Posttreatment Surveillance for Recurrence in Sinonasal Malignancies

Background: Sinonasal malignancy (SNM) represents a variety of aggressive tumors with a high rate of local recurrence. Surgery is a mainstay of treatment and when combined with chemotherapy and radiation, this often leads to the best overall prognosis. Nasal endoscopy is essential for posttreatment surveillance along with physical exam and radiologic evaluation. The ability to directly visualize the sinus cavities after surgery may also improve early detection of tumor recurrence and is another reason to potentially advocate for surgery in these patients.

Purpose: The objective of this study was to assess tumor surveillance modalities and how surgically patent sinus cavities effect the ability of nasal endoscopy to identify tumor recurrence.

Methods: A single-center, retrospective review from 2005 to 2019 of 231 patients with pathology proven primary SNM was conducted. Patients were divided into three subgroups based on treatment: surgery, surgery with adjuvant radiotherapy, and definitive radiotherapy.

Results: The nasal cavity and maxillary sinus were the two most common primary tumor sub-sites. The average follow-up was 42 ± 35 months. The median time to recurrence was 9.8 months. Recurrence was initially detected endoscopically in 23 (34.3%) patients, by imaging in 42 (62.7%) patients, and by physical exam in 2 (3.0%) patients. There was a total of 46 patients (68.7%) with local recurrences, the majority of which (24) were identified via nasal endoscopy as opposed to imaging. Thirteen recurrences were identified via endoscopic surveillance within the surgically patent paranasal sinuses, while 13 were identified of the nasal cavity; 2 patients had multiple sites of recurrence. With the exception of the sphenoid sinus, recurrences following surgical treatment that were detected endoscopically were more likely to be found in the original site of the primary tumor (p < 0.05). Twenty (87.0%) of these cases had confirmation of the location of recurrence in the subsequent imaging. Seven recurrences were identified in the XRT only group, and only two were identified via endoscopy which were within the nasal cavity. Both cases had follow-up imaging that identified additional tumor involvement of the paranasal sinuses. Two local recurrences were identified on MRI surveillance of the paranasal sinuses which were not surgically opened for endoscopic inspection. Overall recurrence including local, regional and metastatic disease was most likely to be detected by routine surveillance with imaging (62.7%).

Conclusion: More than two-thirds of SNM recurrences were local in location, a majority of which were identified by nasal endoscopy. Half of the recurrences identified endoscopically were within the paranasal sinuses. These would not have been easily identified in a clinical examination if the sinuses were not open for inspection. Thus, open sinus cavities aid in the detection of tumor recurrence and are another advantage of surgery for primary SNM. In addition, follow-up radiographic findings have shown to improve the accuracy of clinical exam findings and therefore should be used in compliment with physical examination including nasal endoscopy.