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Low CM, Gruszczynski NR, Moore EJ, Price DL, Janus JR, Kasperbauer JL, Van Abel KM, Stokken JK, Van Gompel JJ, Link MJ, Choby G. Sinonasal Osteosarcoma: Report of 14 New Cases and Systematic Review of the Literature. J Neurol Surg B Skull Base 2021; 82:e138-e147. [PMID: 34306929 PMCID: PMC8289535 DOI: 10.1055/s-0040-1701221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
Objective The objective of this study is to describe the clinical presentation, tumor characteristics, natural history, and treatment patterns of sinonasal osteosarcoma. Methods Fourteen patients who had been treated for osteosarcoma of the nasal cavity and paranasal sinuses at a tertiary care center were reviewed. In addition, a systematic review of the literature for osteosarcoma of the sinonasal cavity was performed. Results In a systematic review, including 14 patients from the authors' institution, 53 total studies including 88 patients were assessed. Median follow-up was 18 months (interquartile range: 8-39 months). The most common presenting symptoms were facial mass or swelling (34%), and nasal obstruction (30%). The most common paranasal sinus involved by tumor was the maxillary sinus (64%), followed by the ethmoid sinuses (52%). The orbit (33%), dura (13%) and infratemporal fossa (10%) were the most common sites of local invasion. The majority of patients underwent surgery followed by adjuvant therapy (52.4%). Increasing age was associated with decreased overall survival rate (unit risk ratio [95% confidence interval (CI)] = 1.02 [1.003-1.043]; p = 0.0216) and T4 disease was associated with decreased disease-specific survival rate (hazard ratio [HR] = 2.87; p = 0.0495). The 2- and 5-year overall survival rates were 68 and 40%, respectively, while 2- and 5-year disease-specific survival rates were 71% and 44%, respectively. Conclusion Sinonasal osteosarcomas are uncommon tumors and can pose a significant therapeutic challenge. Increasing age and T4 disease are associated with worse prognosis. This disease usually warrants consultation by a multidisciplinary team and consideration of multimodality therapy.
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Affiliation(s)
- Christopher M. Low
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel L. Price
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kathryn M. Van Abel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Janalee K. Stokken
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Garret Choby
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Radiation-Induced Sarcomas of the Head and Neck: A Systematic Review. Adv Ther 2021; 38:90-108. [PMID: 33184778 PMCID: PMC7854400 DOI: 10.1007/s12325-020-01556-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 02/08/2023]
Abstract
Introduction As a result of the increased use of radiotherapy (RT) and improved long-term overall survival of patients with cancers of the head and neck (HN), the frequency of radiation-induced sarcomas of the head and neck (RISHN) may be increasing. The main objective of this systematic review was to determine the existing evidence on the frequency, treatment, and outcome of RISHN. Methods Using PRISMA guidelines we conducted a systematic review of the literature published from 2000 to 2020. Results Our review includes data of 560 patients from 64 articles. The total frequency of RISHNs among the reviewed series was 0.15%. The most frequent location of the primary tumor treated by RT was the nasopharynx. The mean RT dose used was 62 Gy, mean latency interval between irradiation and occurrence of RISHN was 11.1 years, and the most common RISHN location was the sinonasal region. Osteosarcoma was the principal histology, followed by fibrosarcoma. Surgery was the most frequently applied treatment modality. Of all patients with RISHN, 40.7% died of this disease after a mean interval of 13.9 months. Conclusions Notwithstanding the increased use of RT, the number of reported RISHNs has not increased substantially during the past two decades. Surgery with wide margins forms the best therapeutic option for these cases, but the outcome remains poor.
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Gore MR. Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:4. [PMID: 29581706 PMCID: PMC5861608 DOI: 10.1186/s12901-018-0052-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/01/2018] [Indexed: 02/06/2023]
Abstract
Background Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas. Methods Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival. Results A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy. Conclusions Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival. Electronic supplementary material The online version of this article (10.1186/s12901-018-0052-5) contains supplementary material, which is available to authorized users.
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Sen S, Chandra A, Mukhopadhyay S, Ghosh P. Sinonasal Tumors: Computed Tomography and MR Imaging Features. Neuroimaging Clin N Am 2015; 25:595-618. [PMID: 26476382 DOI: 10.1016/j.nic.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article describes the computed tomography and MR imaging features of the neoplasms of the sinonasal space. Although a pathologic diagnosis may not always be possible, knowledge of the features may help in narrowing down the differentials and establishing a malignant pathology.
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Affiliation(s)
- Saugata Sen
- Department of Radiology and Nuclear Medicine, Tata Medical Center, 14, Main Arterial Road, Rajarhat, New Town, Kolkata 700156, India.
| | - Aditi Chandra
- Department of Radiology and Nuclear Medicine, Tata Medical Center, 14, Main Arterial Road, Rajarhat, New Town, Kolkata 700156, India
| | - Sumit Mukhopadhyay
- Department of Radiology and Nuclear Medicine, Tata Medical Center, 14, Main Arterial Road, Rajarhat, New Town, Kolkata 700156, India
| | - Priya Ghosh
- Department of Radiology and Nuclear Medicine, Tata Medical Center, 14, Main Arterial Road, Rajarhat, New Town, Kolkata 700156, India
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Zhu W, Hu F, Zhao T, Wang C, Tao Q. Clinical Characteristics of Radiation-Induced Sarcoma of the Head and Neck: Review of 15 Cases and 323 Cases in the Literature. J Oral Maxillofac Surg 2015; 74:283-91. [PMID: 26275593 DOI: 10.1016/j.joms.2015.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE This retrospective study aimed to identify the clinical characteristics of radiation-induced sarcoma of the head and neck (RISHN) that could help in the early diagnosis of this rare disease. MATERIALS AND METHODS From August 1995 through October 2014, 15 cases of RISHN presenting at the authors' department and 323 cases in the literature were reviewed. RESULTS The incidence of RISHN was higher in men than in women (male-to-female ratio, 2.4:1). The mean latency was long (9.3 yr), and the tumor often occurred in middle age (50.0 yr old). Osteosarcoma was the predominant pathologic diagnosis (34.1%). The prognosis of RISHN was poor. CONCLUSION RISHN is a serious long-term complication of radiotherapy and its incidence has been increasing in recent years. Owing to the long latency period, its early diagnosis is difficult to make. RISHN should be considered when a patient who has undergone radiotherapy presents with a mass, pain, or trismus in the irradiated field.
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Affiliation(s)
- Wangyong Zhu
- Resident, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fengchun Hu
- Resident, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tengda Zhao
- Resident, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Attending Physician and Associate Professor, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qian Tao
- Attending Physician and Professor, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
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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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Koshy M, Paulino AC, Mai WY, Teh BS. Radiation-induced osteosarcomas in the pediatric population. Int J Radiat Oncol Biol Phys 2005; 63:1169-74. [PMID: 16054775 DOI: 10.1016/j.ijrobp.2005.04.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 04/04/2005] [Accepted: 04/05/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE Radiation-induced osteosarcomas (R-OS) have historically been high-grade, locally invasive tumors with a poor prognosis. The purpose of this study was to perform a comprehensive literature review and analysis of reported cases dealing with R-OS in the pediatric population to identify the characteristics, prognostic factors, optimal treatment modalities, and overall survival of these patients. METHODS AND MATERIALS A MEDLINE/PubMed search of articles written in the English language dealing with OSs occurring after radiotherapy (RT) in the pediatric population yielded 30 studies from 1981 to 2004. Eligibility criteria included patients <21 years of age at the diagnosis of the primary cancer, cases satisfying the modified Cahan criteria, and information on treatment outcome. Factors analyzed included the type of primary cancer treated with RT, the radiation dose and beam energy, the latency period between RT and the development of R-OS, and the treatment, follow-up, and final outcome of R-OS. RESULTS The series included 109 patients with a median age at the diagnosis of primary cancer of 6 years (range, 0.08-21 years). The most common tumors treated with RT were Ewing's sarcoma (23.9%), rhabdomyosarcoma (17.4%), retinoblastoma (12.8%), Hodgkin's disease (9.2%), brain tumor (8.3%), and Wilms' tumor (6.4%). The median radiation dose was 47 Gy (range, 15-145 Gy). The median latency period from RT to the development of R-OS was 100 months (range, 36-636 months). The median follow-up after diagnosis of R-OS was 18 months (1-172 months). The 3- and 5-year cause-specific survival rate was 43.6% and 42.2%, respectively, and the 3- and 5-year overall survival rate was 41.7% and 40.2%, respectively. Variables, including age at RT, primary site, type of tumor treated with RT, total radiation dose, and latency period did not have a significant effect on survival. The 5-year cause-specific and overall survival rate for patients who received treatment for R-OS involving chemotherapy alone, surgery alone, and surgery plus chemotherapy was 17.3% and 17.3%, 56.6% and 50.3%, and 71.0% and 68.3%, respectively (p < 0.0001, log-rank test). CONCLUSION The type of treatment for R-OS was the most significant factor for cause-specific and overall survival. Patients who develop R-OS should be aggressively treated, because the outcome is not as dismal as once thought.
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Affiliation(s)
- Matthew Koshy
- Department of Radiology, Division of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, and Texas Children's Hospital, Houston, TX 77030, USA
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