J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702308
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Treatment Modality Role in Survival of Patients with Advanced Squamous Cell Carcinoma of the Sinonasal Cavity: A National Cancer Database Study

Chris Johnson
1   Augusta University, Augusta, Georgia, United States
,
Camilo Reyes
1   Augusta University, Augusta, Georgia, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

 

Background: Squamous cell carcinoma (SCCa) is the most common paranasal sinus malignancy and commonly presents in advanced stages. Unfortunately, survival is strongly influenced by tumor stage at presentation leading to universally poor outcomes for many patients with advanced disease. Current data regarding treatment of advanced T-stage paranasal sinus SCCa is lacking and limited to small, retrospective, single institution studies. Over the past two decades of studies have been conducted that investigated the role of neoadjuvant therapy to improve outcomes.

Objective: Review treatment modalities survival of advanced T-stage SCCa of the paranasal sinus.

Methods: Using the National Cancer Database (NCDB), we analyzed over 2,000 cases of paranasal sinus malignancy. Patients were selected for age 18 years or older; first malignancy; tumor stage 4A or 4B; malignancy of the maxillary, ethmoid, sphenoid, and frontal sinus; and complete data regarding treatment, staging, and margin status. Patients were grouped according to the following treatment modalities: primary surgery, concurrent chemoradiaiton, neoadjuvant chemotherapy followed by surgery, and induction chemotherapy followed by surgery. Groups were compared for difference in patient demographics, comorbidities, and disease specific factors. Kaplan–Meier analysis was used to assess overall survival. Cox’s hazard ratio (HR) analysis was used to assess factors affecting overall survival.

Results: A total of 2,711 patients were included in the analysis. The mean age was 62 years and 67.5% of patients were male. The most common subsite was the maxillary sinus (59.3%), followed by the nasal cavity (29.3%), and the ethmoid sinuses (11.3%). The most common treatment modalities were chemoradiation (16.5%), surgery followed by chemoradiation (16%), surgery followed by radiation (15.9%), surgery alone (9.8%), induction chemotherapy followed by radiation (9.3%), and radiation only (7.4%). Kapaln–Meier analysis demonstrated a 5-year overall survival of 45% of for primary surgery patients, 42% for neoadjuvant therapy followed by surgery, 36% for induction chemotherapy followed by radiation, and 27% for chemoradiation alone. On Cox’s hazard analysis maxillary sinus (HR = 1.39), cN2 disease (HR = 1.48), SCCa spindle cell variant (HR = 2.160), advanced age (HR = 1.76), and chemoradiation (HR = 1.27) were found to have a statistically significant impact on the risk of death. Negative margins were associated with a lower risk of death (HR = 0.74). Specifically for T4B tumors, advanced age and chemoradiation remained risk factors for death. When surgically treated patients were grouped according to margin status and compared with the aforementioned treatment groups the difference in survival curves was more pronounced but only achieved statistical significance for worse survival in the chemoradation treatment group.

Conclusion: In our analysis, surgery was a common treatment modality both in the setting of surgery plus adjuvant treatment and neoadjuvant treatment followed by surgery. Overall the surgically treated patients had a trend toward improved survival when compared with other treatment groups but only reached statistical significance when compared with patients treated with chemoradiation alone. The survival differences more pronounced when negative margins were achieved during surgery.

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