Role of Induction Chemotherapy in Orbital Preservation in the Management of Advanced-Stage Sinonasal Malignancies: A Systematic Review

Objectives The role of induction chemotherapy in orbital preservation for advanced-stage sinonasal malignancies with involvement of the periorbita and the orbital soft tissue content has not been established. Herein, we review the published data on patients treated with induction or neoadjuvant chemotherapy for malignancies of the sinonasal cavity with orbital involvement and determine the frequency with which these patients required orbital exenteration for treatment.

Study Design This study is a systematic literature review.

Methods PRISMA guidelines were followed. Data sources included MEDLINE, PubMed, Cochrane library, EMBASE, NCBI Bookshelf, National Guideline Clearinghouse, and Clinicaltrials.gov which yielded 1,758 articles published prior to 6/9/2017. The articles were manually reviewed by two reviewers. The following inclusion criteria were applied: (1) The study has a patient population with three or more of the following previously untreated sinonasal malignancies: squamous cell carcinoma, olfactory neuroblastoma, sinonasal undifferentiated carcinoma (SNUC), sinonasal neuroendocrine carcinoma (SNEC), adenoid cystic carcinoma, or adenocarcinoma; (2) patients underwent induction or neoadjuvant chemotherapy. (3) Pretreatment staging information and orbital involvement were documented (4) Posttreatment orbital status was documented and outcomes were stratified by tumor histology and grade if available.

Results Four studies met inclusion criteria with a total of 65 patients. All studies included were published between 1996 and 2017. All patients studied had confirmed orbital involvement and at least 85% of patients had confirmed T4 disease. All patients underwent platinum-based induction chemotherapy. Eleven patients ultimately underwent orbital exenteration following induction chemotherapy (16.9%). Out of 36 patients with squamous cell carcinoma with orbital involvement, 6 patients underwent orbital exenteration after induction chemotherapy (16.7%, 95% CI = [4.5, 28.9] %). For olfactory neuroblastoma, 4 out of 12 patients with orbital involvement ultimately underwent orbital exenteration after induction chemotherapy (33.3%, 95% CI = [6.6, 60] %). None of the seven patients with SNEC with orbital involvement underwent exenteration after induction chemotherapy (0.0%, [95% CI = (0.00, 44.9%)]. One study was identified which did not stratify results by tumor histology, but had 10 patients with sinonasal malignancies with orbital involvement prior to induction chemotherapy with 1 patient ultimately underwent exenteration (10.0%, 95% CI = [0.003%, 45.5%]).

Conclusion Few high-quality studies exist examining the effect of induction chemotherapy on orbital preservation for patients with sinonasal malignancies involving the periorbita and soft tissue of the orbit. In these studies, there is an orbital preservation rate consistent with, if not better than, other modalities of treatment as reported in the literature. More research is required to further elucidate the effect of induction chemotherapy on orbital preservation in this patient population.