A Comparison of Overall Survival between Definitive Local Therapy and Systemic Therapy in Metastatic Sinonasal Malignancies

Objectives: For patients presenting with metastatic sinonasal neoplasms, systemic chemotherapy usually underpins the standard of care. Emerging evidence has shown that primary tumor resection or ablation may improve overall survival in other metastatic malignancies, including those located at various head and neck subsites. The primary objective of this study is to determine if definitive local therapy improves overall survival in metastatic sinonasal malignancies.

Methods: We conducted a retrospective analysis using the National Cancer Database (NCDB) for patients diagnosed with metastatic sinonasal malignancies between 2004 and 2016. Patients were included if they were treated with systemic chemotherapy with or without definitive local therapy. Definitive local therapy was defined as a cumulative radiation dose ≥60 Gy to the primary site or surgical resection of the primary site. Kaplan–Meier estimates, log-rank tests, and multivariable Cox proportional hazard modeling were used to estimate overall survival.

Results: A total of 221 cases were identified for this analysis. The mean age of all patients was 57.9 (SD: 14.3) and 129 (61.1%) were male. Forty-three patients (20.4%) received definitive local therapy in addition to systemic therapy, with the remaining having only received chemotherapy (168, 79.6%). Among the entire population, the overall median survival was 11.6 months (CI: 9.4–13.8) and 5-year overall survival was 13.0% (CI: 8.8–19.2). Median survival for those that received only chemotherapy was 10.2 months (CI: 8.7–13.1) and for those that received definitive local therapy was 15.8 months (CI: 11.6–22.0). On univariate analysis, the difference in survival between the two groups was not statistically significant (p = 0.236). On multivariable analysis, multiple factors were independent predictors of overall survival including age, race, distance from treatment facility, residence location, and income. Additionally, individuals with adenocarcinoma histology had significantly worse overall survival compared with those with squamous cell carcinoma histology (HR: 4.85, CI: 1.83–12.85). Of note, definitive local therapy was not significantly associated with overall survival on multivariable analysis (HR: 1.32, CI: 0.78–2.27).

Conclusion: A minority of patients with metastatic sinonasal malignancies receive definitive local therapy in addition to primary systemic therapy. Interestingly, definitive local therapy does not provide a survival benefit for such patients. This may indicate that physicians should avoid administering intense locoregional therapy to patients with metastatic disease with the goal of improving overall survival. However, local therapy may still be warranted in certain instances, as symptom palliation likely serves an important role in end of life care for such patients but cannot be quantified in the NCDB.

Fig. 1 Unadjusted Kaplan–Meier chart for patients who received definitive local therapy versus systemic therapy only.

Publication History

Article published online:
12 February 2021