Impact of Age on the Treatment and Survival in Sinonasal Malignancies

Introduction: Proportion and duration of survival of sinonasal malignancy (SNM) patients has consistently increased in the past decade. However, the disease characteristics and survival outcomes in the elderly patients are not well defined. This study was performed to analyze the survival outcomes in elderly SNM patients.

Methods: Retrospective chart review of SNM treated at a tertiary care center. Patients were divided into three groups based on age at presentation: ≤65 years (younger; group Y; 56%), 66 to 80 years (elderly: group E: 35%) and >80 years (very elderly; group VE; 10%). Group Y has been considered as the reference group. Pretreatment comorbidity levels, treatment, and survival outcomes were analyzed (Chi-square and t-tests).

Results: A total of 230 patients were included. 58% were males, 59% smokers, 42% squamous cell carcinoma, 42% TNM stage III/IV, and 90% underwent surgical treatment.

Preoperative Characteristics: Group E had higher Charlson’s comorbidity index score (p = 0.001; 2.99 vs. 2.39), nine times higher incidence of myocardial infarction and three times higher incidence of Diabetes mellitus (p = 0.005) in comparison to the Y group. Group VE in comparison to group Y had, 14 times higher incidence of myocardial infarction (p = 0.004). Demographics including smoking were comparable.

Tumor Characteristics: Group VE had 3.3 times higher proportion of pterygopalatine fossa involvement (p = 0.03) and five times higher proportion of nodal disease at presentation (p = 0.04). TNM staging, skull base, and orbital extension was comparable.

Treatment Characteristics: Groups Y and E underwent comparable treatment, namely, modality, surgical approach, extent of resection, and intent of treatment (curative vs. palliative). Mean radiation dose used to treat group Y was higher than that used for group E (p = 0.01; 62.41 vs. 56.60). Exenteration was thrice more commonly used in group E than group Y (p = 0.04). Debulking procedures (p = 0.02) were 3.4 times and palliative treatment 12 times more commonly used in VE group. Chemotherapy was thrice (p = 0.04) and radiotherapy 3.8 times (p = 0.004) less likely to be used in VE groups.

Posttreatment Complications: Sinusitis was 2.5 times (p = 0.006), adhesions 2.3 times (p = 0.01), and nasal stenosis 2.7 times (p = 0.03) less likely in group E. Group VE also showed 14 times lower incidence of sinusitis (p = 0.002). Other complications including epistaxis, crusting, septal perforation, dysphagia, wound infections, thromboembolism, airway issues, and intra- and postoperative CSF leak rates were comparable.

Survival Outcomes: Group E had two times lower recurrence rates (p = 0.04) while VE had recurrence rate comparable to group Y. A 30-day readmission rates, number of recurrences, and number of reoperations were comparable. Kaplan–Meier survival curves (log rank test) were comparable (p = 0.75 and p = 0.1 for group E and VE, respectively). Mean duration of follow-up was significantly different (group Y: 37.41 months vs. group E: 24.23 months vs. group VE: 15.31 months).

Conclusion: Although, elderly and very elderly patients report worse pretreatment comorbidities than their younger counterparts, they had a lower incidence of sinonasal complications and recurrence. For patients who do undergo curative treatment, survival curves are comparable with that in younger population. Therefore, age, in itself, should not be the main deterrent for SNM treatment.