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Geltzeiler M, Choby GW, Ji KSY, JessMace C, Almeida JP, de Almeida J, Champagne PO, Chan E, Ciporen JN, Chaskes MB, Cornell S, Drozdowski V, Fernandez-Miranda J, Gardner PA, Hwang PH, Kalyvas A, Kong KA, McMillan RA, Nayak JV, Patel C, Patel ZM, Celda MP, Pinheiro-Neto C, Sanusi OR, Snyderman CH, Thorp BD, Van Gompel JJ, Zadeh G, Zenonos G, Zwagerman NT, Wang EW. Radiographic predictors of occult intracranial involvement in olfactory neuroblastoma patients. Int Forum Allergy Rhinol 2023; 13:1876-1888. [PMID: 36841933 DOI: 10.1002/alr.23145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Traditional management of olfactory neuroblastoma (ONB) includes margin-negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. METHODS This retrospective, multi-institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease-free survival (DFS). RESULTS A total of 224 subjects with new diagnoses of ONB (2005-2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: -0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. CONCLUSIONS Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low-grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keven Seung Yong Ji
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - C JessMace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - John de Almeida
- Department of Surgery, University of Toronto, Ontario, Canada
| | | | - Erik Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark B Chaskes
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah Cornell
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Veronica Drozdowski
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | | | - Keonho A Kong
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan A McMillan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Chirag Patel
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Maria Peris Celda
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Olabisi R Sanusi
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nathan T Zwagerman
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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2
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Bahig H, Ehab HY, Garden AS, Ng SP, Frank SJ, Nguyen T, Gunn GB, Rosenthal DI, Fuller CD, Ferrarotto R, Bell D, Su S, Phan J. Long-term outcomes of modern multidisciplinary management of sinonasal cancers: The M. D. Anderson experience. Head Neck 2023. [PMID: 37165701 DOI: 10.1002/hed.27381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
PURPOSE To report long-term outcomes of modern radiotherapy for sinonasal cancers. METHODS AND MATERIALS A retrospective analysis of patients with sinonasal tumors treated with intensity-modulated radiotherapy or proton therapy. Multivariate analysis was used to determine predictive variables of progression free survival (PFS) and overall survival (OS). RESULTS Three hundred and eleven patients were included, with median follow-up of 75 months. The most common histologies were squamous cell (42%), adenoid cystic (15%), and sinonasal undifferentiated carcinoma (15%). Induction chemotherapy was administered to 47% of patients; 68% had adjuvant radiotherapy. Ten-year local control, regional control, distant metastasis free survival, PFS, and overall survival rates were 73%, 88%, 47%, 32%, and 51%, respectively. Age, non-nasal cavity tumor site, T3-4 stage, neck dissection, and radiation dose were predictive of PFS, while age, non-nasal cavity tumor site, T3-4 stage, positive margins, neck dissection, and use of neoadjuvant chemotherapy were predictive of OS. There was a 13% rate of late grade ≥3 toxicities. CONCLUSION This cohort of patients with sinonasal cancer treated with modern radiotherapy demonstrates favorable disease control rate and acceptable toxicity profile.
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Affiliation(s)
- Houda Bahig
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Hanna Y Ehab
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Victoria, Australia
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Theresa Nguyen
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gary B Gunn
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, 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
| | - Shirley Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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3
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Lucidi D, Cantaffa C, Miglio M, Spina F, Alicandri Ciufelli M, Marchioni A, Marchioni D. Tumors of the Nose and Paranasal Sinuses: Promoting Factors and Molecular Mechanisms-A Systematic Review. Int J Mol Sci 2023; 24:ijms24032670. [PMID: 36768990 PMCID: PMC9916834 DOI: 10.3390/ijms24032670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023] Open
Abstract
Sinonasal neoplasms are uncommon diseases, characterized by heterogeneous biological behavior, which frequently results in challenges in differential diagnosis and treatment choice. The aim of this review was to examine the pathogenesis and molecular mechanisms underlying the regulation of tumor initiation and growth, in order to better define diagnostic and therapeutic strategies as well as the prognostic impact of these rare neoplasms. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between September and November 2022. The authors considered the three main histological patterns of sinonasal tumors, namely Squamous Cell Carcinoma, Intestinal-Type Adenocarcinoma, and Olfactory Neuroblastoma. In total, 246 articles were eventually included in the analysis. The genetic and epigenetic changes underlying the oncogenic process were discussed, through a qualitative synthesis of the included studies. The identification of a comprehensive model of carcinogenesis for each sinonasal cancer subtype is needed, in order to pave the way toward tailored treatment approaches and improve survival for this rare and challenging group of cancers.
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Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Carla Cantaffa
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
- Correspondence: ; Tel.: +39-3385313850; Fax: +39-0594222402
| | - Matteo Miglio
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Federica Spina
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Matteo Alicandri Ciufelli
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, 41124 Modena, Italy
| | - Daniele Marchioni
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
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4
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Marino MJ, Hsieh MC, Wu EL, Riley CA, Wu XC, McCoul ED. Early Versus Late Computed Tomography and Nasal Endoscopy in the Diagnosis of Nasopharyngeal and Paranasal Sinus Malignancy. Am J Rhinol Allergy 2019; 33:388-394. [PMID: 30900468 DOI: 10.1177/1945892419838106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) may be associated with an increased risk of subsequent diagnosis of nasopharyngeal carcinoma (NPC) or paranasal sinus cancer (PSC) in elderly Americans. The clinical utility of this association remains uncertain. Objective To compare early computed tomography (CT) or nasal endoscopy (NE) with late diagnostic studies for the diagnosis of NPC or PSC in elderly Americans with CRS or AR. Methods The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was queried from 2003 to 2011 and included 150 088 Medicare beneficiaries. Patients with a diagnosis of CRS or AR were examined for either NE or CT performed within 6 months of the exposure diagnosis. The risk of a cancer diagnosis was determined between the early and the late diagnostic groups. Results The relative risk of early cancer diagnosis with NE was 1.98 (95% confidence interval [CI], 1.60–2.43). The number needed to detect (NND) a case of cancer with NE was 503 (95% CI, 387–718). The relative risk of an early cancer diagnosis using CT was 3.40 (95% CI, 2.85–4.06) and NND was 221 (95% CI, 194–255). The stage of NPC or PSC for the late diagnostic group was not different from those with early NE ( P = .458) or CT ( P = .497). Overall survival was not different between diagnostic groups for NE ( P = .789) or CT ( P = .425). Conclusions Early NE or CT is associated with a higher likelihood of cancer diagnosis in elderly individuals with a diagnosis of CRS or AR. The clinical utility of this association is limited due to the low prevalence of these malignancies and lack of difference in disease stage and overall survival between diagnostic groups.
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Affiliation(s)
- Michael J Marino
- 1 Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | - Mei-Chin Hsieh
- 2 Louisiana Tumor Registry, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Eric L Wu
- 3 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles A Riley
- 4 Division of Otolaryngology, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Xiao-Cheng Wu
- 2 Louisiana Tumor Registry, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Edward D McCoul
- 3 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,5 Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,6 Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana
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5
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Shusharina N, Fullerton B, Adams JA, Sharp GC, Chan AW. Impact of aeration change and beam arrangement on the robustness of proton plans. J Appl Clin Med Phys 2019; 20:14-21. [PMID: 30756466 PMCID: PMC6414139 DOI: 10.1002/acm2.12503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/10/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022] Open
Abstract
This study determines the impact of change in aeration in sinonasal cavities on the robustness of passive‐scattering proton therapy plans in patients with sinonasal and nasopharyngeal malignancies. Fourteen patients, each with one planning CT and one CT acquired during radiotherapy were studied. Repeat and planning CTs were rigidly aligned and contours were transferred using deformable registration. The amount of air, tumor, and fluid within the cavity containing the tumor were measured on both CTs. The original plans were recalculated on the repeat CT. Dosimetric changes were measured for the targets and critical structures. Median decrease in gross tumor volume (GTV) was 19.8% and correlated with the time of rescan. The median change in air content was 7.1% and correlated with the tumor shrinkage. The median of the mean dose Dmean change was +0.4% for GTV and +0.3% for clinical target volume. Median change in the maximum dose Dmax of the critical structures were as follows: optic chiasm +0.66%, left optic nerve +0.12%, right optic nerve +0.38%, brainstem +0.6%. The dose to the GTV decreased by more than 5% in 1 case, and the dose to critical structure(s) increased by more than 5% in three cases. These four patients had sinonasal cancers and were treated with anterior proton fields that directly transversed through the involved sinus cavities. The change in dose in the replanning was strongly correlated with the change in aeration (P = 0.02). We found that the change in aeration in the vicinity of the target and the arrangement of proton beams affected the robustness of proton plan.
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Affiliation(s)
- Nadya Shusharina
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Barbara Fullerton
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMAUSA
| | - Judy A. Adams
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Gregory C. Sharp
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Annie W. Chan
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
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6
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Dionisi F, Amichetti M, Algranati C, Giacomelli I, Barbareschi M, Recla M, Grandi C. Unresectable Ameloblastoma Successfully Treated with Definitive Proton Therapy. Int J Part Ther 2017; 4:7-13. [PMID: 31773001 DOI: 10.14338/ijpt-17-00008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/06/2017] [Indexed: 11/21/2022] Open
Abstract
We report the case of an 87-year-old man affected by an unresectable ameloblastoma of the right jaw that was successfully treated by definitive proton therapy up to a dose of 66 Gy in 33 fractions. Treatment was well tolerated, and there were no interruptions due to toxicity. At follow-up visits, the patient experienced complete response to treatment with no evidence of disease and complete recovery from acute side effects. In this report, we discuss the potential and possible pitfalls of proton therapy in the treatment of specific settings.
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Affiliation(s)
- Francesco Dionisi
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | - Maurizio Amichetti
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | - Carlo Algranati
- Proton Therapy Unit, Department of Medical Physics, Ospedale di Trento, Trento, Italy
| | - Irene Giacomelli
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | | | - Mauro Recla
- Department of Radiology Ospedale di Trento, Trento, Italy
| | - Cesare Grandi
- Department of Otolaryngology, Ospedale di Trento, Trento, Italy
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7
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Siddiqui F, Smith RV, Yom SS, Beitler JJ, Busse PM, Cooper JS, Hanna EY, Jones CU, Koyfman SA, Quon H, Ridge JA, Saba NF, Worden F, Yao M, Salama JK. ACR appropriateness criteria ® nasal cavity and paranasal sinus cancers. Head Neck 2016; 39:407-418. [PMID: 28032679 DOI: 10.1002/hed.24639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/10/2016] [Indexed: 11/09/2022] Open
Abstract
The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Here, we present the Appropriateness Criteria for cancers arising in the nasal cavity and paranasal sinuses (maxillary, sphenoid, and ethmoid sinuses). This includes clinical presentation, prognostic factors, principles of management, and treatment outcomes. Controversies regarding management of cervical lymph nodes are discussed. Rare and unusual nasal cavity cancers, such as esthesioneuroblastoma and sinonasal undifferentiated carcinomas, are included. © 2016 American College of Radiology. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 39: 407-418, 2017.
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Affiliation(s)
| | - Richard V Smith
- Montefiore Medical Center, American College of Surgeons, Bronx, New York
| | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ehab Y Hanna
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Harry Quon
- Johns Hopkins University, Baltimore, Maryland
| | - John A Ridge
- Fox Chase Cancer Center, American College of Surgeons, Philadelphia, Pennsylvania
| | - Nabil F Saba
- Emory University, American Society of Clinical Oncology, Atlanta, Georgia
| | - Francis Worden
- University of Michigan, American Society of Clinical Oncology, Ann Arbor, Michigan
| | - Min Yao
- University Hospitals Case Medical Center, Cleveland, Ohio
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8
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Turri-Zanoni M, Battaglia P, Lambertoni A, Giovannardi M, Schreiber A, Volpi L, Bolzoni-Villaret A, Lombardi D, Bignami M, Magnoli F, Facco C, Antognoni P, Nicolai P, Castelnuovo P. Treatment strategies for primary early-stage sinonasal adenocarcinoma: A retrospective bi-institutional case-control study. J Surg Oncol 2015; 112:561-7. [PMID: 26346184 DOI: 10.1002/jso.24038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/26/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate different treatment strategies for primary early-stage (pT1-T2) sinonasal adenocarcinomas. METHODS Retrospective case-control study. From 2000 to 2011, 61 cases were radically resected using an endoscopic endonasal approach. Surgery as a single treatment modality was adopted for 33 patients (study group) while it was followed by postoperative radiotherapy (poRT) in 28 patients (control group). RESULTS Median follow-up was 61 and 67 months for the study and control group respectively. Patients were stratified according to the pT classification and no statistically significant differences were found in terms of Overall (OS) and Recurrence-free (RFS) survival. When analyzing the high-grade tumors (47 cases), statistically significant differences were observed between the control and study groups both in terms of OS (90.5% ± 6.5% versus 57.6% ± 15.4%, P = 0.03) and RFS (92.3% ± 7.39% versus 80.2% ± 8.88%, P = 0.05). Using multivariate analysis, OS was independently determined by poRT (Hazard Ratio = 0.16; P = 0.03) thus confirming its protective role for high-grade adenocarcinomas. CONCLUSION Our preliminary results suggest that endoscopic endonasal surgery could be used as a single treatment modality for primary early-stage low-grade sinonasal adenocarcinoma, resected with negative margins. Surgery followed by poRT offers the best treatment strategy not only for advanced-stage lesions but also for high-grade adenocarcinomas, regardless of the stage of disease at presentation.
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Affiliation(s)
- Mario Turri-Zanoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy
| | - Alessia Lambertoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, Monzino Hospital, Milan, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Italy
| | - Luca Volpi
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Davide Lombardi
- Unit of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Italy
| | - Maurizio Bignami
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Carla Facco
- Division of Pathology, University of Insubria, Varese, Italy
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy
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9
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Al Felasi MA, Bissada E, Ayad T. Reconstruction of an inferior orbital rim and cheek defect with a pedicled osteomyocutaneous submental flap. Head Neck 2015; 38:E64-7. [PMID: 26041044 DOI: 10.1002/hed.24146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study was to present the feasibility of reconstructing an inferior orbital rim and cheek defect with a pedicled osteomyocutaneous submental flap. METHOD A 77-year-old women with a right nasosinusal adenoid cystic carcinoma invading soft tissues and skin of the cheek, the inferior rim of the orbit, the hard palate, and the middle turbinate is presented. A right radical maxillectomy with preservation of the eye was performed. A pedicled osteomyocutaneous submental island flap was used to reconstruct the defect. An inferior marginal mandibular section was incorporated with the flap and used to reconstruct the inferior orbital rim. RESULTS Satisfactory cosmetic and functional results were reached by reconstructing the inferior rim of the orbit and the cheek skin using this flap. CONCLUSION This is the first case report of an osteomyocutaneous submental flap for reconstruction of an inferior orbital rim defect.
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Affiliation(s)
- Mohammad A Al Felasi
- Department Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Quebec, Canada
| | - Eric Bissada
- Department Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Quebec, Canada
| | - Tareck Ayad
- Department Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Quebec, Canada
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Grosjean R, Gallet P, Baumann C, Jankowski R. Transfacial versus endoscopic approach in the treatment of woodworker's nasal adenocarcinomas. Head Neck 2014; 37:347-56. [PMID: 24415438 DOI: 10.1002/hed.23601] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/14/2013] [Accepted: 01/07/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to present a monocentric retrospective study designed to compare oncologic results and morbidity between transfacial surgery and endoscopic endonasal surgery for nasal adenocarcinomas. METHODS Between 1998 and 2003, 31 patients were operated on via transfacial surgery, and between 2004 and 2009, 43 patients were operated on via endoscopic endonasal surgery. Overall and specific survival, local control, and morbidity (length of hospitalization, intensive care unit [ICU] monitoring, need for nasal packing, and complications) were compared. RESULTS There was no difference in prognostic factors between groups, but the median age was significantly higher for endoscopic endonasal surgery. Three-year overall survival, specific survival, and local control were not different between groups (respectively, 76.7%, 86%, and 81.4% for endoscopic endonasal surgery vs 61.3%, 67.7%, and 71% for transfacial surgery). Morbidity was significantly lower with endoscopic endonasal surgery for all criteria. CONCLUSION Endoscopic surgery may replace transfacial surgery in the treatment of woodworker's adenocarcinomas. Older patients can be operated on by decreasing morbidity and mortality with at least similar oncologic results.
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Affiliation(s)
- Rémy Grosjean
- Head and Neck Surgery, CHU, de Nancy-Hôpital Central, Nancy, France; University of Lorraine, Nancy, France
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FANUCCI E, FIASCHETTI V, FUSCO N, VIARANI S, GARGARI M, BARLATTANI A, ASSAKO E, SIMONETTI G. Role of diagnostic imaging to malignant sinus tumors in presurgical staging. Oral Implantol (Rome) 2008; 1:56-65. [PMID: 23285338 PMCID: PMC3476509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of this study is to describe the current role of imaging in pre-surgical planning, reporting 25 cases of paranasal sinus tumors examined in our Institute. Between June 2006 and May 2008, we identified 25 patients with malignant tumors of the paranasal sinuses. All of the patients were evaluated with CT and/or MR exams. US were used to assess regional lymph node involvement. When necessary CT-PET scanning using FDG, was done. Diagnostic imaging is essential during the initial work-up of a patient suspected of having a paranasal sinus tumor. The role of imaging is to define the tumor extension, nodal involvement, metastases and recurrences in the postoperative patient. CT and MR imaging are the primary modalities employed; each have advantages and disadvantages but tend to be complementary. The involvement of fine bone structures is best evaluated with CT. In assessing the extent of the tumor, MR provides excellent soft tissue detail, allowing for delineation of neoplasm from surrounding inflammatory tissue and secretions. For evaluation of lymph node enlargement color-Doppler US, CT and MR provide morphologic data, while CT-PET provides metabolic data. CT-PET can be used to stage nodal and metastatic disease and for assessing the efficacy of therapy or recurrent disease.
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Affiliation(s)
- E. FANUCCI
- Correspondence to: Prof. Ezio Fanucci, Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome “Tor Vergata”, Viale Oxford, 81 - 00133 Rome, Tel: +39-06-20902374 - Fax: +39-06-2090-2404, E-mail:
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