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Liu Q, Huang X, Chen X, Zhang J, Wang J, Qu Y, Wang K, Wu R, Zhang Y, Xiao J, Yi J, Luo J. Long-Term Outcomes of Endoscopic Resection versus Open Surgery for Locally Advanced Sinonasal Malignancies in Combination with Radiotherapy. J Neurol Surg B Skull Base 2024; 85:28-37. [PMID: 38274487 PMCID: PMC10807958 DOI: 10.1055/a-1980-8567] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Our objective was to compare the long-term outcomes of endoscopic resection versus open surgery in combination with radiotherapy for locally advanced sinonasal malignancies (SNMs). Methods Data for continuous patients with sinonasal squamous cell carcinoma and adenocarcinoma who received surgery (endoscopic or open surgery) combined with radiotherapy in our center between January 1999 and December 2016 were retrospectively reviewed. A 1:1 matching with propensity scores was performed. Overall survival (OS), progression-free survival (PFS), and local recurrence rate (LRR) were evaluated. Results We identified 267 eligible patients, 90 of whom were included after matching: 45 patients in the endoscopy group and 45 in the open group. The median follow-up time was 87 months. In the endoscopic group, 84.4% of patients received intensity-modulated radiotherapy (IMRT), with a mean gross tumor volume (GTV) dose of 68.28 Gy; in the open surgery group, 64.4% of patients received IMRT, with a mean GTV dose of 64 Gy. The 5-year OS, PFS, and LRR were 69.9, 58.6, and 24.5% in the endoscopic group and 64.6, 54.4, and 31.8% in the open surgery group, respectively. Multivariable regression analysis revealed that the surgical approach was not associated with lower OS, PFS, or LRR. The overall postoperative complications were 13% in the endoscopic group, while 21.7% in the open group. Conclusion For patients with locally advanced SNMs, minimally invasive endoscopic resection, in combination with a higher radiation dose and new radiation techniques such as IMRT, yields survival outcomes similar to those of open surgery in combination with radiotherapy.
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Affiliation(s)
- Qian Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Chen M, Li S, Jiang L. Clinicopathological molecular characterizations of sinonasal NUT carcinoma: a report of two cases and a literature review. Front Oncol 2024; 13:1296862. [PMID: 38239638 PMCID: PMC10794637 DOI: 10.3389/fonc.2023.1296862] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024] Open
Abstract
Background Nuclear protein in testis (NUT) carcinoma (NC) is a rare, aggressive tumor with a typical NUTM1 gene rearrangement. Methods Herein, we report a series of 2 cases of sinonasal NC: one in a 16-year-old woman and one in a 37-year-old man. Immunohistochemistry (IHC) staining for NUT (C52B1), fluorescence in situ hybridization (FISH), and next generation sequencing (NGS) sequencing were performed to investigate the morphological and genetic features of sinonasal NC. Results The two cases presented similar pathological features and IHC markers, and typical morphological changes, including undifferentiated cells and abrupt keratinization, were observed, with numerous mitotic figures and widespread tumor necrosis. Diffuse expression of NUT, CK, p63, and p40 was noted, while the tumors were negative for synaptophysin, chromogranin A, S-100, EBV-ISH, and PD-L1. Both tumors harbored a NUTM1 rearrangement. Subsequent sequencing revealed a rare BRD3::NUTM1 fusion and a classic BRD4::NUTM1 fusion. In addition, MCL1 copy number gain (2.1), low tumor mutation burden and stable microsatellites, were also confirmed. Case 1 received surgery and chemoradiotherapy but died 13 months after local recurrence and subsequent lung and bone metastasis. Case 2 underwent chemoradiotherapy and unfortunately died from the disease 6 months later. A review of all previously reported cases of sinonasal NCs (n=55) revealed that these tumors occur more frequently in female pediatric patients (n=11, male: female =3:8), whereas this sex difference is not observed in adult patients (n=44, male: female =23:21). The median survival times of pediatric and adult patients were 17 and 13.8 months, respectively. Conclusion Sinonasal NC presents typical undifferentiated or poorly differentiated cells, abrupt keratinization features and heterogeneous genotypes, including BRD4::NUTM1 and BRD3::NUTM1 fusions, with low tumor mutation burden and stable microsatellites.
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Affiliation(s)
| | | | - Lili Jiang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ryder CY, Bellile EL, VanKoevering KK, McKean EL. Assessing Quality of Life among Radiation-Induced Hypopituitary Patients. J Neurol Surg B Skull Base 2023; 84:567-577. [PMID: 37854537 PMCID: PMC10581824 DOI: 10.1055/a-1934-9377] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022] Open
Abstract
Introduction Radiation-induced hypopituitarism (RIH) has long been recognized as one of the deleterious side effects of skull base radiation. This study aims to assess the quality of life (QoL) among patients with RIH compared with radiated patients who did not develop hypopituitarism using the validated Anterior Skull Base Questionnaire (ASBQ). Methods This was a single-institution retrospective cohort study. Included patients had a history of anterior skull base tumor, underwent at least one round of radiation to the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Three statistical models were used to determine the effect of hypopituitarism and treatment on QoL scores. Results A total of 145 patients met inclusion criteria, and 330 ASBQ surveys were analyzed. Thirty-five percent (51/145) had evidence of RIH at some point after their radiation treatment. Those with hypopituitarism had significantly lower overall ASBQ scores across all three models even after adjusting for potential confounders and intraperson correlation (average decrease of 0.24-0.45 on a 5-point Likert scale; p -values ranging from 0.0004 to 0.018). The increase in QoL with hormonal replacement was modulated by time out from radiation, with long-term survivors (5+ years out from radiation) gaining the most benefit from treatment (increase of 0.89 on a 5-point Likert scale, p 0.0412), especially in the vitality domain. Conclusion This data demonstrates that hypopituitarism is an independent predictor of lower QoL. Early detection and appropriate treatment are essential to avoid the negative impact of hypopituitarism on QoL.
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Affiliation(s)
- C Yoonhee Ryder
- University of Michigan Medical School, Office of Medical Student Education, Ann Arbor, Michigan, United States
| | - Emily L. Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States
| | - Kyle K. VanKoevering
- Department of Otolaryngology, Ohio State University, Columbus, Ohio, United States
| | - Erin L. McKean
- Department of Otolaryngology Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
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Liu Q, Sun M, Wang Z, Qu Y, Zhang J, Wang K, Wu R, Zhang Y, Huang X, Chen X, Wang J, Xiao J, Yi J, Xu G, Luo J. Failure Patterns Within Different Histological Types in Sinonasal Malignancies: Making the Complex Simple. Otolaryngol Head Neck Surg 2023; 169:1513-1522. [PMID: 37727935 DOI: 10.1002/ohn.527] [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: 01/09/2023] [Revised: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To analyze the failure patterns in patients with different histological subtypes of sinonasal malignancies (SNMs). STUDY DESIGN Retrospectively gathered data. SETTING Academic university hospital. METHODS Patients with SNMs treated at a tertiary referral center between January 1999 and January 2019 were included. We assessed the failure patterns within different histological subtypes. RESULTS The study included 897 patients. The median follow-up time was 100 months. Adenoid cystic carcinoma (ACC) had a moderate risk of developing local recurrence (LR) and distant metastasis (DM). Compared with ACC, squamous cell carcinoma (SCC), adenocarcinoma (AC), soft tissue sarcoma (STS), and mucosal melanoma (MM) were classified as a high LR risk group. For DM, neuroendocrine carcinoma (NEC), STS, and MM were in the high-risk group. CONCLUSIONS ACC had intermediate local and distant failure risks, while SCC, AC, STS, and MM were at high LR risks. NEC, STS, and MM were at high DM risk.
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Affiliation(s)
- Qian Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zekun Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Calvaruso F, Lo Manto A, Bisi N, Cantaffa C, Basso M, Ferrulli G, Alicandri-Ciufelli M, Marchioni D. Pericranial Flap-Based Multilayer Reconstruction of Endoscopic Transcribriform Craniectomy for Sinonasal Malignancies. Laryngoscope 2023; 133:2942-2947. [PMID: 37503776 DOI: 10.1002/lary.30921] [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: 04/20/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Diffusion of endoscopic techniques for the resection of ethmoid bone malignancies through a transcribriform approach (TA) has raised new challenges regarding reconstruction options to reduce post-operative complications. Although there is consensus on the advantages of vascularized flaps over free grafts for large defects, no standard protocol exists on reconstruction procedures. In addition, although the pedicled nasoseptal flap has been extensively discussed, few studies have been published on extranasal pedicled flaps. The aim of this manuscript is to provide a detailed description of a reconstruction technique for large anterior skull base defects with the pericranial flap as part of a multilayered reconstruction. Moreover, patients treated with this approach were retrospectively assessed for post-operative complications. METHODS A detailed description of the reconstruction procedure as performed in our departments is provided. Pictures depicting the main surgical steps are also included. In addition, preliminary functional results from a retrospective series of patients who underwent a TA and subsequent pericranial flap-based multilayer reconstruction for ethmoid roof malignancies between 2016 and 2022 at two institutional centers are reported. RESULTS 16 patients were included in the study. Nine patients (56.3%) underwent adjuvant radiotherapy. Two patients had a biochemically-confirmed postoperative CSF leak. Only one of the two patients required surgical revision. During follow-up (mean 13 months), no other early nor delayed complications were observed. CONCLUSION A standardized surgical technique with pericranial flap as part of a multilayered reconstruction for large anterior skull base defects following resection of sinonasal malignancies is proposed, which appears to be a safe choice when endonasal flaps are not available. LEVEL OF EVIDENCE Level 4 Laryngoscope, 133:2942-2947, 2023.
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Affiliation(s)
- Federico Calvaruso
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alfredo Lo Manto
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Nicola Bisi
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Carla Cantaffa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Margherita Basso
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giuseppe Ferrulli
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
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El-Adem D, Yang N, Gudis DA. The Role of Positron Emission Tomography for the Management of Sinonasal Malignancies: A Systematic Review. Am J Rhinol Allergy 2023; 37:593-610. [PMID: 37229633 PMCID: PMC10433402 DOI: 10.1177/19458924231177854] [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] [Indexed: 05/27/2023]
Abstract
BACKGROUND Positron emission tomography (PET) scan is a valuable imaging modality widely used in the management of cancers. Its usage is well defined for most head and neck malignancies. However, there is a lack of consensus regarding the utility of PET scan for sinonasal malignancies. This is highlighted by the latest international consensus statement on endoscopic skull base surgery. OBJECTIVE This systematic review aims to clarify the role of PET scan in the management of sinonasal malignancies. METHODS We conducted a comprehensive literature search using PubMed, MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane databases for research studies of interest. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) updated statement was used to guide the review. RESULTS In total, 1807 articles were assessed for eligibility. Thirty-nine original papers, published between 2004 and 2021, met inclusion criteria. Seven articles focused on the role of PET scan for inverted papilloma, 23 for sinonasal carcinoma, 4 for melanoma, and 3 for lymphoma, and finally, 3 articles focused on the use of specific PET scan tracers for sinonasal malignancies. Qualitative summaries for each potential role of PET scans were provided. In general, included studies were retrospective in nature with low level of evidence. CONCLUSIONS In general, and across all types of sinonasal malignancies, PET scan yielded positive results regarding detection and initial staging. It was also considered as the modality of choice for detection of distant metastases, except in the case of sinonasal lymphoma. PET scan's main limit resides in its inability to detect lesions in or close to the metabolic activity of the brain.
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Affiliation(s)
- David El-Adem
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Nathan Yang
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Canada
| | - David A. Gudis
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York City, United States
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Carsuzaa F, Favier V, Ferrari M, Turri-Zanoni M, Ingargiola R, Camarda AM, Seguin L, Contro G, Orlandi E, Thariat J. Need for close interdisciplinary communication after endoscopic endonasal surgery to further personalize postoperative radiotherapy in sinonasal malignancies. Front Oncol 2023; 13:1130040. [PMID: 36925924 PMCID: PMC10012420 DOI: 10.3389/fonc.2023.1130040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Valentin Favier
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, University of Padova, "Azienda Ospedale Università di Padova", Padova, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology - Head and neck surgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi University Hospital, Varese, Italy
| | - Rossana Ingargiola
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lise Seguin
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Giacomo Contro
- Section of Otorhinolaryngology - Head and Neck Surgery, University of Padova, "Azienda Ospedale Università di Padova", Padova, Italy
| | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Juliette Thariat
- Radiation Oncology, Centre François Baclesse: ARCHADE, Caen, France
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Tzelnick S, Levin EG, Yacobi D, Mizrachi A, Popovtzer A, Soudry E. Recurrence Patterns and Efficacy of Surveillance Modalities for Sinonasal Malignancies. Am J Rhinol Allergy 2022; 36:473-479. [PMID: 35238217 DOI: 10.1177/19458924221079963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is limited information regarding the recurrence patterns and efficacy of surveillance modalities in patients with sinonasal malignancies. METHODS A retrospective study was conducted between the years 2001-2018 at a tertiary care center. Included were all patients with sinonasal malignancies treated in our institution. Data regarding recurrence and survival were analyzed. RESULTS Eighty-one patients were included. Multimodal treatment was administered to the majority of patients. 24 (35.3%) patients recurred with a median time of 17 months (range, 4-180). Although the majority of recurrences occurred within the first 5 years (83.3%), 4 (16.6%) recurred later on (5-15 years). Recurrences were local in 83.3%, regional in 20.8% and distant in 16.6%. All local recurrences occurred within the radiation treatment field and all patients with distant failure had mucosal melanoma. The majority of recurrences (70.6%) were diagnosed clinically or endoscopically, mainly in patients with SCC during the first 2 years of follow up. MRI or PET-CT were crucial in detecting extra-sinus and distant failures. Salvage surgery was feasible in the majority of patients (58.3%). Overall, 5 years survival (OS) rate was 60.9%. CONCLUSIONS Frequent clinic visits with nasal endoscopy combined with frequent imaging studies should be routinely practiced as part of a long-term surveillance plan. Longer follow up duration should be considered in these patients.
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Affiliation(s)
- Sharon Tzelnick
- Rabin Medical Center, Petah Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | | | - Aviram Mizrachi
- Rabin Medical Center, Petah Tikva, Israel
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - Aron Popovtzer
- Tel Aviv University, Tel Aviv, Israel
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - Ethan Soudry
- Rabin Medical Center, Petah Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
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9
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Liu Q, Qu Y, Wang K, Wu R, Zhang Y, Huang X, Zhang J, Chen X, Wang J, Xiao J, Yi J, Xu G, Luo J. Lymph Node Metastasis Spread Patterns and the Effectiveness of Prophylactic Neck Irradiation in Sinonasal Squamous Cell Carcinoma (SNSCC). Front Oncol 2022; 12:793351. [PMID: 35707357 PMCID: PMC9190260 DOI: 10.3389/fonc.2022.793351] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To analyze the incidence and spread of lymph node metastasis (LNM) and the effectiveness of prophylactic neck irradiation in patients with SNSCC. Methods A total of 255 patients with SNSCC were retrospectively reviewed. The LNM spread pattern was revealed. The clinical parameters related to LNM, and the prognostic value of elective neck irradiation (ENI) were assessed. A 1:1 matching with propensity scores was performed between ENI group and observation (OBS) group. Results The initial LNM rate was 20.8%, and the regional recurrence (RR) rate was 7.5%. Lymphatic spreading in SNSCC followed the common trajectories: a. level Ib ➔ level II ➔ level Va/level III/IV lymph nodes (LNs); b. retropharyngeal lymph nodes (RPLNs) ➔ level II LNs. The most frequently involved site was level II LNs (16.1%), followed by level Ib LNs (10.2%), RPLNs (4.7%), level III LNs (3.2%), level Va LNs (1.6%), level IVa LNs (1.4%) and level VIII LNs (0.8%). The median follow-up time was 105 months. The 5-year overall survival (OS) was 55.7% for N0 patients and 38.5% for patients with initial N+ or N- relapse (p = 0.009). After PSM, the 5-year regional recurrence-free survival was 71.6% and 94.7% (p = 0.046) in OBS and ENI group, respectively. The multivariate analysis showed that ENI (p = 0.013) and absence of nasopharynx involvement (p = 0.026) were associated with a significantly lower RR rate. Conclusions Patients with LNM had poorer survival than those who never experienced LNM. Lymphatic spread in SNSCC followed predictable patterns. ENI effectively reduced the RR rate in patients at high risk.
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Affiliation(s)
- Qian Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Abstract
PURPOSE OF REVIEW Sinonasal malignancies are rare and understudied, often diagnosed at late stages, and may behave aggressively. This review explores investigative diagnostic, therapeutic, and scientific advances specific to sinonasal undifferentiated carcinoma (SNUC), intestinal-type adenocarcinoma (ITAC), and olfactory neuroblastoma (ONB). RECENT FINDINGS A number of studies have recently contributed more robust knowledge of the genetic and molecular landscapes of SNUC, ITAC, and ONB. These analyses have identified SMARCB1 and IDH2 mutations in SNUC, potentially allowing for the tumor's subdivision. Recent studies have also defined a role for induction chemotherapy in SNUC. Somatic mutations for ITAC have been identified and may be potentially targetable with FDA approved therapies. Studies defining the tumor microenvironment for ITAC and ONB have introduced the possibility of immune checkpoint inhibition for these tumor types. SUMMARY Studies reviewed here detail promising results of the most current and novel characterization of SNUC, ITAC, and ONB genetic and molecular landscapes, which have informed ongoing therapeutic discovery. With continued multi-institutional efforts, the field of sinonasal tumor research will achieve higher disease control and improved treatment outcomes for patients afflicted with these rare cancers.
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Affiliation(s)
- Diana C. Lopez
- Sinonasal and Skull Base Tumor Program, National Institutes on Deafness and Other Communication Disorders, National Institutes of Health; Bethesda, MD, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrew E. Wadley
- Sinonasal and Skull Base Tumor Program, National Institutes on Deafness and Other Communication Disorders, National Institutes of Health; Bethesda, MD, USA
- Howard University College of Medicine, Washington DC, USA
| | - Nyall R. London
- Sinonasal and Skull Base Tumor Program, National Institutes on Deafness and Other Communication Disorders, National Institutes of Health; Bethesda, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine; Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine; Baltimore, MD, USA
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11
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Issa K, Smith BD, Kaplan SJ, Madden J, Jang DW, Zomorodi A, Brizel D, Abi Hachem R. A systematic review on sinonasal mixed adenoneuroendocrine carcinoma. Int Forum Allergy Rhinol 2021; 11:1391-1394. [PMID: 34013656 DOI: 10.1002/alr.22811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Khalil Issa
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Samantha J Kaplan
- Duke Medical Center Library, Duke University School of Medicine, Durham, NC
| | - John Madden
- Department of Pathology/Division of Pathology Clinical Services, Duke University, Durham, NC
| | - David W Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University, Durham, NC
| | - David Brizel
- Department of Radiation Oncology, Duke University, Durham, NC
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
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12
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Hu W, Hu J, Huang Q, Gao J, Yang J, Qiu X, Kong L, Lu JJ. Particle beam radiation therapy for sinonasal malignancies: Single institutional experience at the Shanghai Proton and Heavy Ion Center. Cancer Med 2020; 9:7914-7924. [PMID: 32977357 PMCID: PMC7643686 DOI: 10.1002/cam4.3393] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background Sinonasal malignancies (SNM) include malignant neoplasms of various histologies that originate from the paranasal sinuses or nasal cavity. This study reported the safety and efficacy of particle‐beam radiation therapy (PBRT) for the treatment of sinonasal malignancies. Methods and materials One‐hundred‐and‐eleven patients with nonmetastatic sinonasal malignancies received definitive (82.9%) or salvage (31.5%) PBRT. The majority (85.6%) of patients presented with T3/4 disease, and only 19 (17.1%) had R0 or R1 resection. Seventy (63.1%) patients received carbon‐ion radiotherapy (CIRT), 37 received proton radiotherapy (PRT) followed by CIRT boost, and 4 received PRT alone. Prognostic factors were analyzed using Cox regression for univariate and multiple regression. Toxicities were reported using the Common Terminology Criteria for Adverse Events (version 4.03). Results The median follow‐up was 20.2 months for the entire cohort. The 2‐year local progression‐free survival (LPFS), regional progression‐free survival (RPFS), distant metastasis‐free survival (DMFS), progression‐free survival (PFS), and overall survival (OS) rates were 83%, 97.2%, 85.9%, 66%, and 82%, respectively. Re‐irradiation and large GTV were the significant factors for OS. Melanoma and sarcoma patients had significantly higher distant metastatic rate, and poorer OS and PFS. Late toxicity occurred in 22 (19.8%) patients, but only 4 (3.6%) patients experienced grades 3‐4 late toxicity. Conclusions Particle‐beam radiation therapy results in excellent local‐regional control with extremely low serve toxicities for patients with SNM. Sarcoma and melanoma were featured with a greater risk of death from distant dissemination. Patients who underwent re‐irradiation had significantly worse OS. PBRT is feasible and safe in the management of SNM.
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Affiliation(s)
- Weixu Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jiyi Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Qingting Huang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jing Gao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jing Yang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Xianxin Qiu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lin Kong
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Jiade J Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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13
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VanKoevering KK, Sabetsarvestani K, Sullivan SE, Barkan A, Mierzwa M, McKean EL. Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening. J Neurol Surg B Skull Base 2020; 81:75-81. [PMID: 32021753 DOI: 10.1055/s-0039-1679893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/20/2018] [Accepted: 12/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background Management of anterior cranial base malignancies requires multidisciplinary care. Radiation therapy remains a mainstay of definitive or adjuvant treatment. Apart from primary hypothyroidism, the effects of radiation on the hypothalamic-pituitary axis after high-dose treatment of head and neck malignancies remain poorly described. We describe a comprehensive screening protocol for surveillance and characterize the incidence of pituitary dysfunction after radiation for anterior cranial base malignancies. Methods A review of patients prospectively enrolled in a skull base registry at an academic center was performed. Included patients had a history of anterior skull base malignancy and external beam radiation to the primary site, with comprehensive post-treatment pituitary serologies and at least 1 year of post-radiation follow-up. Routine hormonal screening was initiated during the study period for all patients with anterior skull base irradiation. Results Eighty-one patients met inclusion. Fifty-eight patients (71%) demonstrated some laboratory abnormality. Thirty patients (37%) demonstrated evidence of hypopituitarism. Twenty-four (29%) demonstrated central hypogonadism, and 16% of patients showed central hypothyroidism. Ten patients (12%) displayed central adrenal insufficiency with six patients demonstrating panhypopituitarism. Primary tumor location and maximum dose of radiation to the gland appeared to correlate with incidence of hypopituitarism. Conclusion Radiation for malignancies of the anterior skull base resulted in a 37% incidence of hypopituitarism in our study. Given the potential morbidity of hypopituitarism, we recommend annual post-treatment screening in these patients. We describe a comprehensive set of serologies that can be utilized, and recommend updating clinical guidelines to reflect the necessity of this screening.
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Affiliation(s)
- Kyle K VanKoevering
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Ariel Barkan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
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14
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Zocchi J, Pietrobon G, Campomagnani I, Riggi E, Veronesi G, Borchini R, Pellini R, Volpi L, Bignami M, Castelnuovo P. The role of a post therapeutic surveillance program for sinonasal malignancies: Analysis of 417 patients. Head Neck 2019; 42:963-973. [PMID: 31889395 DOI: 10.1002/hed.26069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/17/2019] [Revised: 10/08/2019] [Accepted: 12/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Post therapeutic surveillance of head and neck neoplasms is a still debated issue in the current literature: although different works tried to establish frequency, modality, and efficacy of a routine follow-up, little evidence has been produced, in particular considering only sinonasal malignancies. METHODS A retrospective review of patients treated for sinonasal malignancies in a single tertiary center and followed through a regular program of follow-up was carried out. Rate of recurrence, location, timing, diagnosis, and salvage treatment were the main data analyzed. RESULTS Of note, 417 patients were included in the study and 117 experienced at least one relapse. Staging, histological type, and previous treatment represent the main clinical factors to be considered to stratify patient's risk of recurrence. CONCLUSION A regular post therapeutic surveillance can provide an early recurrence detection for patients treated for sinonasal malignancies, offering opportunity for salvage treatment in a high percentage of patients.
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Affiliation(s)
- Jacopo Zocchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Isotta Campomagnani
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Emilia Riggi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria.,SSD Epidemiology and Screening-CPO, University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria
| | - Rossana Borchini
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Luca Volpi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, 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, Ospedale di Circolo e Fondazione Macchi, 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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15
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Ozturk K, Gencturk M, Rischall M, Caicedo-Granados E, Li F, Cayci Z. Role of Whole-Body (18)F-FDG PET/CT in Screening for Metastases in Newly Diagnosed Sinonasal Malignancies. AJR Am J Roentgenol 2019; 212:1327-34. [PMID: 30860894 DOI: 10.2214/AJR.18.20311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The aim of this study is to assess the utility of pretreatment whole-body 18F-FDG PET/CT in screening for distant metastasis (DM) and regional lymphatic metastasis (LM). MATERIALS AND METHODS. Eighty-nine consecutive patients with untreated sinonasal malignant lesions (32 women and 57 men; mean age, 62 years) underwent whole-body FDG PET/CT between January 2009 and August 2017. A retrospective analysis was performed to determine the presence of DM and LM. Any suspected metastases were confirmed by histopathologic analysis or clinical and imaging follow-up in the subsequent 12 months. The statistics were verified by comparing FDG PET/CT results with a reference standard. RESULTS. Overall, the frequency of DM was 24% (21/89), of which 81% (17/21) were identified by whole-body FDG PET/CT. The sensitivity and specificity of FDG PET/CT in predicting DM were 81% (95% CI, 62-95%) and 99% (95% CI, 82-100%), respectively. The most common DM sites were the lungs (n = 6; 28%) and bones (n = 5; 24%), followed by the liver (n = 2; 10%), brain (n = 1; 5%), and spinal canal (n = 1; 5%), with six patients (28%) having DMs at multiple sites. Overall, the frequency of LM according to the reference standard was 20%, of which 83% (15/18) were confirmed with FDG PET/CT. The sensitivity and specificity of FDG PET/CT in detecting LM were 83% (95% CI, 68-97%) and 96% (95% CI, 77-100%), respectively. CONCLUSION. Our study showed that whole-body FDG PET/CT can be used as a screening tool for the detection of DM and LM in sinonasal neoplasms and could be performed as part of the routine pretreatment evaluation of metastatic workup.
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16
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Ozturk K, Gencturk M, Caicedo-Granados E, Li F, Cayci Z. Prediction of survival with combining quantitative 18 F-FDG PET/CT and DW-MRI parameters in sinonasal malignancies. Head Neck 2019; 41:3080-3089. [PMID: 31041831 DOI: 10.1002/hed.25799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/12/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We aimed to establish the prognostic value of 18 F-fluoro-deoxy-glucose positron emission/CT (18 F-FDG PET/CT) and diffusion-weighted (DW) MRI in determining overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) of sinonasal malignancies. METHODS Sixty-eight patients with sinonasal cancer who underwent both pretreatment 18 F-FDG PET/CT scan and head-neck MRI from January 2009 through August 2017 were retrospectively reviewed. Kaplan-Meier survival analysis of 18 F-FDG PET/CT and DW-MRI parameters were performed for OS, PFS, and DMFS. RESULTS Cox regression analysis determined that all the quantitative 18 F-FDG PET/CT and DW-MRI parameters were independently correlated with PFS, DMFS, and OS (P < .05). After controlling for imaging variables, perineural invasion (P = .02) and ill-defined margin (P = .02) were found to be significantly correlated with shorter OS; while the perineural invasion was significantly correlated with shorter PFS (P = .02). CONCLUSIONS The pretreatment DW-MRI and 18 F-FDG PET/CT parameters could be substantial surrogate markers for sinonasal malignancies.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Mehmet Gencturk
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Emiro Caicedo-Granados
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Faqian Li
- Department of Pathology and Laboratory Medicine, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
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17
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Tirelli G, Capriotti V, Sartori G, Tofanelli M, Marcuzzo AV. Primary Adenoid Cystic Carcinoma of the Frontal Sinus: Case Description of a Previously Unreported Entity and Literature Review. Ear Nose Throat J 2019; 98:E8-E12. [PMID: 30922111 DOI: 10.1177/0145561319837881] [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: 11/17/2022] Open
Abstract
Sinonasal adenoid cystic carcinoma is a rare malignant epithelial tumor characterized by slow growth, multiple local recurrences, and perineural invasion; surgery followed by radiotherapy provides the best overall survival by means of an endoscopic, craniofacial, or combined approach. We present a previously undescribed case of frontal sinus adenoid cystic carcinoma involving the subcutaneous tissue and the dura mater treated with an open technique, free flap reconstruction, and hadron therapy together with a summary of the state of the art.
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Affiliation(s)
- Giancarlo Tirelli
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Vincenzo Capriotti
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giovanni Sartori
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Margherita Tofanelli
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- 1 ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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18
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Joshi RR, Husain Q, Roman BR, Cracchiolo J, Yu Y, Tsai J, Kang J, McBride S, Lee NY, Morris L, Ganly I, Tabar V, Cohen MA. Comparing Kadish, TNM, and the modified Dulguerov staging systems for esthesioneuroblastoma. J Surg Oncol 2018; 119:130-142. [PMID: 30466166 DOI: 10.1002/jso.25293] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB) is a rare neuroendocrine tumor. The purpose of this study was to compare the Kadish, tumor-node-metastasis (TNM), and Dulguerov's modified TNM staging in order to determine the impact of the stage on primary surgical treatment selection, margin status, and survival. METHODS The National Cancer Database (NCDB) was used to identify patients diagnosed with ENB between 2004 to 2015. Patients were excluded based on the ability to properly stage their disease as well as the availability of treatment data. RESULTS Eight-hundred eighty-three patients had sufficient data for analysis. On multivariate analysis, age and government insurance were associated with primary surgical treatment, whereas tumor stage, gender, race, hospital type and volume, and comorbidity score were not. Age, charlson-deyo comorbidity (CDCC) score, hospital volume, and nodal status were found to be predictors of survival. Multivariate-analysis controlling for stage failed to demonstrate clear survival differences between staging in both TNM and Kadish systems. T-stage and the presence of regional nodal metastasis were associated with an increased risk of positive margins on multivariate analysis. CONCLUSION Although primary surgical management and positive margins can be predicted by certain patient and tumor factors, clinical staging systems for ENB poorly predict prognosis over a 10-year horizon.
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Affiliation(s)
- Rohan R Joshi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Medical Center, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York
| | - Qasim Husain
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Medical Center, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York
| | | | - Jennifer Cracchiolo
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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19
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Husain Q, Joshi RR, Cracchiolo JR, Roman BR, Ganly I, Tabar V, Cohen MA. Surgical Management Patterns of Sinonasal Malignancy: A Population-Based Study. J Neurol Surg B Skull Base 2018; 80:371-379. [PMID: 31316883 DOI: 10.1055/s-0038-1675233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/28/2018] [Accepted: 08/29/2018] [Indexed: 02/03/2023] Open
Abstract
Objectives Determining surgical trends and outcomes for sinonasal tumors is challenging given their low incidence and heterogeneous pathology. This study utilized the National Cancer Database (NCDB) to identify trends and outcomes associated with surgical management of sinonasal tumors. Design Retrospective database analysis. Setting National Cancer Database. Participants Patients with sinonasal malignancies identified from the NCDB between 2010 and 2015. Main Outcome Measures The primary outcome was the choice of surgical therapy used for sinonasal tumor resection: endoscopic versus open approach. Each was cohort analyzed with respect to various demographic and clinicopathologic factors. A treatment effect model was used to identify potential differences between surgical approaches. Survival was evaluated using Kaplan-Meier analysis. Results A total of 10,193 patients with sinonasal malignancies were identified in the NCDB database; of these, 2,292 had a documented subsite, histology, and definitive surgical treatment with documented surgical approach and were included in the analysis. About 71.9% of patients had an open approach and 28.1% a purely endoscopic procedures. Tumor histology, treatment facility type, margin status, and length of stay were all variables that were associated with significant differences between the open and endoscopic cohort. Five-year survival rates for the open and endoscopic cohorts were not significantly different (59.6 and 60.8%, respectively). Conclusions Assessment of the NCDB revealed that 28% patients with sinonasal malignancy were selected for endoscopic surgery. These patients had comparable oncologic outcomes to open resection.
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Affiliation(s)
- Qasim Husain
- Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, United States.,Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medical College, New York, New York, United States
| | - Rohan R Joshi
- Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, United States.,Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medical College, New York, New York, United States
| | - Jennifer R Cracchiolo
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Benjamin R Roman
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
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20
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Dubal PM, Bhojwani A, Patel TD, Zuckerman O, Baredes S, Liu JK, Eloy JA. Squamous cell carcinoma of the maxillary sinus: A population-based analysis. Laryngoscope 2015; 126:399-404. [PMID: 26393540 DOI: 10.1002/lary.25601] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 07/02/2015] [Revised: 07/16/2015] [Accepted: 07/30/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma (SCC) accounts for > 90% of head and neck cancers and 60% to 75% of malignancies of the paranasal sinuses. The most commonly affected paranasal sinus is the maxillary. Epidemiologic, incidence, and survival trends have been studied for maxillary sinus SCC (MSSCC), but far less is known about its metastatic potential. STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results database was used to extract frequency, incidence, and survival data for MSSCC between 2004 and 2012. The resultant cases were stratified according to patient demographics and collaborative stage information, including extent of disease, lymph node involvement, TNM staging, and regional and distant metastasis. RESULTS A total of 854 cases of MSSCC were identified. The mean age at diagnosis was 66.6 years, with 87.4% presenting at > 50 years. Most patients (65.1%) were male. Whites accounted for 74.6% of cases. A majority (64.3%) of cases presented with stage IV disease. Overall 5-year disease-specific survival was 23.4%. Neck involvement was seen in 7.6% of T1 tumors, 22.2% of T2 tumors, 18.5% of T3 tumors, and 12.2% of T4 tumors. Distant metastasis was not seen in T1-T3 tumors, but was present in 6.8% of T4 tumors. CONCLUSIONS MSSCC is a rare entity with poor overall prognosis. The majority of patients included in this study were white males aged ≥50 years, with most tumors presenting at advanced stages. Nodal involvement and distant metastasis are poor prognostic indicators. T1-T3 tumors did not metastasize to distant sites. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Amit Bhojwani
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford
| | - Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Omry Zuckerman
- Rowan University School of Osteopathic Medicine, Stratford
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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21
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Unsal AA, Dubal PM, Patel TD, Vazquez A, Baredes S, Liu JK, Eloy JA. Squamous cell carcinoma of the nasal cavity: A population-based analysis. Laryngoscope 2015; 126:560-5. [PMID: 26297930 DOI: 10.1002/lary.25531] [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: 06/16/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma of the nasal cavity (NCSCC) is an infrequent malignancy that has been historically difficult to characterize. This study provides new insight into NCSCC utilizing a population-based database. We analyze the propensity for cervical and distant metastasis from NCSCC, as well as survival outcomes. STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2004-2012) was queried for NCSCC cases. Data were analyzed with respect to various demographic and clinicopathologic factors. The results were further examined for regional and distant metastasis. Survival was analyzed using the Kaplan-Meier model. RESULTS A total of 1,180 cases of NCSCC were identified in the SEER database between 2004 and 2012. The mean age at diagnosis was 65.8 years. American Joint Committee on Cancer stage was known in 1,050 cases, of which 53.4% were stage I, 13.3% were stage II, 10.2% were stage III, and 23.0% were stage IV. By tumor (T) stage classification, T1 was the most common (56.6%), followed by T4 (19.3%). Most cases had no nodal (N) involvement at diagnosis (90.8%). Cervical nodal involvement was present in 9.1% of cases, while distant metastasis was seen in 1.9%. Five-year disease-specific survival was 69.5% overall, 39.6% in cases with neck involvement and 0.0% for metastatic cases. CONCLUSIONS This study represents the only known population-based investigation of NCSCC. Metastasis to cervical nodes or distant sites, especially with T1 tumors, is rare. However, any cervical involvement or distant metastasis discovered on presentation is a poor prognostic indicator. LEVEL OF EVIDENCE 4. Laryngoscope, 126:560-565, 2016.
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Affiliation(s)
- Aykut A Unsal
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Alejandro Vazquez
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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22
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Sugawara T, Aoyagi M, Ogishima T, Kawano Y, Tamaki M, Yano T, Tsunoda A, Ohno K, Maehara T, Kishimoto S. Extended orbital exenteration for sinonasal malignancy with orbital apex extension: surgical technique and clinical analysis. J Neurosurg 2015; 123:52-8. [PMID: 25816080 DOI: 10.3171/2014.9.jns141256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 11/06/2022]
Abstract
OBJECT The majority of sinonasal malignancies present with advanced disease, and cure rates are generally poor. Surgical extirpation remains the mainstay of treatment. In cases of sinonasal malignancy with orbital apex extension, gross-total tumor resection requires orbital exenteration and bony skull base resection around the orbital apex to provide sufficient margins. In this retrospective study, the authors describe their surgical strategy in and technique for orbital exenteration with orbital apex resection in patients at Tokyo Medical and Dental University who had sinonasal malignancy with orbital apex extension. They also analyzed the clinical features of and the results in these patients. METHODS Between February 2001 and August 2012 at the authors' institution, sinonasal malignancy with orbital apex extension was treated using craniofacial tumor resection with orbital exenteration including skull base bone around the orbital apex. The authors describe this technique and analyze the surgical indications, extent of resection, primary tumor location, outcome, pathological findings, and neoadjuvant and adjuvant therapies of the patients who underwent the technique. RESULTS The patients consisted of 12 men and 3 women with a mean age of 47.7 years (range 14-79 years). The longest postoperative follow-up was 9.5 years, and the shortest was 0.67 year (mean 3.0 years). Tumor originated at the ethmoid sinus in 6 patients (40%), maxillary sinus in 5 (33%), nasal cavity in 2 (13%), and orbital cavity and maxillary bone in 1 patient each (7%). Histological analysis of tumor specimens revealed squamous cell carcinoma in 9 patients (60%), rhabdomyosarcoma in 2 (13%), and small cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and Ewing sarcoma in 1 patient each (7%). Two patients experienced recurrences at 1 and 5 months after treatment; these patients died at 5 and 10 months after surgery, respectively. Estimated 5-year recurrence-free survival (RFS) was 86.7%, and estimated 5-year overall survival (OS) was 86.2%; there was no perioperative mortality. None of the patients had new neurological deficits as a result of the surgery, but 5 patients suffered infectious complications from the graft transplanted into the cavity after resection. There were no other perioperative complications. CONCLUSIONS These authors are the first to describe a technique for extended orbital exenteration with orbital apex skull base resection. The technique provided sufficient margins for gross-total resection of the sinonasal malignancy with orbital apex extension. The estimated 5-year OS and RFS rates were high, and the perioperative complication rate was acceptably low, demonstrating the safety and efficacy of this technique.
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Affiliation(s)
| | | | | | | | - Masashi Tamaki
- Department of Neurosurgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Tomoyuki Yano
- Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo
| | | | | | | | - Seiji Kishimoto
- Head and Neck Surgery.,Department of Head and Neck Surgery, Kameda Medical Center, Chiba; and
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23
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Ene P, Popescu RC, Voiculescu S, Scaunasu R, Popescu B, Grigore R, Ene R, Cârstoiu C. Sentinel lymph node - work hypothesis in sinonasal carcinoma treatment. Maedica (Bucur) 2011; 6:308-312. [PMID: 22879846 PMCID: PMC3391949] [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
Although rare, sinonasal malignancies (SNM) can be lesions of immense importance. Approximately 60-70% of sinonasal malignancies (SNM) occur in the maxillary sinus and 20-30% occurs in the nasal cavity itself. The lymphatic drainage of the sinuses and nasal cavity include levels I-III as well as the parapharyngian nodes. Elective regional lymph node dissections became controversial because of overtreatment of the many patients without lymph node metastases. Lymphatic metastasis is the most important mechanism of spread in sinonasal squamous cell carcinoma considering the vast network of vessels in this area. The indications and type of neck dissection to be performed in the positive node neck and management of the N0 neck remain controversial. The sentinel lymph node concept is based on the Halsted theory that stressed the importance of locoregional cancer treatment because of the far site spread. Each patient with head and neck malignancies, including sinonasal carcinoma have about 2-3 sentinel lymph nodes of which up to 40% of them contain metastases.
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Affiliation(s)
- Patricia Ene
- Emergency University Hospital, Bucharest, E.N.T. Department
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