Download PDF
J Neurol Surg B Skull Base 2019; 80(01): 088-095
DOI: 10.1055/s-0038-1668537
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Sinonasal Undifferentiated Carcinoma: A 15-Year Single Institution Experience

Alan D. Workman
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Robert M. Brody
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Edward C. Kuan
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Esther Baranov
2   Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Steven G. Brooks
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Michelle Alonso-Basanta
3   Department of Radiation Oncology, University of Pennsylvania, Philadelphia,, Pennsylvania, United States
,
Jason G. Newman
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Christopher H. Rassekh
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Ara A. Chalian
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Alexander G. Chiu
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
4   Department of Otolaryngology – Head and Neck Surgery, University of Kansas, Kansas City, Kansas, United States
,
Gregory S. Weinstein
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Michael D. Feldman
2   Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Nithin D. Adappa
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Bert W. O'Malley Jr.
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
James N. Palmer
1   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

12 February 2018

12 July 2018

Publication Date:
16 August 2018 (online)

   Permissions and Reprints

Abstract

Objective Sinonasal undifferentiated carcinoma (SNUC) is an aggressive neoplasm, with conflicting existing literature regarding prognosis and treatment due to the rarity of disease. Characterization of optimal SNUC management is necessary for improved outcomes.

Study Design Case series with planned data collection and analysis.

Setting Hospital of the University of Pennsylvania and Pennsylvania Hospital.

Participants Patients with pathologically confirmed SNUC treated within a 15-year period were identified, and records were obtained and evaluated for several demographic characteristics.

Main Outcomes Measures Disease-specific survival from diagnosis was the primary endpoint, while disease recurrence was a secondary endpoint of the study.

Results Twenty-seven patients with established SNUC were included in this cohort, with a median age of 55 years. Eighty-five percent of patients were surgically treated, and 85% of patients presented with stage IV disease. Two-year disease-specific survival was 66% and 5-year disease-specific survival was 46%. Ninety-six percent of patients received both chemotherapy and radiation as adjuvant treatment. Nodal disease at presentation and disease recurrence both significantly decreased patient survival (p < 0.05).

Conclusions The majority of patients at this institution presented with clinically advanced disease, and most were managed with a multimodal approach of surgical resection, chemotherapy, and radiation. Extent of disease at presentation and progression of disease following treatment are poor prognostic signs and may merit a more aggressive approach, while early detection and treatment may improve survival and decrease patient morbidity.

Keywords

SNUC - sinonasal undifferentiated carcinoma - survival - treatment paradigms - prognosis
 

  • References

  • 1 Reiersen DA, Pahilan ME, Devaiah AK. Meta-analysis of treatment outcomes for sinonasal undifferentiated carcinoma. Otolaryngol Head Neck Surg 2012; 147 (01) 7-14
    CrossrefPubMedGoogle Scholar
  • 2 Mendenhall WM, Mendenhall CM, Riggs Jr CE, Villaret DB, Mendenhall NP. Sinonasal undifferentiated carcinoma. Am J Clin Oncol 2006; 29 (01) 27-31
    CrossrefPubMedGoogle Scholar
  • 3 Lin EM, Sparano A, Spalding A. , et al. Sinonasal undifferentiated carcinoma: a 13-year experience at a single institution. Skull Base 2010; 20 (02) 61-67
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Musy PY, Reibel JF, Levine PA. Sinonasal undifferentiated carcinoma: the search for a better outcome. Laryngoscope 2002; 112 (8 Pt 1): 1450-1455
    CrossrefPubMedGoogle Scholar
  • 5 Rischin D, Porceddu S, Peters L, Martin J, Corry J, Weih L. Promising results with chemoradiation in patients with sinonasal undifferentiated carcinoma. Head Neck 2004; 26 (05) 435-441
    CrossrefPubMedGoogle Scholar
  • 6 Miyamoto RC, Gleich LL, Biddinger PW, Gluckman JL. Esthesioneuroblastoma and sinonasal undifferentiated carcinoma: impact of histological grading and clinical staging on survival and prognosis. Laryngoscope 2000; 110 (08) 1262-1265
    CrossrefPubMedGoogle Scholar
  • 7 Raja V, Campbell GA. Unusual cases involving the CNS and nasal sinuses: case 2. Sinonasal undifferentiated carcinoma. J Clin Oncol 2003; 21 (20) 3877-3880
    CrossrefPubMedGoogle Scholar
  • 8 Chen AM, Daly ME, El-Sayed I. , et al. Patterns of failure after combined-modality approaches incorporating radiotherapy for sinonasal undifferentiated carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2008; 70 (02) 338-343
    CrossrefPubMedGoogle Scholar
  • 9 Ejaz A, Wenig BM. Sinonasal undifferentiated carcinoma: clinical and pathologic features and a discussion on classification, cellular differentiation, and differential diagnosis. Adv Anat Pathol 2005; 12 (03) 134-143
    CrossrefPubMedGoogle Scholar
  • 10 Smith SR, Som P, Fahmy A, Lawson W, Sacks S, Brandwein M. A clinicopathological study of sinonasal neuroendocrine carcinoma and sinonasal undifferentiated carcinoma. Laryngoscope 2000; 110 (10 Pt 1): 1617-1622
    CrossrefPubMedGoogle Scholar
  • 11 Frierson Jr HF, Mills SE, Fechner RE, Taxy JB, Levine PA. Sinonasal undifferentiated carcinoma. An aggressive neoplasm derived from Schneiderian epithelium and distinct from olfactory neuroblastoma. Am J Surg Pathol 1986; 10 (11) 771-779
    CrossrefPubMedGoogle Scholar
  • 12 Tanzler ED, Morris CG, Orlando CA, Werning JW, Mendenhall WM. Management of sinonasal undifferentiated carcinoma. Head Neck 2008; 30 (05) 595-599
    CrossrefPubMedGoogle Scholar
  • 13 Xu CC, Dziegielewski PT, McGaw WT, Seikaly H. Sinonasal undifferentiated carcinoma (SNUC): the Alberta experience and literature review. J Otolaryngol Head Neck Surg 2013; 42: 2
    CrossrefPubMedGoogle Scholar
  • 14 Kramer D, Durham JS, Sheehan F, Thomson T. Sinonasal undifferentiated carcinoma: case series and systematic review of the literature. J Otolaryngol 2004; 33 (01) 32-36
    CrossrefPubMedGoogle Scholar
  • 15 Righi PD, Francis F, Aron BS, Weitzner S, Wilson KM, Gluckman J. Sinonasal undifferentiated carcinoma: a 10-year experience. Am J Otolaryngol 1996; 17 (03) 167-171
    CrossrefPubMedGoogle Scholar
  • 16 Deutsch BD, Levine PA, Stewart FM, Frierson Jr HF, Cantrell RW. Sinonasal undifferentiated carcinoma: a ray of hope. Otolaryngol Head Neck Surg 1993; 108 (06) 697-700
    CrossrefPubMedGoogle Scholar
  • 17 Jeng YM, Sung MT, Fang CL. , et al. Sinonasal undifferentiated carcinoma and nasopharyngeal-type undifferentiated carcinoma: two clinically, biologically, and histopathologically distinct entities. Am J Surg Pathol 2002; 26 (03) 371-376
    CrossrefPubMedGoogle Scholar
  • 18 Wadsworth B, Bumpous JM, Martin AW, Nowacki MR, Jenson AB, Farghaly H. Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV). Head Neck Pathol 2011; 5 (04) 349-354
    CrossrefPubMedGoogle Scholar
  • 19 Wenig BM. Undifferentiated malignant neoplasms of the sinonasal tract. Arch Pathol Lab Med 2009; 133 (05) 699-712
    CrossrefPubMedGoogle Scholar
  • 20 Gray ST, Herr MW, Sethi RK. , et al. Treatment outcomes and prognostic factors, including human papillomavirus, for sinonasal undifferentiated carcinoma: a retrospective review. Head Neck 2015; 37 (03) 366-374
    CrossrefPubMedGoogle Scholar
  • 21 Mourad WF, Hauerstock D, Shourbaji RA. , et al. Trimodality management of sinonasal undifferentiated carcinoma and review of the literature. Am J Clin Oncol 2013; 36 (06) 584-588
    CrossrefPubMedGoogle Scholar
  • 22 Yoshida E, Aouad R, Fragoso R. , et al. Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck. Am J Otolaryngol 2013; 34 (06) 658-663
    CrossrefPubMedGoogle Scholar
  • 23 Gamez ME, Lal D, Halyard MY. , et al. Outcomes and patterns of failure for sinonasal undifferentiated carcinoma (SNUC): the Mayo Clinic experience. Head Neck 2017; 39 (09) 1819-1824
    CrossrefPubMedGoogle Scholar
  • 24 Ahn PH, Mitra N, Alonso-Basanta M. , et al. Nodal metastasis and elective nodal level treatment in sinonasal small-cell and sinonasal undifferentiated carcinoma: a surveillance, epidemiology and end results analysis. Br J Radiol 2016; 89 (1058): 20150488
    CrossrefPubMedGoogle Scholar
  • 25 Chambers KJ, Lehmann AE, Remenschneider A. , et al. Incidence and survival patterns of sinonasal undifferentiated carcinoma in the United States. J Neurol Surg B Skull Base 2015; 76 (02) 94-100
    PubMedGoogle Scholar
  • 26 Kuan EC, Arshi A, Mallen-St Clair J, Tajudeen BA, Abemayor E, St John MA. Significance of tumor stage in sinonasal undifferentiated carcinoma survival: a population-based analysis. Otolaryngol Head Neck Surg 2016; 154 (04) 667-673
    CrossrefPubMedGoogle Scholar
  • 27 Khan MN, Konuthula N, Parasher A. , et al. Treatment modalities in sinonasal undifferentiated carcinoma: an analysis from the National Cancer Database. Int Forum Allergy Rhinol 2017; 7 (02) 205-210
    CrossrefPubMedGoogle Scholar
  • 28 Al-Mamgani A, van Rooij P, Mehilal R, Tans L, Levendag PC. Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature. Eur Arch Otorhinolaryngol 2013; 270 (01) 293-299
    CrossrefPubMedGoogle Scholar
  • 29 Kim BS, Vongtama R, Juillard G. Sinonasal undifferentiated carcinoma: case series and literature review. Am J Otolaryngol 2004; 25 (03) 162-166
    CrossrefPubMedGoogle Scholar
  • 30 Hitt R, López-Pousa A, Martínez-Trufero J. , et al. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol 2005; 23 (34) 8636-8645
    CrossrefPubMedGoogle Scholar
  • 31 Khalili S, Worrall DM, Brooks S. , et al. Endoscopy versus imaging: analysis of surveillance methods in sinonasal malignancy. Head Neck 2016; 38 (08) 1229-1233
    CrossrefPubMedGoogle Scholar
  • 32 Workman AD, Palmer JN, Adappa ND. Posttreatment surveillance for sinonasal malignancy. Curr Opin Otolaryngol Head Neck Surg 2017; 25 (01) 86-92
    CrossrefPubMedGoogle Scholar
  • 33 Stelow EB, Bishop JA. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2017; 11: 3-15
    CrossrefPubMedGoogle Scholar
  • 34 Rosenthal DI, Barker Jr JL, El-Naggar AK. Sinonasal malignancies with neuroendocrine differentiation: patterns of failure according to histologic phenotype. Cancer 2004; 101 (11) 2567-2573
    CrossrefPubMedGoogle Scholar