla Lana School of Public Health; University of Toronto; Ontario
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario
| | - Jiahua Che
- Dalla Lana School of Public Health; University of Toronto; Ontario
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario
| | - Shao Hui Huang
- Department of Radiation Oncology; Princess Margaret Cancer Centre-University Health Network, University of Toronto; Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
| | - Yazeed Alghonaim
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
| | - Jolie Ringash
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
- Department of Radiation Oncology; Princess Margaret Cancer Centre-University Health Network, University of Toronto; Toronto Ontario Canada
| | - Ian J. Witterick
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario
- Department of Radiation Oncology; Princess Margaret Cancer Centre-University Health Network, University of Toronto; Toronto Ontario Canada
| |
Collapse
|
69
|
Abstract
PURPOSE OF REVIEW Intestinal-type adenocarcinoma (ITAC) is one of the most frequent sinonasal tumors, especially in European countries. The purpose of this article is to review the most recent literature, with special emphasis on biological and genetic profile and treatment guidelines. RECENT FINDINGS Results on large series support transnasal endoscopic surgery as the technique of choice in the large majority of patients with ITAC. Adjuvant radiotherapy is recommended in advanced-stage and high-grade lesions. More robust data are required to confirm that early-stage, low-grade lesions can be treated with exclusive surgery. The efficacy of new chemotherapy and biotherapy regimens and the added value of heavy particle radiotherapy are currently under evaluation. With a 5-year overall survival ranging between 53 and 83%, which is mainly impacted by local recurrences, ITAC requires a more detailed understanding of its biology. Genetic and biological studies have identified alterations in the molecular pathways of EGFR, MET, and H-RAS which might be considered as potential targets for biotherapy. SUMMARY Surgery still plays a key role in the treatment of ITAC, but multidisciplinary management is mandatory. Although further validation is needed, the role of nonsurgical treatment strategies is rising, in agreement with the progresses made in the biological profiling of the disease.
Collapse
|
70
|
Turri-Zanoni M, Maragliano R, Battaglia P, Giovannardi M, Antognoni P, Lombardi D, Morassi ML, Pasquini E, Tarchini P, Asioli S, Foschini MP, Sessa F, Nicolai P, Castelnuovo P, La Rosa S. The clinicopathological spectrum of olfactory neuroblastoma and sinonasal neuroendocrine neoplasms: Refinements in diagnostic criteria and impact of multimodal treatments on survival. Oral Oncol 2018; 74:21-29. [PMID: 29103747 DOI: 10.1016/j.oraloncology.2017.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To provide a comprehensive review of the clinical and histopathological features of olfactory neuroblastoma (ONB) and other sinonasal neuroendocrine neoplasms (NENs), in order to refine diagnostic criteria, analyze treatment outcomes, and identify prognostic factors. METHODS Data from an Italian multi-institutional database were analyzed. Patients were treated surgically via a minimally-invasive endoscopic approach followed by adjuvant radiotherapy or radiochemotherapy. Neoadjuvant cisplatin/etoposide chemotherapy was administered in cases of poorly-differentiated tumors. A centralized pathology review was performed in all cases. Patients were prospectively observed for survival. Overall (OS) and Disease-free survival (DFS) estimates were determined from Kaplan-Meier analysis and compared using the log-rank test. Statistically significant variables were entered in a multivariate Cox regression model. RESULTS 98 patients with a median follow-up of 53months were included. Morphology review and the incorporation of cytokeratin 8/18 in the immunohistochemical panel modified the final diagnosis in 8/98 (8.2%) cases. The neoplasms were ultimately classified into four groups with different immunohistochemical profiles and clinical behaviors: ONB in 67 cases (5-year-OS, 91.6%); NEC (poorly-differentiated neuroendocrine carcinoma) in 22 cases (5-year-OS, 42.6%); MiNEN (mixed neuroendocrine/non-neuroendocrine neoplasm) in five cases (5-year-OS, 0%,0/5 cases); and NET (well-differentiated neuroendocrine tumor) in four cases (5-year-OS, 50%, 2/4 cases). Hyams grade and Ki67 index were independent prognostic factors for ONB. Neoadjuvant chemotherapy appeared to be associated with improved OS and DFS for NEC, independent of other clinicopathological variables. CONCLUSIONS Induction chemotherapy improves survival outcomes in patients affected by poorly-differentiated tumors. Recent advances in histopathological diagnosis, including CK8/18 staining, allow to plan the most appropriate range of multimodal treatments.
Collapse
Affiliation(s)
- Mario Turri-Zanoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Roberta Maragliano
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, Monzino Hospital, Milan, Italy
| | - Paolo Antognoni
- Unit of Radiation Oncology, University of Insubria, Varese, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Italy
| | | | - Ernesto Pasquini
- Ear, Nose and Throat Metropolitan Unit, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | - Paolo Tarchini
- Ear, Nose and Throat Metropolitan Unit, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | - Sofia Asioli
- Unit of Pathology, Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maria Pia Foschini
- Unit of Pathology, Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Fausto Sessa
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
71
|
van Koevering K, Prevedello DM, Carrau RL. Endoscopic endonasal approaches for the management of cranial base malignancies: histologically guided treatment and clinical outcomes. J Neurosurg Sci 2018; 62:667-681. [PMID: 29808637 DOI: 10.23736/s0390-5616.18.04507-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malignancies of the skull base represent a highly diverse and challenging set of pathologies which exhibit a wide array of oncologic behavior. In recent decades, a number of important advances in treatment technique have evolved to improve oncologic outcomes and reduce morbidity in the treatment of these aggressive cancers. Intensity modulated radiation therapy has become the gold standard in radiotherapy owing to its precision planning and reduced morbidity. However heavy ion particle radiation (proton therapy, carbon ion, etc.) are recently emerging with promising results at the skull base related to the reduced exit dose to adjacent structures. Novel systemic therapeutics such as targeted and immunotherapies may dramatically alter the treatment paradigm for many of these pathologies. Nevertheless, most skull base malignancies remain surgical diseases. The evolution of the expanded endonasal approach for a minimally invasive surgical resection has proven validity in treating many of these pathologies when properly selected, and have largely supplanted open approaches owing to the reduced morbidity profile. In spite of these important advances, the most critical aspect in comprehensive treatment is a detailed understanding of the oncologic behavior and outcomes data for each of the specific histopathologies encountered at the skull base. The nuances in management strategy, histologic profile, and surveillance planning can be stratified through the development of a comprehensive, multidisciplinary skull base team to maximize therapeutic effect and minimize morbidity for each patient. This review aims to summarize the key body of data and approaches for each of the histologies frequently encountered in the skull base, while highlighting the value and technique of endonasal approaches.
Collapse
Affiliation(s)
- Kyle van Koevering
- Department of Otolaryngology, Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA -
| |
Collapse
|
72
|
Endoscopic Endonasal Reconstruction of Anterior Skull Base Defects: What Factors Really Affect the Outcomes? World Neurosurg 2018; 116:e436-e443. [PMID: 29753077 DOI: 10.1016/j.wneu.2018.04.225] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Endoscopic endonasal surgery has evolved in recent decades, requiring comparable advances in reconstructive techniques. This study aimed to retrospectively review outcomes of endoscopic anterior skull base reconstruction and to analyze factors associated with failures. METHODS Data from patients who underwent endoscopic endonasal anterior skull base reconstruction in a single institution between 1998 and 2017 were collected. Patients were stratified according to selected risk factors: sex; age; previous surgery; disease treated (cerebrospinal fluid leaks, benign tumors, malignant tumors); single or multiple defects; defect dimension (<1 cm2, 1-2 cm2, 2-6 cm2, >6 cm2) and site (olfactory cleft, ethmoidal roof, planum sphenoidalis, posterior wall of frontal sinus); reconstruction technique (overlay graft, multilayer grafts, pedicled flap) and materials used; postoperative radiotherapy; and year of surgery. Statistical significance was assessed using Fisher exact test. Univariate logistic regression was implemented to analyze the association between risk factors and failures. RESULTS Inclusion criteria were met by 513 cases with median follow-up of 96 months (range, 12-257 months). Success rate for initial repair was 95% (487/513), with 100% success rate for secondary closure after revision surgery. Failures were not significantly related to sex (P = 0.54), reconstruction technique (P = 0.28), location of defect (P = 0.65), dimension (P = 0.69), disease (P = 0.83), or postoperative radiotherapy (P = 0.83). Year of surgery, considered as a continuous variable, was associated with a statistically significant reduction of failures (odds ratio = 0.89, P = 0.005). CONCLUSIONS Endoscopic surgery is safe and effective for anterior skull base reconstruction. Refinements in surgical technique and increasing experience have contributed to improved success rates.
Collapse
|
73
|
Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 26:122-126. [DOI: 10.1097/moo.0000000000000441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
74
|
Kılıç S, Samarrai R, Kılıç SS, Mikhael M, Baredes S, Eloy JA. Incidence and survival of sinonasal adenocarcinoma by site and histologic subtype . Acta Otolaryngol 2018; 138:415-421. [PMID: 29205085 DOI: 10.1080/00016489.2017.1401229] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence and survival of sinonasal adenocarcinoma (SNAC) by subsite and histologic subtype. STUDY DESIGN Retrospective database review. METHODS Using the SEER database, we performed a retrospective analysis, identified cases of SNAC diagnosed between 1973 and 2013 and analyzed demographic, histopathology, clinicopathology, and determinants of disease specific survival (DSS). RESULTS A total of 746 patients with SNAC were identified. Median age at diagnosis was 64 years. Overall incidence was 0.44 per million, and was higher among blacks (O.R.:1.10-2.07:1) and males (O.R.:1.38-2.06:1). Nasal cavity (41.5%) was the most common site, followed by maxillary (26.5%), and ethmoid (17.4%) sinuses. Intestinal-type adenocarcinoma was less likely than Adenocarcinoma not otherwise specified (ANOS) to be found in the maxillary sinus (8.8% vs. 30.6%, p < .05). Surgery alone (48.56%) was the most common treatment modality, followed by surgery and radiotherapy (RT) (32.5%), and RT alone (11.6%). DSS at 5, 10, and 20 years were 63.8%, 57.6%, and 47.0%, respectively. DSS was higher for nasal cavity SNAC, lower grade, lower stage, and those receiving surgery only. CONCLUSIONS SNAC is more common among men and blacks. Incidence has not changed significantly in the past 40 years. Survival varies with grade, stage, histology, subsite, and treatment.
Collapse
Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ruwaa Samarrai
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sarah S. Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mina Mikhael
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
75
|
Schreiber A, Rampinelli V, Ferrari M, Mattavelli D, Farina D, Battocchio S, Nicolai P. Diagnostic reliability of pretreatment biopsy in malignant nasoethmoidal tumors: A retrospective study of 77 cases. Laryngoscope 2018; 128:1772-1777. [PMID: 29314070 DOI: 10.1002/lary.27077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 11/15/2017] [Accepted: 12/04/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Pretreatment biopsy is crucial in histology-based management of malignant nasoethmoidal tumors, because misdiagnosis can lead to inadequate therapeutic planning. Factors influencing the reliability of biopsy were retrospectively investigated in a tertiary referral center. STUDY DESIGN Retrospective case series. METHODS All patients who underwent biopsy, staging magnetic resonance, surgery, and histologic diagnosis for nasoethmoidal tumors in our hospital were retrospectively evaluated. Histologic discrepancy, histology, procedure for biopsy (biopsy under local anesthesia [OB], biopsy under local anesthesia and sedation [SB], or under general anesthesia [GB]), site of the lesion, and the biopsy volume were analyzed. Biopsy reliability rate (BRR) (preoperative biopsy confirmed after surgical treatment) and concordance rate (CR) (postoperative diagnosis identified in preoperative biopsy) were calculated. Univariate and multivariate statistical analyses were used to identify factors influencing histologic discrepancies. RESULTS Seventy-seven patients were included. Five (6.5%) minor and eight (10.4%) major histologic discrepancies were observed (16.9%). OB and SB showed significantly lower biopsy volumes than GB (P < .0001 and P = .002, respectively). The biopsy volume was significantly lower in cases with histologic discrepancies (P = .045). Squamous cell carcinoma was independently associated with lower BRR. Germ cell tumor, salivary gland carcinoma, and sarcoma showed the lowest CR. Adenocarcinoma, mucosal melanoma, and olfactory neuroblastoma showed the highest BRR and CR. CONCLUSIONS The risk of misdiagnosis for nasoethmoidal tumors may be high even in referral centers. Especially when clinical and radiologic findings suggest a diagnosis different from adenocarcinoma, mucosal melanoma, and olfactory neuroblastoma, obtaining abundant material under general anesthesia may reduce the risk of diagnostic error and inadequate treatment. LEVEL OF EVIDENCE 4. Laryngoscope, 1772-1777, 2018.
Collapse
Affiliation(s)
| | | | - Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Brescia, Italy
| | | | | | | | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Brescia, Italy
| |
Collapse
|
76
|
Morand GB, Anderegg N, Vital D, Ikenberg K, Huber GF, Soyka MB, Egger M, Holzmann D. Outcome by treatment modality in sinonasal undifferentiated carcinoma (SNUC): A case-series, systematic review and meta-analysis. Oral Oncol 2017; 75:28-34. [PMID: 29224819 DOI: 10.1016/j.oraloncology.2017.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Sinonasal undifferentiated carcinoma (SNUC) is an aggressive malignancy first described by Frierson et al. in 1986. As the tumor is very rare, current treatment recommendations are based on institutional case reports. We thus felt the need to perform a comprehensive systematic review and meta-analysis to investigate how treatment modalities are associated with survival. DESIGN Case-series, systematic review and meta-analysis METHODS: We searched the OvidMedline, OvidEmbase, Web of Science, Biosis, Scopus and the Cochrane Library database libraries. We extracted aggregate and individual patient data for statistical analysis. To study the association between treatment modalities and survival, we used random-effects meta-regression for the aggregate- and cox mixed-effects models. RESULTS 379 citations were found; 29 case series could be included in the final analysis, including a total number of 390 single patients (34.6% female). Median age at diagnosis was 52 years. 80.9% of patients presented with a T4 tumor and 16.0% with nodal metastasis at diagnosis. In individual patient data (IPD) meta-analysis, single modality (surgery alone or radiation alone) treatment was associated with reduced survival compared to double modality (surgery & radiation or chemoradiation) treatment (adjusted Hazard Ratio [aHR] 2.97, 95% ConfidenceInterval [1.41-6.27]) and compared to triple modality (surgery & radiation & chemotherapy) treatment (aHR 2.80 95%-CI 1.29-6.05 for triple vs. single modality). Triple modality treatment was not superior to double modality treatment. (aHR 1.06, 95%-CI 0.59-1.92). CONCLUSION Double and triple modality treatment are associated with improved survival over single modality but there is no evidence that triple modality is superior to double modality treatment.
Collapse
Affiliation(s)
- Grégoire B Morand
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Domenic Vital
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Kristian Ikenberg
- Department of Surgical Pathology, University Hospital Zurich, Switzerland
| | - Gerhard F Huber
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Michael B Soyka
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - David Holzmann
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland.
| |
Collapse
|
77
|
López F, Lund VJ, Suárez C, Snyderman CH, Saba NF, Robbins KT, Vander Poorten V, Strojan P, Mendenhall WM, Rinaldo A, Ferlito A. The Impact of Histologic Phenotype in the Treatment of Sinonasal Cancer. Adv Ther 2017; 34:2181-2198. [PMID: 28871554 DOI: 10.1007/s12325-017-0605-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 01/04/2023]
Abstract
The management of sinonasal cancer is a challenge due to its low occurrence and anatomical and significant diversity of histological types. The therapeutic modality used should be tailored individually according to the histology, tumour stage, molecular profile and previous treatments. The clinical management of sinonasal cancer has improved greatly owing to developments in endoscopic surgery and precision radiotherapy. Complete surgical resection is the mainstay of sinonasal malignancies' management but multimodality therapy is associated with improved outcomes in certain histologies. The recognition of various histological types with biological behaviours more suitable for non-surgical modalities has allowed treatment protocols to become more tailored to the disease. In this review we aim to describe and to summarise the current data guiding the management of sinonasal cancer with emphasis on phenotypic variation.
Collapse
Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.
| | - Valerie J Lund
- Professorial Unit, Ear Institute, University College London, London, UK
| | - Carlos Suárez
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, ILL, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
78
|
Fu TS, Monteiro E, Witterick I, Vescan A, Zadeh G, Gentili F, de Almeida JR. Costs and Perioperative Outcomes Associated with Open versus Endoscopic Resection of Sinonasal Malignancies with Skull Base Involvement. J Neurol Surg B Skull Base 2017; 78:430-440. [PMID: 28875123 DOI: 10.1055/s-0037-1603907] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/12/2017] [Indexed: 10/19/2022] Open
Abstract
Objective To compare financial and perioperative outcomes between endoscopic and open surgical approaches in the surgical management of sinonasal malignancies. Design Retrospective chart review. Setting Tertiary care hospital. Participants Patients undergoing surgical resection of a sinonasal malignancy from January 2000 to December 2014. Main Outcome Measures In-hospital costs, complications, and length of stay (LOS). Results Of 106 patients, 91 received open surgery (19 free flap and 72 non-free flap) and 15 were treated with purely endoscopic approaches. Free flaps had a significantly higher average cost, operative time, and LOS compared to both non-free flap ( p < 0.001, < 0.001, and < 0.01) and endoscopic ( p = 0.01, 0.04, and < 0.01) groups. There were no significant differences in average costs between endoscopic and non-free flap groups ($19,157 vs. $14,806, p = 0.20) or LOS (5.7 vs. 6.4 days, p = 0.72). Compared with the non-free flap group, the endoscopic group had a longer average operative time (8.3 vs. 5.5 hours, p < 0.01) and higher rates of cerebrospinal fluid (CSF) leak (13 vs. 0%, p = 0.01) and intensive care unit (ICU) admission (80 vs. 36%, p < 0.01). Surgical approach (open vs. endoscopic) was not a significant predictor of any financial or perioperative outcome on multivariable analysis. Conclusion Hospital costs are comparable between endoscopic and open approaches when no free tissue reconstruction is required. Longer operative times, higher CSF leak rates, and our institutional protocol necessitating ICU admission for endoscopic cases may account for the failure to demonstrate cost savings with endoscopic surgery.
Collapse
Affiliation(s)
- Terence S Fu
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Gelareh Zadeh
- Department of Neurosurgery, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Department of Neurosurgery, University of Toronto, Toronto, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
79
|
Abstract
The extra-skeletal form is an unusual type of Ewing sarcoma (ES) arising from soft tissue and in the literature there are reports of less than 50 patients describing the tumor in the paranasal sinuses and skull base. The histological diagnosis is crucial to plan the correct treatment and the molecular confirmation is mandatory in equivocal patients. A multimodality treatment with chemotherapy, surgery and radiotherapy improved the outcomes of these diseases during the last decades and a free-margin resection with the endoscopic transnasal technique is one of the most recent ways to manage these pathologies in selected patients, reducing the morbidities of the external approaches and preserving the quality of life of the patient.Here, the authors present the first patient of primary sinonasal ES free from disease after 5 years of follow-up and treated with an endoscopic endonasal approach and a second patient of sinonasal metastases of ES treated with and endoscopic transnasal approach.
Collapse
|
80
|
Green B, Elhamshary A, Gomez R, Rahimi S, Brennan PA. An update on the current management of head and neck mucosal melanoma. J Oral Pathol Med 2017; 46:475-479. [DOI: 10.1111/jop.12526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Ben Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - Ahmed Elhamshary
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| | - Ricardo Gomez
- Department of Oral Surgery & Pathology; School of Dentistry; Universidade Federal de Minas Gerais-UFMG; Belo-Horizonte Brazil
| | - Siavash Rahimi
- Department of Histopathology; Queen Alexandra Hospital; Portsmouth UK
| | - Peter A. Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| |
Collapse
|
81
|
Turri-Zanoni M, Salzano G, Lambertoni A, Giovannardi M, Karligkiotis A, Battaglia P, Castelnuovo P. Prognostic value of pretreatment peripheral blood markers in paranasal sinus cancer: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio. Head Neck 2016; 39:730-736. [DOI: 10.1002/hed.24681] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/10/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mario Turri-Zanoni
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria; Varese Italy
| | - Giovanni Salzano
- Division of Maxillofacial Surgery; Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”; Naples Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, Monzino Hospital IRCCS; Milan Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria; Varese Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria; Varese Italy
| |
Collapse
|
82
|
Management of Malignant Tumors of the Anterior Skull Base and Paranasal Sinuses. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
83
|
Malignant Primary Neoplasms of the Nasal Cavity and Paranasal Sinus. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0134-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
84
|
Salzano G, Turri-Zanoni M, Karligkiotis A, Zocchi J, Dell'Aversana Orabona G, Califano L, Battaglia P, Castelnuovo P. Infraorbital nerve transposition to expand the endoscopic transnasal maxillectomy. Int Forum Allergy Rhinol 2016; 7:149-153. [PMID: 27682471 DOI: 10.1002/alr.21858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 07/28/2016] [Accepted: 08/30/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The infraorbital nerve (ION) is a terminal branch of the maxillary nerve (V2) providing sensory innervation to the malar skin. It is sometimes necessary to sacrifice the ION and its branches to obtain adequate maxillary sinus exposure for radical resection of sinonasal tumors. Consequently, patients suffer temporary or permanent paresthesia, hypoestesthia, and neuralgia of the face. We describe an innovative technique used for preservation of the ION while removing the anterior, superior, and lateral walls of the maxillary sinus through a medial endoscopic transnasal maxillectomy. METHODS All patients who underwent transnasal endoscopic maxillectomy with ION transposition in our institute were retrospectively reviewed. RESULTS Two patients were identified who had been treated for sinonasal cancers using this approach. No major complications were observed. Transient loss of ION function was observed with complete recovery of skin sensory perception within 6 months of surgery. One patient referred to a mild permanent anesthesia of the upper incisors. No diplopia or enophthalmos were encountered in any of the patients. CONCLUSION The ION transposition is useful for selected cases of benign and malignant sinonasal tumors that do not infiltrate the ION itself but involve the surrounding portion of the maxillary sinus. Anatomic preservation of the ION seems to be beneficial to the postoperative quality of life of such patients.
Collapse
Affiliation(s)
- Giovanni Salzano
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Jacopo Zocchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giovanni Dell'Aversana Orabona
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Califano
- Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
85
|
Hachem RA, Beer-Furlan A, Elkhatib A, Rangarajan S, Prevedello D, Blakaj D, Bhatt A, Carrau R. Modern Treatment Outcomes in Sinonasal Malignancies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|