Retrospective Review of a Tertiary Referral Center of Epithelial Sinonasal and Anterior Skull Base Tumors: A 6-Year Review

Objective To study the oncologic outcomes of epithelial sinonasal neoplasms based on TNM grading.

Methods Single-center retrospective study of all base of skull malignancies treated at our institution from January 2000 to December 2016. Descriptive statistics.

Results Review of electronic charts alone (2010–2016) identified 125 cases of sinonasal and anterior skull base tumors treated by endoscopic and/or open surgery approach. Out of the 125 cases, 49 were malignant neoplasms while the remaining 76 cases were inflammatory/infectious or benign tumors of the skull base. Twenty-five epithelial tumors were identified at this stage. Active data collection for the remaining 366 article charts is in process.

Out of the 25 epithelial tumors, 32% (n = 8) were adenoid cystic carcinoma, 28% (n = 7) were squamous cell carcinoma, 20% (n = 5) were sinonasal undifferentiated carcinoma, 8% (n = 2) were salivary carcinoma, and the remaining 12% were made up of 1 adenocarcinoma, 1 myoepithelial carcinoma, and 1 mucoepidermoid carcinoma. Tumor sites most frequently involved the nasal cavity (44%), the maxillary sinus (28%), the nasopharynx (12%), the ethmoid sinus (8%), the clivus and petrous apex (4%), and the frontal sinus (4%). Intraorbital extension was seen in 16% (n = 4) of cases and intracranial tumor extension in 24% (n = 6) of cases. Sixteen percent (n = 4) suffered from visual impairment preoperatively, of which 2 showed no improvement and 2 gained visual function postoperatively. Seventy-six percent (n = 19) were locally advanced tumors (T3 or T4). Twelve percent (n = 3) presented with locoregional metastases. None had distant metastases. The most frequent surgical complications were hypoesthesia and paresthesia in the trigeminal nerve distribution (20%, n = 5) and CSF leaks (20%, n = 5).

Sixty-eight percent (n = 17) were treated with a combined open and endoscopic approach. The remaining 25% (n = 8) were treated with a purely endoscopic approach. Eighty percent (n = 20) of patients benefited from definitive resection of the tumor except with T4 tumors.

Overall survival was 32.5 month and disease-free survival was 25.5 months with no significant change in survival when stratified by T stage.

Conclusion Epithelial malignancies of the sinonasal cavities and anterior skull base are rare and highly aggressive cancers. The present partial data do not show a difference in survival based on T stage. We expect to see larger differences in outcomes based on stage, histology, treatment regimens, and recurrence status in the entire series.