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.

Publication History

Publication Date:
02 February 2018 (online)