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Novak S, Balatkova Z, Fikova A, Grega M, Kalfert D, Plzak J. Preservation of orbit in tumor invasion through the periorbita in sinonasal malignancy. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08757-z. [PMID: 38914815 DOI: 10.1007/s00405-024-08757-z] [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: 12/05/2023] [Accepted: 05/26/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE One of the possible risks of sinonasal malignancy is its possible spread in the orbit. However, there is no clear consensus among the different departments as to whether it is necessary to exenterate the orbit in limited tumorous infiltration of periorbital fat. The purpose of the study was to demonstrate that periorbital infiltration and periorbital fat invasion without involvement of deeper orbital tissues are not the indication of orbital exenteration. MATERIALS AND METHODS Retrospective analysis was performed over a 17-year period of patients undergoing surgical treatment for sinonasal malignancy with histologically verified periorbital infiltration or deeper invasion into the orbit. A total of 32 patients were included in the study. For each group, the following data were analysed: sex, age, preoperative imaging studies, histological findings, site of origin, stage, surgical reconstruction, oncological treatment, survival, cause of death, number of recurrences in the orbit and functional status of preserved eyes. RESULTS Based on our criteria for orbital exenteration, orbital preservation was feasible in 18 patients. Orbital exenteration was performed in 14 patients with deeper tumor infiltration. There was a statistically insignificant difference in survival between the two groups. The 5-year overall survival (OS) was 44% for the orbital preservation group (only 2 patients died from local tumor recurrence) and 34% for the orbital exenteration group. The groups did not differ in other observed factors other than the extent of orbital infiltration. In 11 (61.1%) patients, vision was without significant change after radiation therapy. In 2 (11.1%) patients, visual function was impaired due to diplopia. 5 (27.8%) patients had severely impaired vision due to optic nerve atrophy after radiation therapy. CONCLUSIONS Our results show a relatively high survival rate in the group of patients with orbital preservation with a high chance of vision preservation, which justifies our approach to orbital preservation even in some tumors with periorbital infiltration.
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Affiliation(s)
- Stepan Novak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, Prague, 150 06, Czech Republic.
| | - Zuzana Balatkova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, Prague, 150 06, Czech Republic
| | - Alzbeta Fikova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, Prague, 150 06, Czech Republic
| | - Marek Grega
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, Prague, 150 06, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, V Uvalu 84, Prague, 150 06, Czech Republic
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Zhao J, Jiang X, Hanna E, Su SY, Moreno A, Gunn B, Frank SJ, Ferrarotto R, Ning J, Esmaeli B. Orbital and periocular complications in patients with sinonasal tumours with orbital invasion. Br J Ophthalmol 2024; 108:465-470. [PMID: 36707226 PMCID: PMC10372198 DOI: 10.1136/bjo-2022-322855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/14/2023] [Indexed: 01/28/2023]
Abstract
AIMS The purpose of this study was to determine the frequency and associated risk factors of orbital/periocular complications in patients with sinonasal tumour with orbital invasion managed with eye-sparing treatments. METHODS A retrospective case series of patients with primary sinonasal tumour with orbital invasion from January 2008 to December 2018. Patient factors were compared between the following groups: (1)patients with orbital/periocular complications versus those who did not and (2) patients who needed secondary oculoplastic surgical procedures versus those who did not. RESULTS Out of 80 patients, 48 had eye-sparing surgery, 8 had orbital exenteration and 24 were managed non-surgically. The most common histology was squamous cell carcinoma (n=28, 35%). Among the eye-sparing treatment group, 51/72 patients experienced one or more orbital/periocular complication(s), with motility deficit (N=26, 36%) being the most frequent. Factors associated with higher risk of complications included tumour involving the orbital floor (p=0.019), clinical disease stage III/IV (p=0.038), maxillectomy (p=0.004), resection of the orbital floor (p=0.027) and cigarette smoking (p=0.041). Tumour involving the orbital floor had an OR of 3.9 (95% CI 1.3 to 11.6, p=0.016) in predicting orbital/periocular complication. In the eye-sparing surgery group, the most frequent secondary oculoplastic procedures was dacryocystorhinostomy (n=6, 13%). The use of a free flap in reconstruction had an OR of 8.2 (95% CI 2.1 to 31.8, p=0.002) in predicting need for secondary oculoplastic surgery. CONCLUSION Majority of patients with sinonasal tumours and secondary orbital invasion were managed with eye-sparing multidisciplinary treatments. Preservation of the eye can lead to reasonably good functional outcome despite expected orbital and periocular complications.
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Affiliation(s)
- Jiawei Zhao
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xinyang Jiang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven Jay Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Scholfield DW, Levyn H, Tabar VS, Ganly I, Della Rocca D, Cohen MA. The medial transorbital approach in cranioendoscopic skull base tumor resections for locally advanced tumors. J Clin Neurosci 2024; 119:198-204. [PMID: 38134571 PMCID: PMC11238899 DOI: 10.1016/j.jocn.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/02/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Orbital structure preservation and avoidance of facial incisions without compromising oncological outcome are key to maintaining function and quality of life in locally advanced sinonasal tumor surgery. A transorbital approach at our institution has proven invaluable during cranioendoscopic skull base tumor resections and there are few descriptions of this in the literature. METHODS An IRB-approved retrospective chart review was conducted at a tertiary cancer center for patients between 2020 and 2022 undergoing cranioendoscopic tumor resections utilizing a transorbital approach. Data collected included histopathology, sinus origin, disease extent, stage, operative details, length of stay, neo-adjuvant treatment and adjuvant treatment. Recurrence, survival, and complication rates were assessed. RESULTS Four patients were identified for inclusion, including a SMARCB1-deficient carcinoma, esthesioneuroblastoma, squamous cell carcinoma and meningioma. All patients had resection of gross and microscopic disease with preservation of orbital contents. Post-operatively, one patient had mild diplopia on inferior gaze, all other patients had normal vision. Median follow-up was 9.5 months. One patient had recurrence of disease intracranially. CONCLUSIONS The cranioendoscopic approach with a medial transorbital incision has multiple benefits. It avoids the need for a Weber-Ferguson incision with associated facial scar, allows for early intra-operative assessment for orbital invasion using tactile feedback and safe dissection of disease while protecting the globe and rectus muscles. This leads to preservation of eye function while ensuring an oncological resection. Other advantages include ligation of the anterior ethmoid artery and access for reconstruction of the medial orbital wall.
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Affiliation(s)
- Daniel W Scholfield
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helena Levyn
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viviane S Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Della Rocca
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc A Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Agarwal A, Philips R, Landers K, Savitch S, Barbarite E, Krein H, Heffelfinger R. Functional and Symmetry Outcomes After Forehead Flap Reconstruction of Medial Peri-Ocular Defects. Laryngoscope 2023; 133:2584-2589. [PMID: 36644993 DOI: 10.1002/lary.30566] [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: 09/28/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Orbital defects have a profound impact on orbital function and symmetry of the face and are difficult to reconstruct given the complexity of this area. The paramedian forehead flap (PMFF) has not been well studied in reconstruction of orbital defects. METHODS Retrospective review of patients who underwent reconstruction of periorbital defects with PMFF between 2016 and 2021. Variables were ocular adnexal asymmetry, functional outcomes, and orbital complications. RESULTS Eighteen patients met inclusion criteria. Mean defect size was 11.1 ± 7.5 cm. The most common subsite involved was medial canthus in 88.9% of patients. There was no statistically significant difference between mean medial canthus to midline ratio and mean medial brow to midline ratio when compared to the assumed normal of 1. The medial canthus to pupil ratio and medial canthus to lateral canthus ratio had a statistically significant mean difference from 1.0 (p = 0.003 for both). In 22.2% of patients, the orbit was functional with impairment; the remaining had no impairment. Surgical sequelae occurred in 12/18 (66.7%) of patients, most commonly epiphora in 9/18 (50%) of patients, and ectropion in 5/18 (27.7%). CONCLUSION The PMFF is feasible for medial periorbital reconstruction with acceptable functional and symmetrical outcomes and low morbidity. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2584-2589, 2023.
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Affiliation(s)
- Aarti Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramez Philips
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kathryn Landers
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Rush University, Chicago, Illinois, USA
| | - Samantha Savitch
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Barbarite
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Howard Krein
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan Heffelfinger
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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5
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Han AY, Nader ME, Lam K, Su SY. Current status of sinonasal cancer survivorship care. Head Neck 2023; 45:2458-2468. [PMID: 37449544 DOI: 10.1002/hed.27457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Sinonasal cancer is a heterogeneous orphan disease of diverse histologies, each with distinct clinical, oncologic, and toxicity profiles. Because of the comparative rarity of these cancers, sinonasal cancers are treated as a grouped diagnosis despite their clinical and biological heterogeneity. Multimodality treatment with a combination of surgery, chemotherapy, and/or radiotherapy is the standard-of-care for advanced-stage patients but there are few surveillance or follow-up practice guidelines or formalized survivorship care pathways. A scoping literature review was conducted via PubMed, EMBASE, and Google Scholar. A total of 112 studies were included, which were grouped along the following topics: surveillance, second primary tumors, quality of life, and symptom burden. Sinonasal cancer tends to exhibit a higher rate of local failure and occur in a delayed fashion compared to mucosal malignancies of the head and neck. Moreover, the site of failure and time-varying risk of recurrence is histology-specific. Following multimodality treatment of the skull base, patients may experience endocrine, visual, auditory, sinonasal, olfactory, and neurocognitive deficits, as well as psychosocial impairments that impact multiple physical and neuropsychological domains, resulting in diminished quality of life. Sinonasal cancer patients would benefit from tailored, histology-specific survivorship programs to address the recurrence, second primary, and functional impairments resulting from disease and treatment toxicity.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Keng Lam
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Verma R, Chen AJ, Murdock J, Geltzeiler M, Wax MK, Dailey RA, Ng JD. Acellular cadaveric dermal matrix grafts for orbital wall reconstruction in patients with sinonasal malignancies. Orbit 2023; 42:25-29. [PMID: 36696248 DOI: 10.1080/01676830.2021.2020850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To describe the utilization of acellular cadaveric dermal matrix (ACDM) in patients undergoing orbital wall reconstruction after orbital preservation surgery for sinonasal malignancy. METHODS Retrospective case series of seven patients with sinonasal malignancy who had orbital reconstruction with ACDM implants from January 2012 to August 2020. Orbital preservation was performed in all patients with tumor extension up to and including periorbital. The main outcome measures were implant exposure, orbital infection, diplopia in primary gaze, enophthalmos, and eyelid malposition. RESULTS Patients ranged 37-78 years old (median: 66 years) and included 4 females and 3 males. The median follow-up time was 9 months (range 6-43 months) from the date of surgery. Squamous cell carcinoma comprised the majority of tumors with all patients needing medial wall reconstruction. Three patients received postoperative radiation therapy. No patients had any implant exposure, orbital infection, enophthalmos, or eyelid malposition. CONCLUSIONS ACDM grafts can be used safely in orbital wall reconstruction in patients with sinonasal malignancies.
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Affiliation(s)
- Rohan Verma
- Division of Oculofacial Plastic and Reconstructive Surgery, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Allison J Chen
- Shiley Eye Institute and Viterbi Department of Ophthalmology, UC San Diego, San Diego, California, USA
| | - Jennifer Murdock
- Division of Oculofacial Plastic and Reconstructive Surgery, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Roger A Dailey
- Division of Oculofacial Plastic and Reconstructive Surgery, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - John D Ng
- Division of Oculofacial Plastic and Reconstructive Surgery, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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7
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Popić B, Kopić A, Holik D, Dinjar K, Kopić V, Matijević M, Popić F. Lateral orbital wall reconstruction after basal cell carcinoma penetration—Case report. Front Surg 2022; 9:925824. [PMID: 36132206 PMCID: PMC9483005 DOI: 10.3389/fsurg.2022.925824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Advanced periorbital basal cell carcinomas may necessitate orbital exenteration and consequent vision loss, which significantly reduces patients’ life quality. Orbital reconstruction is a demanding surgical procedure due to the complex orbital anatomy and vital structures located in the orbit. In this report, we presented an 83-year-old patient with advanced basal cell carcinoma that had expanded into the orbit. An orbitotomy was performed to remove the tumor completely while preserving the eye function. Orbital reconstruction was performed by a standard surgical method using a titanium mesh modeled according to a natural phantom skull. This maintained the eye function and achieved satisfactory facial esthetics.
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Affiliation(s)
- Bruno Popić
- Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia
| | - Andrijana Kopić
- Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Correspondence: Andrijana Kopić
| | - Dubravka Holik
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Kristijan Dinjar
- Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vlatko Kopić
- Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marko Matijević
- Dental Practice, Community Healthcare Center of Osijek-Baranja County, Osijek, Croatia
| | - Fran Popić
- Dental Practice, Community Healthcare Center of Osijek-Baranja County, Osijek, Croatia
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8
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Collins J, Takhar A, Niziol R, Fry A, Oakley R, Hopkins C, Surda P. Single-stage endoscopic-assisted eye sparing resection with primary orbital reconstruction for sinonasal malignancy. Rhinology 2022; 60:397-400. [PMID: 35818924 DOI: 10.4193/rhin22.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J Collins
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Takhar
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Niziol
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Fry
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Oakley
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - C Hopkins
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - P Surda
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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9
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Shin CH, Lee HJ, Chung YS, Kim JH. Treatment Outcomes of Sinonasal Malignancies Involving the Orbit. Skull Base Surg 2022; 83:e430-e437. [DOI: 10.1055/s-0041-1730353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Objective Orbital invasion is associated with a poor prognosis in cases of sinonasal malignancy. This study aimed to analyze the oncological outcomes of sinonasal malignancies involving the orbit.
Patients and Methods We reviewed the medical records of 116 patients with a sinonasal malignancy who had orbital invasion at initial diagnosis and followed up at least 6 months between June 1991 and October 2017 at a single institute. The overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) rates according to the clinicopathological factors, extent to orbit, and treatment modality were compared.
Results Patients were mainly treated with surgery and postoperative radiation (n = 39, 33.6%) and concurrent chemoradiation (n = 72, 62.1%). Only five patients (5.1%) underwent orbital exenteration. The OS, DSS, and PFS rates significantly decreased in patients older than 60 years of age and in patients with a higher Charlson Comorbidity Index Score (each p < 0.001). The OS and DSS rates were higher in patients at clinical T3 and N0 stage than in patients at clinical T4 and N1–2 stage (each p < 0.05). There were no significant differences in survival and local control rates according to the extent of orbital invasion, treatment modalities, and orbital preservation. However, neoadjuvant chemotherapy and adjuvant radiation or concurrent chemoradiation increased survival rates in the patients treated with surgery.
Conclusion Orbit preservation and relatively successful oncological outcome could be obtained with surgery and adjuvant radiation or concurrent chemoradiation.
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Affiliation(s)
- Chul Ho Shin
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jun Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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López F, Shah JP, Beitler JJ, Snyderman CH, Lund V, Piazza C, Mäkitie AA, Guntinas-Lichius O, Rodrigo JP, Kowalski LP, Quer M, Shaha A, Homma A, Sanabria A, Ferrarotto R, Lee AWM, Lee VHF, Rinaldo A, Ferlito A. The Selective Role of Open and Endoscopic Approaches for Sinonasal Malignant Tumours. Adv Ther 2022; 39:2379-2397. [PMID: 35352310 PMCID: PMC9122878 DOI: 10.1007/s12325-022-02080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
Endoscopic endonasal surgery has been demonstrated to be effective in the treatment of selected cases of sinonasal cancers. However, in cases of locally advanced neoplasms, as well as recurrences, the most appropriate approach is still debated. The present review aims to summarize the current state of knowledge on the utility of open approaches to resect sinonasal malignant tumours. Published comparative studies and meta-analyses suggest comparable oncological results with lower morbidity for the endoscopic approaches, but selection biases cannot be excluded. After a critical analysis of the available literature, it can be concluded that endoscopic surgery for selected lesions allows for oncologically safe resections with decreased morbidity. However, when endoscopic endonasal surgery is contraindicated and definitive chemoradiotherapy is not appropriate, craniofacial and transfacial approaches remain the best therapeutic option.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain.
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Maine General Hospital, Augusta, Maine, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Valerie Lund
- The Royal National Throat Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy, Brescia, Italy
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Luiz P Kowalski
- Department of Otorhinolaryngology, Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Akihiro Homma
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Victor H F Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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11
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Jozaghi Y, Phan J, Hanna EY, Kupferman ME, Su SY. Functional Outcomes and Quality of Life in Patients with Sinonasal, Nasopharyngeal, and Anterior Skull Base Tumors. Curr Oncol Rep 2022; 24:775-781. [PMID: 35290597 DOI: 10.1007/s11912-022-01214-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This article will review functional and QOL outcomes among patients treated predominantly for sinonasal and nasopharyngeal malignancies. RECENT FINDINGS Treatment advances and interdisciplinary supportive care help to lessen the functional impairments and the reduction in quality of life (QOL) that were once accepted as inevitable tradeoffs for cure. Recent progress in QOL and Patient-Reported Outcome (PRO) instruments for this population will be covered. Sinonasal and nasopharyngeal tumors affect patients' quality of life, appearance, and critical functions. Tumors arise in proximity of vital structures including the orbit, cranial nerves, carotid artery, brain, cervical spine, and pituitary gland. Surgical morbidity, along with acute and late effects of systemic therapy and radiotherapy on normal tissues in this functionally critical region, may result in wide-ranging symptoms. Patients with skull base tumors report a high symptom burden at presentation, prior to treatment, relative to other malignancies in the head and neck region.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA.
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12
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Conservative management of orbital involvement in malignant tumors. Curr Opin Otolaryngol Head Neck Surg 2022; 30:125-129. [DOI: 10.1097/moo.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Vahdani K, Rose GE. Ophthalmic Presentation and Outcomes for Malignant Sinonasal Tumors. Ophthalmic Plast Reconstr Surg 2022; 38:29-33. [PMID: 33782330 DOI: 10.1097/iop.0000000000001972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the ophthalmic clinical features and functional outcomes for patients with malignant sinonasal tumors who initially presented with orbital symptoms. PATIENTS AND METHODS Retrospective chart review for patients seen at Moorfields Eye Hospital between 1997 and 2020. Patient demographics and clinical features, radiology, histology, and treatment outcomes were reviewed. RESULTS Forty patients (22 females; 55%) with sinonasal cancers first presented to an ophthalmologist at an average age of 53.9 years (median 56; range 8-92 years), with their having had first symptoms at 53.6 years (median 55.8; range 7.8-91.9 years). The commonest symptoms were persistent periorbital ache (19/40; 48%), periocular swelling (18; 45%), proptosis (16; 40%), and diplopia (15; 38%). All midface tumors affected only 1 orbit, and 13 of 40 (33%) eyes presented with an acuity of 20/60 or worse-5 having no perception of light-and 10 eyes (25%) had a relative afferent pupillary defect. An average of 4.5 mm relative exophthalmos was present (median 4 mm; range 0-9 mm), and a palpable mass in 19 of 40 (48%) orbits. Reduced eye movements and nonaxial displacement were recorded in 29 (73%) and 34 (85%) patients, respectively, and 9 (23%) had an abnormal optic disc or fundus. Bone erosion affected 95% of orbits, and almost a half had involvement of the neighboring extraocular muscles, orbital apex, or intracranially. The commonest tumor groups were sinonasal carcinomas (45%), sarcomas (28%), or lymphomas (11%). Of 37 globe-sparing treatments, 25 (68%) had persistence of previously impaired ophthalmic functions and 6 of 37 (16%) developed new impairment; only 6 of 37 (16%) of affected orbits retained normal function, and 6 patients lost all vision on the affected side. CONCLUSIONS Sinonasal malignancies that present with orbital invasion are probably at the more aggressive end of the cancer spectrum, might be expected to carry a worse prognosis, and usually arise from the ethmoid or maxillary sinuses. In our series, carcinomas and sarcomas were the commonest malignancies, with similar 5-year overall survivals (of just over 50%), and over three-quarters of patients developed permanent impairment of orbital function and/or visual loss.
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Affiliation(s)
- Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
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14
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Koka K, Rahim FE, El-Hadad C, Bell D, Debnam JM, Guo Y, Esmaeli B. Primary Ewing's sarcoma with orbit involvement: Survival and visual outcomes after eye-sparing multidisciplinary management in eight patients. Head Neck 2021; 43:3857-3865. [PMID: 34632670 DOI: 10.1002/hed.26884] [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: 02/08/2021] [Revised: 08/13/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To describe the clinical presentation, treatment, and overall prognosis in eight patients with primary Ewing's sarcoma (ES) involving the orbit. METHODS A retrospective interventional study of all biopsy-proven cases of primary ES involving the orbit was done. RESULTS There were seven males and one female with a median age of 14 years. Imaging showed osseous involvement in all eight cases with extraorbital extension in four. Complete tumor resection was done in four, partial resection in three, and biopsy followed by sinus surgery in one. EWSR1 gene rearrangement analysis was done to confirm diagnosis. All patients received multidrug systemic chemotherapy and seven patients received adjuvant radiotherapy. Eye salvage was achieved in all patients. At a mean follow-up duration of 52.63 months, seven patients were doing well with no evidence of disease. CONCLUSIONS ES involving the orbit is sensitive to chemotherapy and radiation. Aggressive multimodality treatment can help salvage the globe and improve overall survival.
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Affiliation(s)
- Kirthi Koka
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Farrah E Rahim
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Christian El-Hadad
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Diana Bell
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - J Matthew Debnam
- Department of Neuroradiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Yunxia Guo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Castelnuovo P, Lambertoni A, Sileo G, Valentini M, Karligkiotis A, Battaglia P, Turri-Zanoni M. Critical review of multidisciplinary approaches for managing sinonasal tumors with orbital involvement. ACTA ACUST UNITED AC 2021; 41:S76-S89. [PMID: 34060523 PMCID: PMC8172109 DOI: 10.14639/0392-100x-suppl.1-41-2021-08] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
Orbital invasion is frequently observed in tumors involving the maxillary, ethmoid and frontal sinuses given the proximity of the orbit to the sinonasal tract and ventral skull base. The main objective of the present review is to determine the existing evidences on the frequency, treatment, and outcomes of orbital invasion in benign and malignant sinonasal tumors. A systematic review of the literature published from 1995 to 2020 was performed and data sources included PubMed, Cochrane library, NCBI Bookshelf, National Guideline Clearinghouse. Orbital invasion was reported in 2-4% of inverted papillomas, 12-15% of fibro-osseous lesions, 27-32% of juvenile angiofibromas, 35-45% of low-grade malignancies, and 50-80% of high-grade cancers. Surgical resection with negative margins represents the cornerstone of management for benign and low-grade malignant tumors. Histology-specific induction chemotherapy can be used for high-grade sinonasal cancers in order to downstage the tumor and increase the possibility of orbital preservation. When a significant response to induction chemotherapy is observed, exclusive chemoradiation should be offered to improve overall survival rates. Appropriate reconstruction of any surgical defects is essential in order to minimize complications and optimize functional and aesthetic outcomes. Orbital apex invasion represents a negative prognostic factor. In conclusion, a multidisciplinary teamwork is mandatory to maximize local control, minimize morbidity and improve orbital preservation rates.
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Affiliation(s)
- 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
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Valentini
- Division of Otorhinolaryngology, 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, 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
| | - 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
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16
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Ferrari M, Cazzador D, Taboni S, Trimarchi MV, Emanuelli E, Nicolai P. When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement? ACTA ACUST UNITED AC 2021; 41:S3-S17. [PMID: 34060516 PMCID: PMC8172110 DOI: 10.14639/0392-100x-suppl.1-41-2021-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
The term “sinonasal tumours” includes a large spectrum of diseases, which are characterized by heterogeneous biological behavior and prognosis, and located in a critical anatomic area. Diagnosis and treatment of sinonasal tumours require the contribution of different disciplines. A narrative review was performed to highlight the role of surgeons in contributing to a multidisciplinary approach to sinonasal tumours. Diagnosis and staging of sinonasal tumours is challenging and requires collaboration between surgeons, radiologists, and pathologists. The identification and management of critical extensions (orbital or intracranial encroachment, vascular abutment or encasement) is fundamental for successful treatment. Most cases of advanced sinonasal tumours can undergo surgical intervention by an adequately trained otorhinolaryngological team. The contribution of neurosurgeons and oculoplastic surgeons is required in selected scenarios. In rare circumstances, multidisciplinary reconstructive strategies can be indicated for complex tissue defects. Furthermore, a multidisciplinary approach is pivotal in the management of perioperative complications. While surgery remains the mainstay of treatment, the role of non-surgical adjuvant or even exclusive treatments is constantly expanding.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy.,Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada
| | - Diego Cazzador
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Vittoria Trimarchi
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Enzo Emanuelli
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
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17
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Surgical Management of Sinonasal Cancers: A Comprehensive Review. Cancers (Basel) 2021; 13:cancers13163995. [PMID: 34439150 PMCID: PMC8393312 DOI: 10.3390/cancers13163995] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/21/2022] Open
Abstract
Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, specific criteria related to the tumor (tumor extensions, tumor pathology), the patient, or the surgeon himself. The aims of this review are (i) to provide a complete overview of the surgical techniques available for the management of sinonasal malignant tumors, with a special focus on recent developments in the field of transnasal endoscopic surgery; (ii) to summarize the criteria that lead to the choice of one technique over another. In particular, the oncological outcomes, the morbidity of the different techniques, and the specificities of each histologic subtype will be discussed based on a comprehensive literature review.
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18
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Panda S, Raveendran S, Kumar R, Thakar A. Neoadjuvant chemotherapy for locoregionally advanced squamous cell carcinoma of the paranasal sinuses-Is it worthwhile? Cancer 2021; 127:3264. [PMID: 34081774 DOI: 10.1002/cncr.33674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/05/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Smriti Panda
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarath Raveendran
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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19
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Martel A, Baillif S, Nahon-Esteve S, Gastaud L, Bertolotto C, Lassalle S, Lagier J, Hamedani M, Poissonnet G. Orbital exenteration: an updated review with perspectives. Surv Ophthalmol 2021; 66:856-876. [PMID: 33524457 DOI: 10.1016/j.survophthal.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 01/15/2023]
Abstract
Orbital exenteration is a radical and disfiguring surgery mainly performed in specialized tertiary care centers. Orbital exenteration has long been considered the treatment of choice for managing periocular tumors invading the orbit or primary orbital malignancies. Over the past decades, attention has been directed toward reducing the perioperative morbidity by developing new surgical devices and new strategies and promoting cosmetic rehabilitation by providing adequate facial prostheses. Despite these advances, several studies have questioned the role of orbital exenteration in improving overall survival. The last decade has been marked by the emergence of a new paradigm: the "eye-sparing" strategies based on conservative surgery with or without adjuvant radiotherapy and/or targeted therapies and immunotherapies. We summarize the data on orbital exenteration, including epidemiology, etiologies, use of surgical ablative and reconstructive techniques, complications, outcomes, and the related controversies.
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Affiliation(s)
- Arnaud Martel
- Université Côte d'Azur, Ophthalmology department, Centre Hospitalier Universitaire de Nice, Nice, France.
| | - Stephanie Baillif
- Université Côte d'Azur, Ophthalmology department, University Hospital of Nice, Nice, France
| | - Sacha Nahon-Esteve
- Université Côte d'Azur, Ophthalmology department, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Lauris Gastaud
- Oncology department, Antoine Lacassagne Cancer Centre, Nice, France
| | | | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology and Biobank BB-0033-00025, Nice, France
| | - Jacques Lagier
- Université Côte d'Azur, Ophthalmology department, University Hospital of Nice, Nice, France
| | - Mehrad Hamedani
- Oculoplastic department, Jules Gonin Eye hospital, Lausanne, Switzerland
| | - Gilles Poissonnet
- Cervico-facial department, Institut Universitaire de la Face et du Cou, Nice, France
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20
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Ferrari M, Migliorati S, Tomasoni M, Crisafulli V, Nocivelli G, Paderno A, Rampinelli V, Taboni S, Schreiber A, Mattavelli D, Lancini D, Gualtieri T, Ravanelli M, Facchetti M, Bozzola A, Ardighieri L, Maroldi R, Bossi P, Farina D, Battocchio S, Deganello A, Nicolai P. Sinonasal cancer encroaching the orbit: Ablation or preservation? Oral Oncol 2021; 114:105185. [PMID: 33517131 DOI: 10.1016/j.oraloncology.2021.105185] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/10/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Encroachment on the orbital cavity represents a challenge in the management of sinonasal cancer. Criteria guiding orbital preservation lack univocal consensus. Stage of orbital involvement is best assessed through magnetic resonance imaging (MRI). METHODS Patients affected by orbit-encroaching sinonasal cancer with available preoperative MRI, receiving surgery-based treatment at the University of Brescia between May 2005 and October 2018 were included. All cases were reviewed by expert radiologists and pathologists. Diagnostic performance of MRI was calculated using pathological information as reference. Survival analysis was performed. RESULTS The study included 123 patients. The orbit was abutted in 53 (43.1%) patients, whereas orbital invasion reached the periorbit in 18 (14.6%), extraconal fat and/or medial lacrimal sac in 29 (23.6%), extrinsic ocular muscles in 7 (5.7%), intraconal compartment in 4 (3.3%), and orbital apex in 12 (9.8%). Seventy-six (61.8%) patients received orbit-sparing surgery, 47 (38.2%) underwent orbital ablation (OA). Accuracy of MRI in detecting involvement by cancer was ≥80.0% for the orbital wall, extraconal fat, and muscles, and <80.0% for the periorbit and intraconal compartment. Previous surgery, neoadjuvant chemotherapy, and perineural invasion decreased MRI accuracy. Age, histology, tumor grade, pT category, N status, perineural invasion, orbital invasion stage, and need for OA were found to affect prognosis. Five-year orbital dysfunction-free survival was 92.8%. CONCLUSION Conservative management of sinonasal cancers encroaching the orbit is feasible. MRI is essential to preoperatively stage orbital invasion, yet with some limitation. Given the dismal prognosis despite aggressive surgery, neoadjuvant non-surgical therapies should be considered in patients requiring OA.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.
| | - Sara Migliorati
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Valentina Crisafulli
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Giorgio Nocivelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Mattia Facchetti
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Anna Bozzola
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Laura Ardighieri
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Farina
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Simonetta Battocchio
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
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Yang J, Song X, Lai Y, Zhao W, Zhou J, Liu Q, Li W, Zhang H, Wang H, Shi P, Yu H, Sun X, Wang D. Development and validation of a postoperative nomogram for predicting overall survival after endoscopic surgical management of olfactory neuroblastoma. EClinicalMedicine 2020; 29-30:100577. [PMID: 33305194 PMCID: PMC7711220 DOI: 10.1016/j.eclinm.2020.100577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Olfactory neuroblastoma (ONB) is a rare malignancy arising in the nasal vault. Endoscopic resection has been reported to improve overall survival (OS). At present, clinicopathological predictors of the prognosis of ONB remain undefined. METHODS Data including demographics, clinical characteristics and follow-up information of ONB patients treated with endoscopic surgery were collected. Risk factors on OS rates were investigated by LASSO and Cox analyses. A nomogram was developed and evaluated with internal validation. Risk groups were established according to patients' points in the nomogram. FINDINGS 154 ONB patients treated with surgery were included in this single center study. A nomogram based on multivariate Cox regression model including multiple tumor history, orbital invasion, carotid canal invasion, modified Kadish stage, delivery sequence of RT and surgery, sequence of chemotherapy and surgery was developed. The bias-corrected C-index (0.886 [95% CI: 0.843-0.943]) was significantly higher than of conventional staging classifications. The AUC of nomogram regarding 1-, 2- and 5-year OS probabilities reached 0.912, 0.929 and 0.957, respectively. The risk levels based on nomogram points were more discriminative than conventional classifications. INTERPRETATION Validation analysis showed good predictive accuracy and discriminative ability of the nomogram. Therefore, the nomogram could be utilized to individually predict survival probability for ONB patients after endoscopic resection. FUNDING This study was funded by the Chinese Academy of Medical Sciences (No. 2019-I2M-5-003), the Shanghai Science and Technology Commission (No. 19411950600), the Shanghai Hospital Development Center (No. SHDC12018118) and the Eye, Ear, Nose and Throat Hospital of Fudan University (No. SYB202006).
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Affiliation(s)
- Jingyi Yang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Xiaole Song
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Yuting Lai
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Weidong Zhao
- Department of Nasal and Cranial Surgery, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Jiaying Zhou
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Quan Liu
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Wanpeng Li
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Huankang Zhang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Huan Wang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Peng Shi
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110000, PR China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
- Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor, Chinese Academy of Medical Sciences, Shanghai 200031, PR China
| | - Xicai Sun
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Dehui Wang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
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Reyes C, Patel M, Solares CA. Sinonasal Malignancy and Orbital Exenteration Sparing Cancer Surgery. J Neurol Surg B Skull Base 2020; 81:369-375. [PMID: 33072478 DOI: 10.1055/s-0040-1713937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This article reviews the most common locations and natural history of sinonasal carcinomas. It also reviews surgical indications and current evidence regarding adjuvant and neoadjuvant therapies. In the past, orbital clearance was generally done for ethmoid and maxillary cancers, even without a marked neoplastic infiltration; however, such indications have changed in the recent years due to advances in our understanding of the disease, as well as new chemotherapeutic and radiotherapy protocols. Surgical resection of tumors close to the orbit exhibits the challenging task of balancing treatment goals and patient's desires.
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Affiliation(s)
- Camilo Reyes
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, Georgia, United States
| | - Mihir Patel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute at Emory University, Emory University, Atlanta, Geogia, United States
| | - C Arturo Solares
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute at Emory University, Emory University, Atlanta, Geogia, United States
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Sanomura T, Norikane T, Fujimoto K, Kawanishi M, Hoshikawa H, Nishiyama Y. A case of bleeding from maxillary carcinoma embolized from the maxillary and ophthalmic arteries. CVIR Endovasc 2020; 3:74. [PMID: 33006699 PMCID: PMC7532231 DOI: 10.1186/s42155-020-00167-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background The majority of maxillary sinus cancers are advanced at initial detection due to anatomical limitations and lack of early symptoms. In patients with orbital invasion, the feeding arteries of the tumor are often associated with the ophthalmic artery in addition to the maxillary artery. We describe a case of tumor bleeding in a patient with recurrent maxillary carcinoma that was treated with embolization from the maxillary and ophthalmic arteries. Case presentation A 70-year-old man was treated for left maxillary carcinoma from the maxillary artery with 6 cycles of selective intra-arterial cisplatin infusion with concomitant radiation therapy. He subsequently had epistaxis and underwent arterial embolization for hemostasis. He had almost no sight by this time. Angiography of the left external carotid artery and internal carotid artery revealed blood supply from the maxillary and ophthalmic arteries. Regarding the maxillary artery, coil embolization was performed after embolization with 300-500 μm Embosphere. On the other hand, for the ophthalmic artery, the 3rd portion, supratrochlear artery and dorsal nasal artery, were selected and embolized with coils. Final angiography revealed disappearance of tumor staining and a residual choroidoretinal blush. There was no bleeding that needed treatment up to 2 months after embolization. Conclusions In embolization of the ophthalmic artery, it is necessary to embolize the second and subsequent parts because the arteries associated with visual function branch off from the first part. Even in patients whose visual acuity has been almost lost, like in this case, there is a risk of eye pain from embolization at the proximal end, and distal embolization is necessary.
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Affiliation(s)
- Takayuki Sanomura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Kengo Fujimoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Masahiko Kawanishi
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Hiroshi Hoshikawa
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Ophthalmic and orbital considerations in the evaluation of skull base malignancies. J Neurooncol 2020; 150:483-491. [PMID: 32361865 DOI: 10.1007/s11060-020-03516-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system. METHODS We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base. RESULTS AND CONCLUSION Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes.
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Meerwein CM, Pazahr S, Soyka MB, Hüllner MW, Holzmann D. Diagnostic accuracy of computed tomography and magnetic resonance imaging compared to surgical exploration for anterior skull base and medial orbital wall infiltration in advanced sinonasal tumors. Head Neck 2020; 42:2002-2012. [DOI: 10.1002/hed.26129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christian M. Meerwein
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Shila Pazahr
- University of Zurich Zurich Switzerland
- Department of NeuroradiologyUniversity Hospital Zurich Zurich Switzerland
| | - Michael B. Soyka
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Martin W. Hüllner
- University of Zurich Zurich Switzerland
- Department of Nuclear MedicineUniversity Hospital Zurich Zurich Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
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The value of preoperative radiotherapy in the treatment of locally advanced nasal cavity and paranasal sinus squamous cell carcinoma: A single institutional experience. Oral Oncol 2019; 101:104512. [PMID: 31869689 DOI: 10.1016/j.oraloncology.2019.104512] [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: 08/20/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to explore the value of preoperative radiotherapy in the comprehensive treatment of locally advanced nasal cavity and paranasal sinus squamous cell carcinomas (LA-NPSCCs). MATERIALS This retrospective study included 140 patients with stage III-IVB NPSCCs treated with pre-/postoperative radiotherapy plus surgery. The complete resection rate, pathologic complete response (pCR) rate, and orbital content retention rate were calculated. The overall survival (OS), local control (LC), distance metastasis free survival (DMFS) and disease-free survival (DFS) between treatment groups were evaluated. RESULTS With a median follow-up of 92.3 months, the 5-year OS, LC, DMFS, and DFS of entire cohort were 62.0%, 65.5%, 85.4%, and 57.8%, respectively. The preoperative radiotherapy group achieved similar LC, DFS, DMFS, and OS rates compared to postoperative radiotherapy group, despite higher rates of stage IV and orbital content/apex invasion. The preoperative radiotherapy resulted in significantly improved complete resection rate (93.3% vs 38.0%, p < 0.001). In the preoperative radiotherapy group, one third of patients achieved pathologic complete response. The pCR subgroup achieved statistically higher 5-year OS, LC, DFS (p < 0.05), but similar 5-year DMFS (p > 0.05) compared to non-pCR subgroup. The actual orbital content retention rate in preoperative radiotherapy group was 85.7%, superior to 58.3% in postoperative radiotherapy group (p = 0.049). CONCLUSION On the basis of multimodality therapy becoming standard paradigm for LA-NPSCCs, preoperative radiotherapy significantly improved complete resection rate and orbital content retention rate. Therefore, preoperative radiotherapy followed by surgery might be desirable for LA-NPSCCs, especially for those with organ preservation intention.
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Owen JL, Kibbi N, Worley B, Kelm RC, Wang JV, Barker CA, Behshad R, Bichakjian CK, Bolotin D, Bordeaux JS, Bradshaw SH, Cartee TV, Chandra S, Cho NL, Choi JN, Council ML, Demirci H, Eisen DB, Esmaeli B, Golda N, Huang CC, Ibrahim SF, Jiang SB, Kim J, Kuzel TM, Lai SY, Lawrence N, Lee EH, Leitenberger JJ, Maher IA, Mann MW, Minkis K, Mittal BB, Nehal KS, Neuhaus IM, Ozog DM, Petersen B, Rotemberg V, Samant S, Samie FH, Servaes S, Shields CL, Shin TM, Sobanko JF, Somani AK, Stebbins WG, Thomas JR, Thomas VD, Tse DT, Waldman AH, Wong MK, Xu YG, Yu SS, Zeitouni NC, Ramsay T, Reynolds KA, Poon E, Alam M. Sebaceous carcinoma: evidence-based clinical practice guidelines. Lancet Oncol 2019; 20:e699-e714. [PMID: 31797796 DOI: 10.1016/s1470-2045(19)30673-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Abstract
Sebaceous carcinoma usually occurs in adults older than 60 years, on the eyelid, head and neck, and trunk. In this Review, we present clinical care recommendations for sebaceous carcinoma, which were developed as a result of an expert panel evaluation of the findings of a systematic review. Key conclusions were drawn and recommendations made for diagnosis, first-line treatment, radiotherapy, and post-treatment care. For diagnosis, we concluded that deep biopsy is often required; furthermore, differential diagnoses that mimic the condition can be excluded with special histological stains. For treatment, the recommended first-line therapy is surgical removal, followed by margin assessment of the peripheral and deep tissue edges; conjunctival mapping biopsies can facilitate surgical planning. Radiotherapy can be considered for cases with nerve or lymph node involvement, and as the primary treatment in patients who are ineligible for surgery. Post-treatment clinical examination should occur every 6 months for at least 3 years. No specific systemic therapies for advanced disease can be recommended, but targeted therapies and immunotherapies are being developed.
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Affiliation(s)
- Joshua L Owen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nour Kibbi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ryan C Kelm
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jordan V Wang
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramona Behshad
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | | | - Diana Bolotin
- Section of Dermatology, The University of Chicago, Chicago, IL, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott H Bradshaw
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Todd V Cartee
- Division of Dermatology, Pennsylvania State University, Hershey, PA, USA
| | - Sunandana Chandra
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Jennifer N Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Laurin Council
- Division of Dermatology, Center for Dermatologic and Cosmetic Surgery, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Eisen
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Conway C Huang
- Department of Dermatology, University of Alabama, Birmingham, AL, USA
| | - Sherrif F Ibrahim
- Department of Dermatology, University of Rochester, Rochester, NY, USA
| | - S Brian Jiang
- Department of Dermatology, University of California San Diego, San Diego, CA, USA
| | - John Kim
- Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Timothy M Kuzel
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Stephen Y Lai
- Departments of Head and Neck Surgery and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naomi Lawrence
- Department of Dermatology, Cooper Hospital, Rowan University, Camden, NJ, USA
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Margaret W Mann
- Department of Dermatology, University Hospital, Cleveland, OH, USA
| | - Kira Minkis
- Department of Dermatology, Weill-Cornell Medical College, New York, NY, USA
| | - Bharat B Mittal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Isaac M Neuhaus
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Brian Petersen
- Department of Dermatology, Colorado Permanente Medical Group, Denver, CO, USA
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandeep Samant
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA
| | - Sabah Servaes
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ally-Khan Somani
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William G Stebbins
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Regan Thomas
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Valencia D Thomas
- Dermatology and Dermatopathology, Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David T Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abigail H Waldman
- Brigham and Women's Hospital Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Michael K Wong
- Division of Cancer Medicine, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Gloria Xu
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, USA
| | - Siegrid S Yu
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Timothy Ramsay
- The Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Kelly A Reynolds
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Li R, Tian S, Zhu Y, Zhu W, Wang S. Management of orbital invasion in sinonasal squamous cell carcinoma: 15 years' experience. Int Forum Allergy Rhinol 2019; 10:243-255. [PMID: 31756058 DOI: 10.1002/alr.22465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study was intended to review our management strategy for sinonasal squamous cell carcinomas (SNSCCs) with orbital invasion and to explore the role of radiotherapy in orbital preservation. METHODS We retrospectively analyzed 93 SNSCC patients with orbital invasion who underwent radiotherapy with or without surgery over the past 15 years. The degree of orbital invasion was classified into 3 grades. RESULTS Eighty-eight patients presented with T4 tumors and 36 had grade III orbital invasion. Seventy-two patients received surgery plus radiation and 67 received platinum-based chemotherapy. The median follow-up for surviving patients was 60 months. Five-year overall survival (OS) for the whole group was 57.4%. The patients treated with surgery plus radiation had a 5-year survival rate of 62.2% and orbital preservation was feasible in 90.3% of cases. Twenty-one patients with SNSCCs that extended into the extraocular muscles or eye globe also underwent orbital preservation. Five-year locoregional relapse-free survival (LRFS) was 69.5% for patients treated with orbital preservation and 57.1% for those treated with orbital exenteration, indicating no statistical difference. Five-year survival, 5-year progression-free survival (PFS), and 5-year distant metastasis-free survival (DMFS) were similar between groups. Grade III orbital invasion was independently associated with shorter OS, LRFS, PFS, and DMFS. CONCLUSION Orbital invasion in grade III was associated with the worst survival outcomes. Invasion of either the extraocular muscles or eye globe is not a contraindication for eye-sparing surgery. Preoperative chemoradiation continues to offer hope to patients with a strong desire to preserve their eyes.
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Affiliation(s)
- Ruichen Li
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shu Tian
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Wenjia Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Sugiyama S, Katsui K, Tominaga Y, Waki T, Katayama N, Matsuzaki H, Kariya S, Kuroda M, Nishizaki K, Kanazawa S. Dose distribution of intensity-modulated proton therapy with and without a multi-leaf collimator for the treatment of maxillary sinus cancer: a comparative effectiveness study. Radiat Oncol 2019; 14:209. [PMID: 31752928 PMCID: PMC6873663 DOI: 10.1186/s13014-019-1405-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe complications, such as eye damage and dysfunciton of salivary glands, have been reported after radiotherapy among patients with head and neck cancer. Complications such as visual impairment have also been reported after proton therapy with pencil beam scanning (PBS). In the case of PBS, collimation can sharpen the penumbra towards surrounding normal tissue in the low energy region of the proton beam. In the current study, we examined how much the dose to the normal tissue was reduced by when intensity-modulated proton therapy (IMPT) was performed using a multi-leaf collimator (MLC) for patients with maxillary sinus cancer. METHODS Computed tomography findings of 26 consecutive patients who received photon therapy at Okayama University Hospital were used in this study. We compared D2% of the region of interest (ROI; ROI-D2%) and the mean dose of ROI (ROI-mean) with and without the use of an MLC. The organs at risk (OARs) were the posterior retina, lacrimal gland, eyeball, and parotid gland. IMPT was performed for all patients. The spot size was approximately 5-6 mm at the isocenter. The collimator margin was calculated by enlarging the maximum outline of the target from the beam's eye view and setting the margin to 6 mm. All plans were optimized with the same parameters. RESULTS The mean of ROI-D2% for the ipsilateral optic nerve was significantly reduced by 0.48 Gy, and the mean of ROI-mean for the ipsilateral optic nerve was significantly reduced by 1.04 Gy. The mean of ROI-mean to the optic chiasm was significantly reduced by 0.70 Gy. The dose to most OARs and the planning at risk volumes were also reduced. CONCLUSIONS Compared with the plan involving IMPT without an MLC, in the dose plan involving IMPT using an MLC for maxillary sinus cancer, the dose to the optic nerve and optic chiasm were significantly reduced, as measured by the ROI-D2% and the ROI-mean. These findings demonstrate that the use of an MLC during IMPT for maxillary sinus cancer may be useful for preserving vision and preventing complications.
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Affiliation(s)
- Soichi Sugiyama
- Departments of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Radiology, Tsuyama Chuo Hospital, Tusyama, Okayama, 708-0841, Japan
| | - Kuniaki Katsui
- Departments of Proton Beam Therapy, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Yuki Tominaga
- Department of Radiation Technology, Tsuyama Chuo Hospital, Tusyama, Okayama, 708-0841, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, Tusyama, Okayama, 708-0841, Japan
| | - Norihisa Katayama
- Departments of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hidenobu Matsuzaki
- Departments of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shin Kariya
- Departments of Otolaryngology-Head and Neck Surgery, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazunori Nishizaki
- Departments of Otolaryngology-Head and Neck Surgery, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Departments of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Orbital outcomes after orbit-sparing surgery and free flap reconstruction. Oral Oncol 2019; 98:78-84. [DOI: 10.1016/j.oraloncology.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/07/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
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Ophthalmic Changes Following Maxillectomy With or Without Postoperative Radiation Therapy. J Craniofac Surg 2019; 30:1448-1451. [PMID: 31299741 DOI: 10.1097/scs.0000000000005437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate ophthalmic complications and quantitatively assess anatomic changes following maxillectomy with or without adjuvant radiotherapy in patients with midface malignancy. METHODS Twenty-four patients who underwent maxillectomy for sinus and/or paranasal cancer were included for retrospective review. Patients with complete ophthalmic examinations were evaluated for postoperative findings corresponding to sequelae of treatment. When available, anatomical changes including eyelid position were quantified from preoperative and postoperative full-face photos using computer software. RESULTS The most common complications identified in patients after maxillectomy were retraction/ectropion (50%), epiphora (29%), and exposure keratopathy/dry eye syndrome (25%). Patients treated with maxillectomy with adjuvant radiation therapy were more frequently found to have ophthalmic complications following treatment. In patients with available postoperative photos (n = 10), the mean ipsilateral margin reflex distance (MRD)2 and inferior scleral show were 8.4 mm and 2.4 mm, respectively. In patients with available preoperative photos (n = 5), the mean change in MRD2 and inferior scleral show following maxillectomy was 3.4 mm and 2.8 mm, respectively. CONCLUSION Patients undergoing maxillectomy for the treatment of head and neck malignancy may be at significant risk for development of specific periocular complications. Lower eyelid malposition was the most significant postoperative quantitative eyelid change following maxillectomy, which may be exacerbated by adjuvant radiotherapy and inferior orbital rim removal.
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Legocki AT, Miles BA. Considerations in Orbital Reconstruction for the Oncologic Surgeon: Critical versus Optimal Objectives. Indian J Plast Surg 2019; 52:231-237. [PMID: 31602141 PMCID: PMC6785328 DOI: 10.1055/s-0039-1696624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Orbital reconstruction following oncologic midface resection is uniquely challenging, and makes critical contributions to patient aesthetics, function, and identity. Approach is largely dependent on surgeon and patient preferences, and there exists no consensus on defect characterization. Objective The goal of the study is to provide a mental framework for the reconstructive oncologic surgeon to use as a foundation during his or her approach to the orbit. Design The design of the study is based on the review of current literature and expert opinion. Conclusions Critical versus optimal objectives must be set in orbital reconstruction, and a systematic approach should be followed. We approach orbital reconstruction by first deciding whether globe-sparing surgery is possible, or if orbital exenteration will be necessary. We then set critical and optimal objectives for our chosen pathway. Critical goals in globe-sparing reconstruction include maintaining orbital volume and preserving visual function, and an optimal goal includes preservation of the nasolacrimal system. Critical goals in orbital exenteration include obliterating the defect, sealing the skull base and nasal cavities, and allowing eye protection to be worn over the contralateral eye postoperatively. Optimal goals in exenteration include preparation for prosthetics, volume and bony replacement, eyelid-sparing technique, and consideration of postoperative radiation.
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Affiliation(s)
- Alex T Legocki
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, United States
| | - Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, United States
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Li R, Tian S, Zhu Y, Yan L, Zhu W, Quan H, Wang S. Management of orbital invasion in esthesioneuroblastoma: 14 years' experience. Radiat Oncol 2019; 14:107. [PMID: 31196122 PMCID: PMC6567903 DOI: 10.1186/s13014-019-1313-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022] Open
Abstract
Background There is a scarcity of data about the prognostic value of orbital invasion in esthesioneuroblastoma (ENB), as well as about its management strategies. Indications for the preservation of orbital contents remain controversial, and the evaluation of orbital invasion has been ill defined. Methods This retrospective analysis contained 60 ENB patients with orbital invasion who underwent radiotherapy with or without surgery over the past 14 years. Orbital invasion was classified into three grades. Results There were 52 patients at stage C and 8 at stage D, according to Foote classifications. Grade I, grade II and grade III orbital invasion was detected in 12, 23, and 25 patients, respectively. The median follow-up was 57 months (IQR 32–95 months). Fourteen patients received radical radiotherapy, with a 5-year overall survival (OS) of 63.5%; 46 received surgery plus radiation, with a 5-year OS of 70.7%; and the difference was not statistically significant (p = 0.847). Orbital preservation was feasible in 100% of cases, including 18 cases that extended to extraocular muscles or the eye globe. Five-year locoregional relapse-free survival was 100% in patients with prophylactic elective neck irradiation (PENI) and 58.1% in patients without PENI (p = 0.004). Univariate analysis showed that grade II/III orbital invasion was associated with poorer OS and progression-free survival. Neck metastasis (with a Foote stage of D) was independently associated with shorter OS and distant metastasis–free survival in multivariate analysis. Conclusions Our data suggested that primary radiotherapy achieved comparable survival to surgery plus radiotherapy in advanced ENB. Invasion of either the extraocular muscles or the eye globe is not a contraindication for eye-sparing surgery. Orbital invasion in grade II/III was significantly associated with adverse survival outcomes. Prophylactic radiotherapy to the neck with N0 significantly reduces the risk of regional recurrence.
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Affiliation(s)
- Ruichen Li
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Shu Tian
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Li Yan
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Wenjia Zhu
- Department of E.N.T, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Huatao Quan
- Department of E.N.T, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China.
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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.
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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
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Khoury T, Jang D, Carrau R, Ready N, Barak I, Hachem RA. Role of induction chemotherapy in sinonasal malignancies: a systematic review. Int Forum Allergy Rhinol 2018; 9:212-219. [DOI: 10.1002/alr.22229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/29/2018] [Accepted: 09/10/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Tawfiq Khoury
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery; Duke University; Durham NC
| | - David Jang
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery; Duke University; Durham NC
| | - Ricardo Carrau
- Department of Otolaryngology-Head & Neck Surgery; Ohio State University Medical Center; Columbus OH
| | - Neal Ready
- Division of Medical Oncology, Department of Medicine; Duke University; Durham NC
| | - Ian Barak
- Biostatistics Core, Department of Biostatistics and Bioinformatics; Duke University School of Medicine; Durham NC
| | - Ralph Abi Hachem
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery; Duke University; Durham NC
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Abstract
Paranasal fibrosarcoma of nasal cavity and paranasal sinuses is a very rare malignant tumor. It is usually presented with nasal obstruction and epistaxis. In this clinical report, clinical symptoms, pathogenesis, and treatment principles of a paranasal fibrosarcoma originating from the right maxillary sinus and obstructing the right nasal passage are discussed.A 55-year-old male patient was admitted to the authors clinic with complaints of nasal obstruction and epistaxis lasting for 2 years. Anterior rhinoscopy revealed a mass lesion which obstructed the right nasal passage and caused frequent epistaxis. An opacity consistent with soft tissue lesion which was originated from the right maxillary sinus and filled the right nasal passage was observed in paranasal tomography. Magnetic resonance imaging revealed that the mass lesion was contrasted. Tumor was seen to erode orbital floor, and lateral and anterior walls of the maxillary sinus. Biopsy result was reported as papilloma. The patient was treated with Denker approach as anterior wall of the maxillary sinus was eroded by the tumor lesion and the mass lesion was excised. The patient received postoperative radiotherapy as pathological diagnosis was reported as paranasal fibrosarcoma.
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Abstract
Background Oncologic resection of the maxilla requires management of the nasolacrimal sac/duct system (NLS). A variety of techniques may be used: simple transection, transection with transcanalicular stenting, drilling of the entire nasolacrimal bony canal to the inferior meatus with mobilization of an intact NLS, marsupialization of the NLS with or without stenting, and simple transection with routine delayed dacryocystorhinostomy (DCR) for symptomatic epiphora. Rates of prolonged epiphora range from 13 to 63%. Objectives We present our approach to NLS management during maxillectomy, and our rates of epiphora. Study Design Review of 212 consecutive patients who underwent transection of the NLS during medial maxillectomy, complete maxillectomy with preservation of orbital contents, suprastructure maxillectomy, or maxillectomy as part of anterior craniofacial resection. Patients with primary NLS tumors were excluded. Prolonged epiphora is defined as persistent if it lasts more than 6 months. Methods After exposure of the anterior maxillary wall and inferior and medial orbital rim, a high-speed drill and Kerrison rongeurs are used to remove the anterior wall of the nasolacrimal canal. The NLS is transected 12–15 mm distal to the periorbita and removed from the canal. Two 4–6-mm opposing incisions are made at the distal duct. Two semicircular flaps are everted, folded, and sutured to the proximal sac or periorbita. A transcanalicular stent is not placed. Results Two-hundred twelve patients underwent the abovementioned procedure. Four patients (1.9%) developed prolonged epiphora, which required delayed DCR. Conclusions Marsupialization of the NLS without stenting provided us with an acceptably low rate of prolonged epiphora.
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Affiliation(s)
- Ramez Habib
- Department of Otolaryngology, SUNY Downstate Medical Center and Continuum Cancer Centers, Brooklyn, NY Presented as a poster at the American Rhinologic Society 49th annual meeting, September 20, 2003, Orlando, FL
| | - Gady Har-El
- Department of Otolaryngology, SUNY Downstate Medical Center and Continuum Cancer Centers, Brooklyn, NY Presented as a poster at the American Rhinologic Society 49th annual meeting, September 20, 2003, Orlando, FL
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Kim HJ, Lee TH, Lee HS, Cho KS, Roh HJ. Periorbita: Computed Tomography and Magnetic Resonance Imaging Findings. ACTA ACUST UNITED AC 2018; 20:371-4. [PMID: 16955762 DOI: 10.2500/ajr.2006.20.2889] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose The periorbita has been regarded as the critical structure in decision of exenteration in the patients with paranasal (PNS) malignancies. The purpose of this study is to present the CT and MRI findings of the periorbita with PNS malignancies. Materials and Methods Ten patients with PNS cancers were chosen for this study. PNS CT and MRI scans were performed on all patients. The imaging findings were reviewed retrospectively by consensus of two neuroradiologists. Assessment of the defect of the orbital bone and invasion of the orbital fat was made by CT and MRI. The signal intensity (SI), thickness, enhancement, and correlation with the orbital bone of the periorbita were analyzed on MRI. The intraoperative and pathologic reports were used as the gold standard for orbital invasion. Results In patients with bone defects, it was impossible to differentiate the periorbita from the mass on CT. The periorbita showed hypointensity on T2-weighted images compared with the SI of mass. On Gd-enhanced T1-weighted images, the periorbita showed less enhancement than the mass in nine patients. Six patients showed two hypointense layers (the outer bony wall and the inner periorbita) between the mass and orbital fat on T2-weighted images. The thickness of the periorbita was 0.79–1.4 millimeter. Orbital invasion was more conspicuous on T2-weighted coronal images than on the CT images. Conclusions MRI was more conspicuous for detecting orbital invasion than CT. The mass beyond the thickened periorbita on T2-weighted images was considered to be a positive finding of orbital invasion.
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Affiliation(s)
- Hak Jin Kim
- Department of Radiology, College of Medicine, Medical Research Institute, Pusan National University, Pusan, South Korea
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39
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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]
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40
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A review of nasal, paranasal, and skull base tumors invading the orbit. Surv Ophthalmol 2017; 63:389-405. [PMID: 28739401 DOI: 10.1016/j.survophthal.2017.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
Abstract
Tumors that invade the orbit are uncommon. The majority are meningiomas arising from the sphenoid ridge (66%). Others are bone and cartilage tumors arising from the surrounding bones of the orbit, pituitary adenomas, and epithelial tumors arising from the paranasal sinuses and nasal cavity. Meningiomas occur more often in women, whereas epithelial tumors have a predilection for men. Meningiomas and epithelial tumors typically present in the sixth decade of life, whereas bone tumors tend to affect individuals in their third decade of life. Patients often present with a combination of ophthalmological and otorhinolaryngological symptoms, including proptosis, pain, decreased visual acuity, restrictions in motility of the eye, epistaxis, and nasal obstruction. Sarcomas and benign bone and cartilage tumors arise from surrounding structures, whereas carcinomas usually arise from the paranasal sinuses. Surgery is the mainstay of treatment. Depending on the aggressiveness and histology of the tumor, surgery may be combined with radiation and chemotherapy. The prognosis is generally poor, but varies depending on histology and cell origin, size of the tumor, and degree of invasion. Meningiomas and benign bone tumors have the best prognoses. Sinonasal undifferentiated carcinomas, small-cell neuroendocrine carcinomas, osteosarcomas, and rhabdomyosarcomas have poorer prognoses.
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41
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Neel GS, Nagel TH, Hoxworth JM, Lal D. Management of Orbital Involvement in Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 2017; 50:347-364. [DOI: 10.1016/j.otc.2016.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kobayashi K, Mori T, Matsumoto F, Murakami N, Teshima M, Fukasawa M, Matsumoto Y, Matsumura S, Itami J, Asai M, Yoshimoto S. Impact of microscopic orbital periosteum invasion in orbital preservation surgery. Jpn J Clin Oncol 2017; 47:321-327. [DOI: 10.1093/jjco/hyw207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/28/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kenya Kobayashi
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
| | - Taisuke Mori
- Department of Pathology, National Cancer Center Hospital, Tokyo
| | - Fumihiko Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
| | - Naoya Murakami
- Department of Radiation oncology, National Cancer Center Hospital, Tokyo
| | - Masanori Teshima
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
| | - Masahiko Fukasawa
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
| | - Yoshifumi Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
| | - Satoko Matsumura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
| | - Jun Itami
- Department of Radiation oncology, National Cancer Center Hospital, Tokyo
| | - Masahiro Asai
- Department of Otolaryngology, Kamagaya General Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo
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Gerring RC, Ott CT, Curry JM, Sargi ZB, Wester ST. Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival. Eye (Lond) 2016; 31:379-388. [PMID: 27768120 DOI: 10.1038/eye.2016.218] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/03/2016] [Indexed: 12/16/2022] Open
Abstract
PurposeTo describe prognostic factors and survival outcomes in patients who underwent orbital exenteration for periocular non-melanoma cutaneous malignancies.MethodsThe authors performed an institutional review board-approved retrospective review of all patients who underwent orbital exenteration for non-melanoma periocular cutaneous malignancies at a tertiary care hospital system over a 10-year period. Patient demographics, tumor, and treatment data were recorded. Survival outcomes included disease-free survival (DFS) and overall survival (OS). Log-rank tests were used to test for difference in survival curves among various potential prognostic indicators, and multivariate analysis was performed using Cox's proportional hazards model.ResultsForty-nine patients with an average age of 70.3 years were followed with a median follow-up of 17.5 months. At 2 years the OS was 78% while the DFS was 61%. The mean DFS for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous gland carcinoma (SGC) were 52.6, 39.2 and 28.1 months, respectively. Multivariate analysis demonstrated that only positive final surgical margin was predictive of worse outcome (P=0.002). Recurrences were most frequent in the first 2 years.ConclusionsDespite the relatively more aggressive nature of periocular malignancies that have invaded the orbit, orbital exenteration offers an overall 2-year DFS of ~60%. BCC had the greatest mean survival time, however this was not statistically significant. We found worse prognosis with positive final surgical margins and recommend a multidisciplinary surgical approach to achieve complete resection when indicated.
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Affiliation(s)
- R C Gerring
- Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - C T Ott
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - J M Curry
- Department of Otolaryngology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Z B Sargi
- Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - S T Wester
- Department of Ophthalmology, Division of Oculoplastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Muscatello L, Fortunato S, Seccia V, Marchetti M, Lenzi R. The implications of orbital invasion in sinonasal tract malignancies. Orbit 2016; 35:278-284. [PMID: 27541943 DOI: 10.1080/01676830.2016.1193532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/20/2016] [Indexed: 06/06/2023]
Abstract
In recent decades, the management of sinonasal tumors abutting the orbit has been widely discussed. A real guideline has yet to be proposed, as prospective randomized studies on this topic are very difficult to organize, given the relative rarity of this pathology, the wide spectrum of histologic patterns, and the different clinical behavior of tumors. Nevertheless, in recent years, a better assessment of tumor extension has been obtained thanks to the refinement of preoperative imaging tools and, therefore, more conservative approaches could be adopted, with no worsening of the oncological outcomes and, at the same time, with more attention given to the post-surgical quality of life. Currently, tumors that extend to the bony orbital walls with or without focal infiltration of the periorbit are amenable to orbital preservation. On the other hand, infiltration of extraocular muscles and neurovascular structures are an indication to orbital exenteration. The ideal surgical treatment in cases of limited involvement of orbital fat still remains a matter of debate. We report and discuss the recent English literature on this interesting topic.
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Affiliation(s)
- Luca Muscatello
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| | - Susanna Fortunato
- b Department of Neuroscience, Unit of Otolaryngology, Audiology and Phoniatrics , University of Pisa , Italy
| | - Veronica Seccia
- c 1st Otorhinolaryngology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Manuela Marchetti
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| | - Riccardo Lenzi
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
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Amsbaugh MJ, Yusuf M, Silverman C, Bumpous J, Perez CA, Potts K, Tennant P, Redman R, Dunlap N. Organ preservation with neoadjuvant chemoradiation in patients with orbit invasive sinonasal cancer otherwise requiring exenteration. Radiat Oncol J 2016; 34:209-215. [PMID: 27592515 PMCID: PMC5066443 DOI: 10.3857/roj.2016.01739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/23/2016] [Accepted: 06/21/2016] [Indexed: 12/15/2022] Open
Abstract
Purpose We sought to determine if organ preservation (OP) with neoadjuvant chemoradiation (CRT) was feasible in patients with sinonasal cancer determined to require exenteration. Materials and Methods Twenty patients were determined to require exenteration for definitive treatment from 2005 to 2014. Fourteen patients underwent OP and 6 patients received exenteration with adjuvant CRT. Exenteration free survival (EFS), locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) were estimated. Results Five patients (36%) receiving OP had complete disease response at time of surgery. With a median follow-up of 18.8 months, EFS was 62% at 2 years for patients undergoing OP. At 2 years, there were no significant differences in LRC, PFS or OS (all all p > 0.050) between the groups. Less grade 3 or greater toxicity was seen in patients undergoing OP (p = 0.003). Visual function was preserved in all patients undergoing OP. Conclusion For patients with sinonasal cancer, OP may avoid exenteration, offering similar disease control and improved toxicity.
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Affiliation(s)
- Mark J Amsbaugh
- Department of Radiation Oncology, University of Louisville, Louisville, KY, USA
| | - Mehran Yusuf
- Department of Radiation Oncology, University of Louisville, Louisville, KY, USA
| | - Craig Silverman
- Department of Radiation Oncology, University of Louisville, Louisville, KY, USA
| | - Jeffrey Bumpous
- Department of Otolaryngology, University of Louisville, Louisville, KY, USA
| | - Cesar A Perez
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Keven Potts
- Department of Otolaryngology, University of Louisville, Louisville, KY, USA
| | - Paul Tennant
- Department of Otolaryngology, University of Louisville, Louisville, KY, USA
| | - Rebecca Redman
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, KY, USA
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Lisan Q, Kolb F, Temam S, Tao Y, Janot F, Moya-Plana A. Management of orbital invasion in sinonasal malignancies. Head Neck 2016; 38:1650-1656. [PMID: 27131342 DOI: 10.1002/hed.24490] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/06/2016] [Accepted: 03/17/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Indications for preservation of orbital contents in case of malignant sinonasal tumors invading the orbit remain controversial. METHODS A retrospective consecutive review was conducted of patients in a tertiary care center over a 15-year period. RESULTS Ninety-three patients were diagnosed with a malignant tumor invading the orbit. Eighty-three were treated with curative intent of which 58 underwent surgery. Mean follow-up was 45 months. Orbital preservation was feasible in 66% of cases, whereas orbital clearance was performed in cases of locally advanced disease (invasion of extraocular muscles, ocular globe, or orbital apex). Local control rate was 70% for patients treated with orbital clearance and 74% for those with orbital preservation, with no statistical difference. Five-year survival and 5-year relapse-free survival were similar in both groups. CONCLUSION Using our strategy, the eye can be spared in more patients than what is currently proposed, without oncologic or survival disadvantages. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
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Affiliation(s)
- Quentin Lisan
- Department of Head and Neck Surgery, Gustave Roussy Cancer Institute, Villejuif Cedex, France.
| | - Frédéric Kolb
- Department of Head and Neck Surgery, Gustave Roussy Cancer Institute, Villejuif Cedex, France
| | - Stéphane Temam
- Department of Head and Neck Surgery, Gustave Roussy Cancer Institute, Villejuif Cedex, France
| | - Yungan Tao
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif Cedex, France
| | - François Janot
- Department of Head and Neck Surgery, Gustave Roussy Cancer Institute, Villejuif Cedex, France
| | - Antoine Moya-Plana
- Department of Head and Neck Surgery, Gustave Roussy Cancer Institute, Villejuif Cedex, France
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Reconstruction of Extended Orbitomaxillectomy and Hemimandibulectomy Defects With Fibula Flaps and Patient-Specific Implants. J Craniofac Surg 2016; 27:380-4. [DOI: 10.1097/scs.0000000000002417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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48
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Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M. Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management. World Neurosurg 2016; 89:240-54. [PMID: 26875653 DOI: 10.1016/j.wneu.2016.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Craniofacial resection (CFR) for advanced sinonasal malignant tumors (SNMTs) is mandatory for radical resection. Surgeons must be aware of perioperative complications and long-term outcome because this procedure is extremely invasive, especially when the tumor involves the anterior skull base. METHODS Thirty-eight consecutive surgical patients with advanced SNMT of T4 stage or Kadish stage C (31 men and 7 women; mean age, 55 years; range: 19-76 years) treated with CFR in the past 28 years were followed up for 59.4 months. In cases of unilateral orbital extension, en-bloc resection was achieved using several neurosurgical techniques (extended CFR) from 2005 onwards. Herein, we evaluated the safety and effectiveness of surgery by comparing survival data between 2 time periods (first stage: 1984-2004, second stage: 2005-2012). RESULTS Squamous cell carcinoma was the most common histological type observed (65.8%), followed by esthesioneuroblastoma (15.8%). Using a combination of adjuvant radiation therapy, the 5-year overall survival and the 5-year disease-specific survival rates were 55.5% and 59.4%, respectively. Sarcomatous histology was a poor prognostic factor. The 5-year disease-specific survival rate was 48.9% in the first stage and improved to 82.1% in the second stage (P = 0.057); this was related to improvements in local control rate. CONCLUSIONS CFR and postoperative radiotherapy are safe and effective for treating advanced SNMTs. Extended CFR, including radical orbital exenteration, may contribute to good long-term outcomes. A diverse surgical team may help perform radical resection and reconstruction in patients with advanced tumors.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
| | - Akiteru Maeda
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Noriyuki Koga
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Hirohito Umeno
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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49
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Song JW, Oh JH, Kim JY, Kwon JH. A Immediate Orbital Floor Reconstruction after Suprastructure Maxillectomy. JOURNAL OF RHINOLOGY 2016. [DOI: 10.18787/jr.2016.23.2.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jun Woong Song
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Jung Ho Oh
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Joo Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Jae Hwan Kwon
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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50
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Hoffman GR, Jefferson ND, Reid CBA, Eisenberg RL. Orbital Exenteration to Manage Infiltrative Sinonasal, Orbital Adnexal, and Cutaneous Malignancies Provides Acceptable Survival Outcomes: An Institutional Review, Literature Review, and Meta-Analysis. J Oral Maxillofac Surg 2015; 74:631-43. [PMID: 26475973 DOI: 10.1016/j.joms.2015.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Orbital exenteration (OE) is an aggressive operative undertaking that results in a disfiguring and dysfunctional outcome for patients. The purpose of our study was to determine the survival outcome for patients who underwent OE for malignant disease that had invaded the orbit. MATERIALS AND METHODS We conducted an ambispective cohort study based on a review of the records of 31 consecutive patients who had undergone OE within John Hunter Hospital. The study period was 2006 to 2013. The predictor variables were the demographic, tumor site, and clinicopathologic characteristics that might influence survival. The secondary outcome variable was survival. Descriptive statistics were calculated for the categorical and continuous variables. Kaplan-Meier estimates of the survival distribution were plotted. We also performed a review of published studies and a meta-analysis to investigate the nature of OE performed by various surgical disciplines. RESULTS Of the 31 patients included in the present study, 24 were men and 7 were women. The mean age was 65 years. Of the 31 cases, 15 were squamous cell carcinoma, 8 were basal cell carcinoma, and 8 were a mixture of other pathologic types. The time to median (50%) survival for all patients was 78.4 months. The 1-year survival rate was 93.4% and the 5-year survival rate was 54.1%. Although not statistically significant, notable differences were found in the interval to death with respect to the identification of perineural invasion, lymphovascular invasion, and histopathologic features. The review of published studies suggested a difference in the histologic features and location of the disorder treated, the extent of OE undertaken, and the method of reconstruction between the ophthalmology and nonophthalmology surgical disciplines. CONCLUSIONS Although OE results in significant disfigurement and dysfunction, it does provide good survival outcomes, given the extent of disease at presentation, evident in our group of patients. Continuation of the study, with greater numbers of patients, will serve to increase the statistical power of our observations.
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Affiliation(s)
- Gary Russell Hoffman
- Visiting Medical Officer (Attending Surgeon), Division of Oral-Maxillofacial-Head and Neck Surgery, Head and Neck Surgeon, and Head, Department of Maxillofacial Surgery, John Hunter Hospital, and Conj. Associate Professor, University of Newcastle Medical School, New South Wales, Australia.
| | - Niall David Jefferson
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Colin Bruce A Reid
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Robert Leonard Eisenberg
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
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