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Hagemann J, Roesner J, Helling S, Jacobi C, Doescher J, Engelbarts M, Kuenzel J, Krauss P, Becker S, Betz CS. Long-term Outcome for Open and Endoscopically Resected Sinonasal Tumors. Otolaryngol Head Neck Surg 2018; 160:862-869. [DOI: 10.1177/0194599818815881] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective Endoscopic resection of sinonasal cancer has become an alternative to open craniofacial surgery and leads to safe and satisfying results in emerging numbers. Randomized study data comparing outcomes between approaches are missing. Hence, it remains unclear which subgroups of patients might profit most from each technique. We aimed to identify such patient and tumor characteristics and gather information for future prospective study design. Study Design Case series with chart review. Setting Tertiary academic center. Subjects and Methods This study is based on a retrospective chart review of 225 patients undergoing open craniofacial or endoscopic resection for sinonasal malignancy between 1993 and 2015 at Munich University Hospital. Statistical analyses include t test, chi-square, Kaplan-Meier charts, and univariate and multivariate analyses. Results The sample size was similar between the endoscopic and open surgery groups. Tumors were significantly larger in patients who underwent open craniofacial resection. The risk of notable bleeding ( P = .041) was lower and hospital stay shorter ( P = .001) for endoscopic interventions of all tumor stages. Rates of overall ( P = .024) and disease-specific ( P = .036) survival were significantly improved for endoscopic cases; improved recurrence-free survival rates did not achieve statistical significance ( P = .357). For cases matched for tumor size, this improvement was confirmed for T3 tumors ( P = .038). Regional and distant metastatic tumor spread generally worsened survival in both surgical subgroups. Multivariate Cox regression analysis revealed independent prognosticators for overall survival. Conclusion Endoscopic tumor resection remains a suitable option for distinct indications and showed improved outcome in intermediate-stage tumors in our collective. Further randomized studies acknowledging the here-identified factors are needed to improve future therapy guidelines and patient care.
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Affiliation(s)
- Jan Hagemann
- Department of Otolaryngology–Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
- Department of Otolaryngology–Head and Neck Surgery, Klinikum der Universität München, Munich, Germany
| | - Jana Roesner
- Department of Otolaryngology–Head and Neck Surgery, Klinikum der Universität München, Munich, Germany
| | - Soenke Helling
- Department of Otolaryngology–Head and Neck Surgery, Klinikum der Universität München, Munich, Germany
| | - Christian Jacobi
- Department of Otolaryngology–Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Doescher
- Department of Otolaryngology–Head and Neck Surgery, Universitätsklinikum Ulm, Ulm, Germany
| | - Matthias Engelbarts
- Department of Otolaryngology–Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Julian Kuenzel
- Department of Otolaryngology–Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Philipp Krauss
- Department of Neurosurgery, UniversitätsSpital Zurich, Zurich, Switzerland
| | - Sven Becker
- Department of Otolaryngology–Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Christian Stephan Betz
- Department of Otorhinolaryngology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Lepera D, Leone F, Volpi L, Bignami M, Karligkiotis A, Lambertoni A, Pistochini A, Accorona R, Nicolai P, Castelnuovo P. Endoscopic endonasal approach for sinonasal and anterior skull base malignancies in the elderly. Head Neck 2018; 40:917-926. [DOI: 10.1002/hed.25045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/07/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Davide Lepera
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Federico Leone
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Luca Volpi
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Apostolos Karligkiotis
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Alessia Lambertoni
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Andrea Pistochini
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Remo Accorona
- Department of Otorhinolaryngology, Spedali Civili; University of Brescia; Brescia Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology, Spedali Civili; University of Brescia; Brescia Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
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3
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Govindaraj S, Iloreta AM, Tong CCL, Hernandez-Prera JC. Evaluation of Patients with Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 2017; 50:221-244. [PMID: 28314398 DOI: 10.1016/j.otc.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A wide variety of tumors present in the sinonasal and ventral skull base. Patients often have nonspecific symptoms initially and present with advanced tumors, affecting the orbit and other adjacent structures. Evaluation of these malignancies with modern imaging techniques can define tumor invasion, but biopsy is often required to establish a diagnosis because most have a nonspecific appearance. A thorough understanding of the anatomy is the key to treatment planning, and a multidisciplinary approach determines the optimal strategy.
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Affiliation(s)
- Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave. L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave. L. Levy Place, Box 1189, New York, NY 10029, USA
| | - Charles C L Tong
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave. L. Levy Place, Box 1189, New York, NY 10029, USA
| | - Juan C Hernandez-Prera
- Department of Pathology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, First Avenue at 16th Street, New York, NY 10003, USA
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4
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Alonso JE, Han AY, Kuan EC, Suh JD, John MAS. Epidemiology and survival outcomes of sinonasal verrucous carcinoma in the United States. Laryngoscope 2017; 128:651-656. [PMID: 28865078 DOI: 10.1002/lary.26790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/01/2017] [Accepted: 06/12/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Verrucous carcinoma (VC) is a rare, variant of squamous cell carcinoma with benign cytohistopathologic features and a generally favorable prognosis. Epidemiologic and clinical outcomes data are lacking as a result of limited cases of sinonasal VC. OBJECTIVE To describe the incidence and determinants of survival of patients with verrucous carcinoma of the sinonasal tract between the years of 1973 to 2014 using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS The SEER registry was utilized to calculate survival trends for patients with verrucous carcinoma of the sinonasal tract between 1973 and 2014. Patient data then was analyzed with respect to age, sex, race, and treatment modalities (surgery and radiation therapy). Overall survival (OS) and disease-specific survival (DSS) were calculated. RESULTS A total of 86 cases of VC of the sinonasal tract were identified. The cohort was comprised of 69.8% males. The mean age at diagnosis was 67.4 years. The nasal cavity was the most common primary site (51.2%), followed by the maxillary sinus (40.7%) and nasopharynx (5.8%). The median OS was 97.6 months. 89.5% of cases underwent surgery and 20.9% received both surgery and radiation therapy. Overall survival at 2, 5, and 10 years was 73%, 59%, and 36%, respectively. On multivariate analysis, advanced age (P < 0.05) and primary site (P < 0.05) were associated with worse OS and DSS, respectively. Primary nasopharyngeal tumor site was associated with reduced DSS (P < 0.05). Surgery improved OS (P < 0.001) and DSS (P < 0.001). CONCLUSION Verrucous carcinoma of the sinonasal tract is associated with a generally favorable prognosis. Age, primary site, and surgical therapy are independent predictors of OS and DSS, respectively. We present the first population-based analysis of sinonasal VC, thus clarifying the prognosis and reinforcing the management of this malignancy. LEVEL OF EVIDENCE 4. Laryngoscope, 128:651-656, 2017.
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Affiliation(s)
- Jose E Alonso
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Albert Y Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Edward C Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, U.S.A.,UCLA Head and Neck Cancer Program, Ronald Reagan UCLA Medical Center, Los Angeles, California, U.S.A
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5
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Rawal RB, Farzal Z, Federspiel JJ, Sreenath SB, Thorp BD, Zanation AM. Endoscopic Resection of Sinonasal Malignancy. Otolaryngol Head Neck Surg 2016; 155:376-86. [DOI: 10.1177/0194599816646968] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 04/08/2016] [Indexed: 01/23/2023]
Abstract
Objectives The use of endoscopic approaches for sinonasal malignancy resection has increased, but survival data are limited secondary to disease rarity and new surgical technique. Here we present a systematic review and meta-analysis of endoscopic endonasal resection of sinonasal malignancy. Data Sources MEDLINE, PubMed Central, NCBI Bookshelf, Cochrane Library, clinicaltrials.gov, National Guideline Clearinghouse. Review Methods PRISMA/MOOSE guidelines were followed. MeSH terms were “endoscopic” AND (“esthesioneuroblastoma” OR “sinonasal adenocarcinoma” OR “squamous cell carcinoma” OR “sinonasal undifferentiated carcinoma”). For studies in which individual-level data were available, results were obtained by direct pooling. For studies in which only summary Kaplan-Meier curves were available, numerical data were extracted, traced, and aggregated by fitting a Weibull model. Results Of 320 studies identified, 35 case series were included (n = 952 patients), with 15 studies analyzed via aggregate modeling and 20 studies analyzed via direct pooling. Two- and 5-year survival rates for patients in aggregate modeling were 87.5% and 72.3%, respectively (mean follow-up: 32.9 months). Two- and 5-year survival for patients in direct pooling were 85.8% and 83.5%, respectively (mean follow-up: 43.0 ± 19.5 months). Significant overall survival difference was found between low- and high-grade cancers ( P = .015) but not between low- and high-stage cancers ( P = .79). Conclusion Overall 2- and 5-year survival rates are comparable and sometimes greater than those from open craniofacial resection. Survival rates significantly differ by cancer grade but not stage. Journals and investigators should be encouraged to publish retrospective and prospective case series with staged survival updates based on established guidelines.
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Affiliation(s)
- Rounak B. Rawal
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zainab Farzal
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jerome J. Federspiel
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Satyan B. Sreenath
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian D. Thorp
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam M. Zanation
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Maroldi R, Ravanelli M, Farina D, Facchetti L, Bertagna F, Lombardi D, Nicolai P. Post-treatment Evaluation of Paranasal Sinuses After Treatment of Sinonasal Neoplasms. Neuroimaging Clin N Am 2015; 25:667-85. [PMID: 26476385 DOI: 10.1016/j.nic.2015.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of imaging in the follow-up of asymptomatic patients treated for sinonasal neoplasms is to detect submucosal relapsing lesions. The challenge is to discriminate recurrent tissue within the changes resulting from unpredictable healing of tissue after surgery and radiotherapy. Scar, inflammation, and recurrence can be better separated with a multisequence MR imaging approach. The choice of the field of view should take into account the risk of in-field intracranial recurrences, craniofacial bone metastases, and perineural spread. Fluorodeoxyglucose-PET has a role in assessing distant metastasis. Its usefulness in local and regional surveillance has yet to be established.
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Affiliation(s)
- Roberto Maroldi
- Department of Radiology, University of Brescia, Radiologia 2 - Spedali Civili, Piazzale Spedali Civili 1, Brescia I-25123, Italy.
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Radiologia 2 - Spedali Civili, Piazzale Spedali Civili 1, Brescia I-25123, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Radiologia 2 - Spedali Civili, Piazzale Spedali Civili 1, Brescia I-25123, Italy
| | - Luca Facchetti
- Department of Radiology, University of Brescia, Radiologia 2 - Spedali Civili, Piazzale Spedali Civili 1, Brescia I-25123, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia, Piazzale Spedali Civili 1, Brescia I-25123, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology, University of Brescia, Piazzale Spedali Civili 1, Brescia I-25123, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Piazzale Spedali Civili 1, Brescia I-25123, Italy
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7
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Quality of life in advanced maxillary sinus cancer after radical versus conservative maxillectomy. J Craniofac Surg 2015; 24:1368-72. [PMID: 23851810 DOI: 10.1097/scs.0b013e31828601d6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE A study of patients with advanced maxillary sinus cancer who underwent radical or conservative maxillectomy was performed to show the differences between the 2 groups in patients' survival rate and quality of life (QOL). METHODS A total of 61 advanced maxillary sinus cancer patients from Weifang People's Hospital in China were traced: 27 radical maxillectomy and 34 conservative maxillectomy. Survival rate was compared between the 2 groups. Quality of life assessments were performed at the time of preoperation as well as 6, 12, and 18 months after the operation. Measures included the University of Washington-QOL scale (UW-QOL) and the Hospital Anxiety and Depression Scale. RESULTS The UW-QOL scale scores of the composite score, appearance, activity, recreation, swallowing, speech, and chewing in the conservative surgical group were much higher than those in the radical surgical group. However, there is no big difference in total survival rate between these 2 groups. Also, no significant difference can be seen in the scores of pain, employment, and shoulder between the 2 groups. At the 6-month follow-up, the radical maxillectomy had more effects on anxiety than the conservative maxillectomy, while they are almost equally effective on depression. The 12-month and 18-month follow-ups showed that the radical maxillectomy made a greater impact on both anxiety and depression than the conservative maxillectomy. CONCLUSIONS Conservative maxillectomy is more effective than radical maxillectomy to preserve the QOL of patients with advanced maxillary sinus cancer.
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Murphy J, Isaiah A, Wolf JS, Lubek JE. Quality of life factors and survival after total or extended maxillectomy for sinonasal malignancies. J Oral Maxillofac Surg 2014; 73:759-63. [PMID: 25661508 DOI: 10.1016/j.joms.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Total and extended maxillectomy results in significant morbidity that can have an effect on quality of life factors. Modern reconstructive techniques have ameliorated this effect, but they have not been quantified. The purpose of the present study was to evaluate the quality of life factors and survival of patients undergoing total or extended maxillectomy for malignant disease. MATERIALS AND METHODS A retrospective study was performed of all patients who had undergone total or extended maxillectomy at a tertiary care cancer center from January 2008 to May 2013. The minimum follow-up period was 6 months. The quality of life factors analyzed included swallowing function and diet consistency, pain control, and postoperative complications. RESULTS A total of 25 patients (13 women and 12 men) met the inclusion criteria. Using the American Joint Committee on Cancer staging system, 76% of the patients had stage IV disease. Of the 25 patients, 13 received a free tissue transfer, 11 an obturator flap, and 1 a regional flap. None of the patients with a free tissue transfer experienced failure. The tumor size had no systemic influence on the reconstructive method chosen (P = .32 to P = .98). The median follow-up period was 41 weeks (range 24 to 252). One death was recorded, and 10 patients were lost to follow-up. Eleven patients progressed to a regular diet. Fifteen patients required a tracheostomy, and all were decannulated at a mean of 14 days postoperatively. One patient had dental implants placed. The type of reconstruction did not influence swallowing function (P = .49) or long-term pain (P = .38). The mean pain score was 4.9 ± 2.7. Pain management proved difficult in 7 patients. Also, 6 patients developed a surgical site infection, 3 of whom required a return to the operating room. Seven patients were readmitted to the hospital for complications; however, the reconstructive method did not influence the incidence of complications (P = .64). CONCLUSIONS The inevitable morbidity, with respect to quality of life factors, that result from the disfiguring effects of total or extended maxillectomy can be deemed acceptable by patients. We recommend discussing all reconstructive options regarding the management of late-stage maxillary malignancies and the potential effect they can have on patients' quality of life.
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Affiliation(s)
- James Murphy
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Amal Isaiah
- Chief Resident, Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Jeffrey S Wolf
- Associate Professor, Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD
| | - Joshua E Lubek
- Assistant Professor and Fellowship Director, Department of Oral and Maxillofacial Surgery, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD.
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Mensi C, Consonni D, Sieno C, De Matteis S, Riboldi L, Bertazzi PA. Sinonasal cancer and occupational exposure in a population-based registry. Int J Otolaryngol 2013; 2013:672621. [PMID: 24082884 PMCID: PMC3777129 DOI: 10.1155/2013/672621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/19/2013] [Indexed: 01/12/2023] Open
Abstract
We examined occupational exposures among subjects with sinonasal cancer (SNC) recorded in a population-based registry in the Lombardy Region, the most populated and industrialized Italian region. The registry collects complete clinical information and exposure to carcinogens regarding all SNC cases occurring in the population of the region. In the period 2008-2011, we recorded 210 SNC cases (137 men, 73 women). The most frequent occupational exposures were to wood (44 cases, 21.0%) and leather dust (29 cases, 13.8%), especially among men: 39 cases (28.5%) to wood and 23 cases (16.8%) to leather dust. Exposure to other agents was infrequent (<2%). Among 62 subjects with adenocarcinoma, 50% had been exposed to wood dust and 30.7% to leather dust. The proportions were around 10% in subjects with squamous cell carcinoma and about 20% for tumors with another histology. The age-standardized rates (×100,000 person-years) were 0.7 in men and 0.3 in women. Complete collection of cases and their occupational history through a specialized cancer registry is fundamental to accurately monitor SNC occurrence in a population and to uncover exposure to carcinogens in different industrial sectors, even those not considered as posing a high risk of SNC, and also in extraoccupational settings.
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Affiliation(s)
- Carolina Mensi
- Department of Preventive Medicine, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy
| | - Dario Consonni
- Department of Preventive Medicine, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy
| | - Claudia Sieno
- Department of Preventive Medicine, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy
| | - Sara De Matteis
- National Heart & Lung Institute, Department of Occupational & Environmental Medicine, Imperial College London, London SW3 6LR, UK
- Department of Clinical Science and Community Health, Università Degli Studi di Milano, Via San Barnaba 8, 20122 Milan, Italy
| | - Luciano Riboldi
- Department of Preventive Medicine, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy
| | - Pier Alberto Bertazzi
- Department of Preventive Medicine, Fondazione IRCCS Ca' Granda—Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy
- Department of Clinical Science and Community Health, Università Degli Studi di Milano, Via San Barnaba 8, 20122 Milan, Italy
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Harvey RJ, Winder M, Parmar P, Lund V. Endoscopic skull base surgery for sinonasal malignancy. Otolaryngol Clin North Am 2012; 44:1081-140. [PMID: 21978897 DOI: 10.1016/j.otc.2011.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Management of malignant neoplasms of the sinonasal tract and skull base is hampered by the relative low incidence and pathologic diversity of patient presentations. Many studies have reported successful outcomes in the endoscopic management of malignancy since 1996, and these are summarized in this article. Nonsurgical adjuvant therapies are important for locoregional control because surgery occurs in a restricted anatomic space with close margins to critical structures, and distant disease is an ongoing concern in these disorders. There remains a need for collaborative consistent multicenter reporting, and international registries have been established to assist in such efforts.
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Affiliation(s)
- Richard J Harvey
- Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
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11
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Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis. Int Forum Allergy Rhinol 2011; 1:255-61. [PMID: 22287429 DOI: 10.1002/alr.20051] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/23/2010] [Accepted: 01/04/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endoscopic approaches of sinonasal malignancies are now being described. This study aims to conduct a systematic review with a pooled-data analysis to compare outcomes of endoscopic vs craniofacial resection of sinonasal malignancies. METHODS A search was conducted of MEDLINE (1966-2008), EMBASE (1980-2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases and supplemented by references in retrieved articles. All authors used a detailed list of inclusion and exclusion criteria to determine articles eligible for final inclusion. The authors extracted data regarding study criteria appraisal, sinonasal malignancy characteristics, survival outcomes, and recurrence. Kaplan-Meier survival and locoregional control rates were calculated and compared using the log-rank test. RESULTS Of the 2314 citations reviewed, the search yielded 15 case series with individual data on 226 patients. The most common malignancies were esthesioneuroblastoma (47%), adenocarcinoma (24%), and undifferentiated carcinoma (22%). The overall 5-year survival rate for the sample was 56.5% (standard error [SE] ± 3.8). Because of the paucity of data with endoscopic resection of high-stage malignancies, the outcome results were highly variable and no useful comparison could be made. Among low-stage malignancies (T1-2 or Kadish A-B), the endoscopic and open approaches demonstrated no statistically significant difference in outcome results. The 5-year overall survival was 87.4% (SE ± 5.3) in the endoscopic group vs 76.8% (SE ± 8.3) for open approaches (p = 0.351); disease-specific survival was 94.7% (SE ± 3.7) vs 87.7% (SE ± 6.7; p = 0.258); and locoregional control rate was 89.5% (SE ± 5.0) vs 77.2% (SE ± 10.4; p = 0.251). CONCLUSION Transnasal endoscopic resection appears to be a reasonable alternative to craniofacial resection in the management of low-stage sinonasal malignancies.
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Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Endoscopic Sinus, and Skull Base Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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Khademi B, Moradi A, Hoseini S, Mohammadianpanah M. Malignant neoplasms of the sinonasal tract: report of 71 patients and literature review and analysis. Oral Maxillofac Surg 2009; 13:191-199. [PMID: 19795137 DOI: 10.1007/s10006-009-0170-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The present study aimed to report the characteristics, prognostic factors, and treatment outcomes of 71 cases of malignant neoplasms of the sinonasal tract and literature review and analysis of major report series. METHODS Seventy-one consecutive patients diagnosed with primary malignant neoplasm of the sinonasal tract that were treated and followed up at a university hospital between May 2000 and March 2008 were selected for the present study. Thirty-four patients were treated with surgery followed by a combination of chemotherapy and radiotherapy, 15 with surgery alone, 14 with combined radiotherapy and chemotherapy, six with radiotherapy alone, and two with surgery followed by radiotherapy. To find out the major series of related studies over the last 20 years, a literature review of PubMed was performed. In all, we found 42 major series including 8,164 patients with malignant neoplasms of the sinonasal tract. RESULTS There were 35 women and 36 men ranging in age from 5 to 80 years, with a median age of 55 years at diagnosis. The primary sites included were paranasal sinuses in 51 and nasal cavity in 20. There were one case of stage I, 20 of stage II, 27 of stage III, and 23 of stage IV. Epithelial tumors constituted 65% of all neoplasms. After a median follow-up of 39 months for surviving patients, 33 patients are alive and without disease, eight are alive with disease, and 30 patients died due to disease. Local recurrence was the most frequent treatment failure. The 5-year disease-free, local control, and overall survival rates were 42.1%, 59.5%, and 54.5%, respectively. On univariate analysis, cervical lymph nodes involvement, primary tumor size, histologic type, response to therapy, and stage of disease were independent prognostic factors for overall survival. In the literature review and by analyzing the data collection from 42 major reported series, the median age was 57 years and male/female ratio was 1.8. Epithelial tumors consisted of 69% of all malignant neoplasms of sinonasal tract and stages III and IV disease constituted 74.7% of all stages. Local recurrence was the dominant treatment failure in nearly all series. Five-year local control and overall survival rates were 56% and 45.5%, respectively. CONCLUSIONS In this review and by analyzing the large data collection of recent major reported series, we found that malignant neoplasms of the sinonasal tract tend to present at locally advanced stage, with a high frequency of local failure and a moderate to poor outcome. More effective local treatment for improving the local control and overall survival is needed.
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Affiliation(s)
- Bijan Khademi
- Department of Otolaryngology, and Head and Neck Surgery, Khalili Hospital, Shiraz University of Medical Sciences, Shiraz 71936-13311, Iran
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Snyderman CH, Carrau RL, Kassam AB, Zanation A, Prevedello D, Gardner P, Mintz A. Endoscopic skull base surgery: Principles of endonasal oncological surgery. J Surg Oncol 2008; 97:658-64. [DOI: 10.1002/jso.21020] [Citation(s) in RCA: 211] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jurkiewicz D, Wojdas A, Hermanowski M. [Malignant tumors of the nose and paranasal sinuses in the years 1971-2005 in the material of the Otolaryngology Clinic WIM]. Otolaryngol Pol 2008; 61:572-5. [PMID: 18260254 DOI: 10.1016/s0030-6657(07)70487-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED The aim of this study was retrospective analysis of evidence concerning to malignant tumors of the nasal cavity and the paranasal sinuses diagnosed in Otolaryngology Clinic of the Military Institute of the Health Service 1971-2005. The methods of therapy were also discussed. MATERIAL AND METHODS Material comprised 113 patients (35 females and 78 males) with diagnosis of malignant tumors of the nose and paranasal sinuses. The clinical aspects, sex, age, TNM classification and therapy methods (surgery, radiotherapy, chemotherapy) were analysed. RESULTS There were 31% females and 69% males (ratio 1 : 2.23). Each year on average 3.23 cases occurred. The highest morbidity was observed in 1997 and 2001 (6 cases each). In 89 subjects (23 females and 66 males) the neoplasm of epithelial origin were diagnosed. The age range of patients was 14-74 years (mean 68.2 years). The most numerous were groups of 60-69 (50 patients) and 70-79 (44 patients). In 82 cases (over 72%) tumors in advanced stages (T3, T4) were revealed. Two subjects (T1) were opera tem on and others 88 (T2, T3, T4) were treated surgically with subsequent radiotherapy. Three of patients did not agree for therapy. CONCLUSIONS The most frequent of malignant tumors of the nose and paranasal sinuses was cancer. The clinical symptoms of tumor were disclosed most often in age of 60-80 years. The method of choice in treatment is surgery combined with postoperative radiation.
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Affiliation(s)
- Dariusz Jurkiewicz
- Klinika Otolaryngologii, Centralny Szpital Kliniczny MON, WIM w Warszawie
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