Induction Chemotherapy for Sinonasal Squamous Cell Carcinoma

Objective Squamous cell carcinoma is the most common type of sinonasal malignancy. Despite improvement in surgical resection and adjuvant therapy, which are considered the standard of care, the outcome for patients with locoregionally advanced disease is still poor. The aim of this study is to investigate the role of induction chemotherapy in patients with locoregionally advanced sinonasal squamous carcinoma and determine the oncologic outcomes in those patients.

Methods A retrospective review of the medical records of 125 consecutive patients with previously untreated locoregionally advanced (stage III and IV) sinonasal squamous cell carcinoma who were treated in MD Anderson Cancer Center between 1988 and 2015 with induction chemotherapy for curative intent followed by definitive local therapy. Patient demographics, tumor staging, treatment details, and oncologic outcomes were reported. Primary outcome was the overall survival (OS) defined as time from diagnosis of the original disease till date of death. Our secondary endpoints were disease-specific survival (DSS) and organ preservation. Descriptive statistics were utilized, and Kaplan–Meier curve was utilized to assess survival.

Results The median follow-up was 31 months (range: 0–346). Of those patients, 112 (89.6%) had been diagnosed clinically as T4 and 13 (10.4%) as T3. Nodal disease at the time of presentation was seen in 37 patients (29.6%). The overall stage was IV in 113 patients (90.4%) and III in 12 patients (9.6%). The chemotherapy regimen consisted of combination of platinum and taxane in the majority of cases (112 patients, 88%) either by themselves (39 patient) or in combination with a third agent such as 5-Fluorouracil (36 patients), ifosfamide (27 patients), or cetuximab (8 patients). Of these patients, 67 (56.8%) achieved at least partial response with 6 patients achieving a complete response. Subsequent treatment after induction chemotherapy was either (1) definitive chemoradiation (CRT) or radiation (RT) followed by surgery for any residual disease or (2) surgery followed by RT or CRT. For patients with at least partial response (67), definitive CRT or RT with surgical salvage for any residual disease was done in 41 patients (68%) of whom 38 patients were able to avoid any surgery. For the nonresponders (51), surgery with or without postoperative CRT was done in half of those patients. Overall surgical resection was performed in 53 patients (42%) who received induction chemotherapy. The 3-year OS and DSS rates were 74.2 and 76.9%, respectively. The rate of orbital preservation was 88.8%. Recurrence rate was 23.2% (29 patients), with distant metastases occurring in 10 patients (5%). Patients with at least partial response or stable disease had better OS and DSS compared with those with progressive disease (p = 0.01 and 0.03, respectively).

Conclusion Induction chemotherapy achieves good response in patients with sinonasal squamous cell carcinoma. Induction chemotherapy followed by local treatment is feasible for locoregional advanced sinonasal squamous cell carcinoma. Response to chemotherapy may be predictive of treatment outcome with a chance of organ preservation. Favorable response to induction chemotherapy is associated with improved survival.