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Wang L, Wang J, Wang T, Li Y, Song X. The Role of Elective Nodal Irradiation in Treating Clinically Node-Negative Sinonasal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00695-3. [PMID: 38862085 DOI: 10.1016/j.ijrobp.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE This study aims to examine the role of elective nodal irradiation (ENI) in clinically node-negative (cN0) sinonasal squamous cell carcinoma (SNSCC) and to define the optimal radiation fields for ENI. METHODS AND MATERIALS We retrospectively reviewed 368 patients with cN0 SNSCC treated between 2009 and 2021. The study evaluated the impact of ENI on overall survival, progression-free survival, regional failure-free survival, and distant metastasis-free survival, along with the coverage areas of ENI. RESULTS The majority of patients underwent surgery (316/368, 85.9%), with 276 of 368 (75%) having tumors in the maxillary sinus or nasal cavity and 249 of 368 (67.7%) presenting with T4 disease. Additionally, in 119 of the 368 cases (32.3%), tumors were poorly differentiated. The 5-year overall survival, progression-free survival, regional failure-free survival, and distant metastasis-free survival rates were 59.3%, 54.0%, 57.6%, and 58.8%, respectively. ENI was performed in 217 patients (59%), with 16 experiencing neck relapse during follow-up. Although ENI did not enhance survival rates, it significantly reduced the overall regional failure rate (7.9% vs 1.8%; χ2 = 7.98; P < .01) and the cumulative incidence of regional failure (P = .045). Additionally, the subgroups with maxillary sinus origin (2.3% vs 13.5%; P = .025), T4 stage (1.8% vs 8.5%; P = .028), and poor differentiation (2.4% vs 13.5%; P = .029) had higher cumulative incidences of regional failure in patients without ENI. No significant difference was observed in survival and regional failure rates between patients treated with ENI to levels Ib and II with or without level III, as well as between cN0 patients with nonmidline crossing lesions receiving unilateral or bilateral ENI. CONCLUSIONS Despite no survival benefit, ENI significantly decreases the regional failure rate in patients with cN0 SNSCC. For primary lesions not crossing the midline, ipsilateral ENI targeting levels Ib and II proves to be an effective strategy.
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Affiliation(s)
- Li Wang
- Department of Radiation Oncology, Eye & Ear Nose Throat Hospital, Fudan University, Shanghai, China
| | - Jie Wang
- Department of Radiation Oncology, Eye & Ear Nose Throat Hospital, Fudan University, Shanghai, China
| | - Tian Wang
- Department of Radiation Oncology, Eye & Ear Nose Throat Hospital, Fudan University, Shanghai, China
| | - Yi Li
- Department of Oncology, 920th Hospital of Joint Logistics Support Force, Kunming, China.
| | - Xinmao Song
- Department of Radiation Oncology, Eye & Ear Nose Throat Hospital, Fudan University, Shanghai, China.
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Tsuji T, Asato R, Kada S, Kitamura M, Tamaki H, Mizuta M, Tanaka S, Watanabe Y, Hori R, Kojima T, Shinohara S, Takebayashi S, Maetani T, Harada H, Kitani Y, Kumabe Y, Tsujimura T, Honda K, Ichimaru K, Ushiro K, Omori K. A multi-institutional retrospective study of 340 cases of sinonasal malignant tumor. Auris Nasus Larynx 2024; 51:86-98. [PMID: 37248104 DOI: 10.1016/j.anl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Sinonasal malignant tumors (SNMT) are relatively rare among head and neck malignant tumors. Most are squamous cell carcinomas, and malignant melanomas, olfactory neuroblastomas, adenoid cystic carcinomas, sarcomas, and others also occur. The most common primary site of nasal sinus squamous cell carcinoma is the maxillary sinus. In recent years, a decrease in incidence of maxillary sinus squamous cell carcinoma (MSSCC) has been reported along with a decrease in the incidence of sinusitis. MSSCC is treated with a combination of surgery, radiation, and chemotherapy. Treatment decisions are made according to the progression of the disease, the patient's general condition, and the patient's own wishes. There are variations in treatment policies among facilities due to the specialty of staff and cooperation with other departments at each facility. We conducted a multi-institutional retrospective study to compare outcomes by treatment strategy. METHODS In this study, 340 patients with SNMT who were treated at 13 Hospitals (Head and Neck Oncology Group (Kyoto-HNOG) ) during the 12-year period from January 2006 to December 2017 were included. There were 220 patients with squamous cell carcinoma, 32 with malignant melanoma, 21 with olfactory neuroblastoma, and 67 with other malignancies. Of the squamous cell carcinomas, 164 were of maxillary sinus origin. One hundred and forty cases of MSSCC that were treated radically were included in the detailed statistical analysis. RESULTS There were 5 cases of cStage I, 9 cases of cStage II, 36 cases of cStage III, 74 cases of cStage IVa, and 16 cases of cStage IVb. There were 92 cases without clinical lymph node metastasis (cN(-)) and 48 cases with clinical lymph node metastasis(cN(+)). Primary tumors were treated mainly by surgery in 85 cases (Surg) and by radical radiation therapy (with or without chemotherapy) of 6-70 Gy in 55 cases(non-Surg). The 5-year overall/disease-free survival rate (OS/DFS) for MSSCC was 65.1%/51.6%. Old age, renal dysfunction, and clinical T progression were independent risk factors for OS, and renal dysfunction was an independent risk factor for DFS. In cN(-) patients, OS and DFS were significantly better in Surg group than in non-Surg group. In cN(+) patients, there was no significant difference in OS and DFS between Surg and non-Surg groups. CONCLUSION For patients with MSSCC without lymph node metastasis, aggressive surgery on the primary tumor contributes to improved prognosis.
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Affiliation(s)
- Takuya Tsuji
- Department of Otolaryngology, Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
| | - Ryo Asato
- Department of Otolaryngology, Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Shinpei Kada
- Department of Otolaryngology, Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan; Department of Otolaryngology, Head and Neck Surgery, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu-shi, Shiga, 520-8511, Japan
| | - Morimasa Kitamura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Head and Neck-Thyroid Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan
| | - Hisanobu Tamaki
- Department of Otolaryngology, Head and Neck Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-ku, Osaka-shi, Osaka 543-8555, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology, Head and Neck Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-ku, Osaka-shi, Osaka 543-8555, Japan; Katsuragawa Mizuta ENT Clinic, 37 Shimotsubayashiminamidaihan-nya-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8036, Japan
| | - Shinzo Tanaka
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan; Department of Otolaryngology, Head and Neck Surgery, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji-shi, Kyoto, 611-0041, Japan
| | - Yoshiki Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Ryusuke Hori
- Department of Otolaryngology, Tenri Hospital, 200 Misima-cho, Tenri-shi, Nara, 632-8552, Japan; Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Occupational and Environmental Health
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Otolaryngology, Tenri Hospital, 200 Misima-cho, Tenri-shi, Nara, 632-8552, Japan
| | - Shogo Shinohara
- Department of Otolaryngology, Head and Neck Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Shinji Takebayashi
- Department of Otolaryngology, Head and Neck Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan; Department of Otorhinolaryngology, Shiga General Hospital, 5-4-30, Moriyama, Moriyama-shi, Shiga, 524-8524, Japan
| | - Toshiki Maetani
- Department of Otolaryngology, Head and Neck Surgery, Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Hiroyuki Harada
- Department of Otolaryngology, Head and Neck Surgery, Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Yoshiharu Kitani
- Department of Otolaryngology, Head and Neck Surgery, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, Shizuoka City, 420-8527, Japan
| | - Yohei Kumabe
- Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Nanba-cho, Amagasaki-shi, Hyogo, 660-8550, Japan
| | - Takashi Tsujimura
- Department of Otolaryngology, Head and Neck Surgery, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu-shi, Shiga, 520-8511, Japan; Department of Otolaryngology, Head and Neck Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama City, Wakayama, 640-8558, Japan
| | - Keigo Honda
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Otolaryngology, Head and Neck Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama City, Wakayama, 640-8558, Japan
| | - Kazuyuki Ichimaru
- Department of Otolaryngology, Head and Neck Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyushu-shi, Fukuoka, 802-8555, Japan
| | - Koji Ushiro
- Department of Otolaryngology, Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan; Department of Otorhinolaryngology, Shiga General Hospital, 5-4-30, Moriyama, Moriyama-shi, Shiga, 524-8524, Japan
| | - Koichi Omori
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Heianna J, Makino W, Hirakawa H, Yamashita Y, Tomita H, Murayama S. Therapeutic efficacy of intra-arterial docetaxel and nedaplatin infusion concomitant with radiotherapy for T4 maxillary sinus squamous cell carcinoma. Int J Oral Maxillofac Surg 2021; 51:1123-1130. [PMID: 34955352 DOI: 10.1016/j.ijom.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the efficacy of intra-arterial chemoradiotherapy with docetaxel and nedaplatin for T4 maxillary sinus squamous cell carcinoma (MSSCC). Data were retrospectively analysed for 22 consecutive patients with T4 MSSCC who underwent intra-arterial chemoradiotherapy. Participants received intensity-modulated radiotherapy (70 Gy in 35 fractions) concomitantly with docetaxel (60 mg/m2) and nedaplatin (80 mg/m2) administered every 4 weeks for a total of three sessions. The median follow-up period was 49 months (range 12-91 months). T4a tumours were found in 16 patients (73%) and T4b tumours in six patients (27%). Cervical metastasis was found in nine patients (41%; five N2b, four N2c). The 5-year loco-regional control, disease-free survival, and overall survival rates for patients with T4a disease were 92.3%, 92.3%, and 90.3%, respectively, compared to 83.3% (P = 0.42), 66.7% (P = 0.07), and 83.3% (P = 0.46), respectively, for those with T4b disease. The 5-year loco-regional control, disease-free survival, and overall survival rates for patients with cervical lymph node metastasis were all 87.5% compared to 92.3% (P = 0.86), 84.6% (P = 0.69), and 92.3% (P = 0.93), respectively, for those without cervical metastasis. Intra-arterial chemoradiotherapy with docetaxel and nedaplatin may provide favourable loco-regional control and increased survival in T4 MSSCC.
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Affiliation(s)
- J Heianna
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan.
| | - W Makino
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - H Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Y Yamashita
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - H Tomita
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan; Department of Radiology, St Marianna University School of Medicine, Miyamae, Kawasaki, Kanagawa, Japan
| | - S Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Outcome of Definitive and Postoperative Radiotherapy in Patients with Sinonasal Squamous Cell Carcinomas. TUMORI JOURNAL 2015; 102:426-32. [DOI: 10.5301/tj.5000431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/20/2022]
Abstract
Aims To evaluate outcomes in patients with sinonasal squamous cell carcinoma (SCC) treated with definitive radiotherapy (DRT) and postoperative radiotherapy (PORT). Methods Between 1990 and 2013, 73 patients with sinonasal SCC were treated with radiotherapy. Fifty-two patients (71.2%) were treated with DRT and 21 (28.8%) were treated with PORT. The primary tumor sites were the maxillary sinus in 47 patients (64.4%), the nasal cavity in 18 (24.7%), the ethmoid sinus in 7 (9.6%), and the frontal sinus in 1 (1.4%). Four (5.4%), 11 (15.1%), 24 (32.9%), 17 (23.3%), and 17 (23.3%) patients had T1, T2, T3, T4a, and T4b tumors, respectively. N stage was N0, N1, N2a, N2b, N2c, and N3 in 60 (82.2%), 6 (8.2%), 2 (2.7%), 2 (2.7%), and 3 (4.1%) patients, respectively. The median follow-up period was 23 months (range 3-196). Results The 5-year local progression-free survival (LPFS), regional progression-free survival (RPFS), distant metastasis-free survival (DMFS), and overall survival (OS) in the DRT and PORT groups were 50.6%, 82.1%, 91.1%, and 84.4% and 85.7%, 72.1%, 76.1%, and 83.5%, respectively, without any statistically significant differences. Conclusions The LPFS, RPFS, DMFS, and OS were not significantly different between the DRT and PORT groups. Given the possibility of functional disability and cosmetic disfigurement with facial surgery, DRT might be considered as a surrogate to surgery followed by PORT for patients with locally advanced sinonasal SCC.
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