Nonsurgical Approaches in Sinonasal Undifferentiated Carcinoma

Objective Sinonasal undifferentiated carcinoma (SNUC) is a locally aggressive undifferentiated neuroendocrine tumor originating from nasal cavity or paranasal sinus epithelium. The value of adding induction chemotherapy to definitive treatment is unknown. This study aimed to assess the role of induction chemotherapy followed by concurrent chemoradiotherapy (CRT) compared with surgery for SNUC.

Methods This study investigated 97 patients with stage II (N = 8), III (N = 13), and IV (n = 76) SNUC treated between 1995 and 2016 in MD Anderson Cancer Center. SNUC patients were treated with three cycles of cisplatin (60−80 mg/m²) and etoposide (100−120 mg/m²) every 21 days. The primary endpoint was disease-specific survival. Our secondary outpoints were overall and disease-free survival and organ (i.e., palate, eye, and brain) preservation.

Results The median follow-up was 28 months (range: 2−281 months). Induction chemotherapy was administered to 69 (70%) patients. Of those, 41 (60%) had subsequent concurrent chemoradiotherapy and 11(16%) had surgery. Surgery (n = 20) or CRT (n = 8) were the primary therapy in 28 (30%) patients. The 5-year overall survival (OS) rates were 61 and 56% in the induction chemotherapy and surgery/CRT treatment groups, respectively (p = 0.52). The 5-year disease-specific survival (DSS) rates were 61 and 59% in induction chemotherapy and surgery/CRT treatment groups, respectively (p = 0.35). The 5-year disease-free survival (DFS) did not differ significantly between treatment groups (p = 0.76). Local recurrence was the most common form of treatment failure and occurred in 23 (24%) patients. Distant metastasis, most commonly to the lungs, occurred in 20 (n = 21%) patients. The 5-year distant metastasis rates were similar in patients treated systemically with induction chemotherapy (73%) or surgery/CRT (73%, p = 0.88). The rate of organ preservation was 91 and 89% in the induction chemotherapy and surgery/RT treatment groups, respectively (p = 0.79). Multivariate analysis revealed that the patient's age and extent of disease were independent predictors of 5-year disease-specific survival.

Conclusion In patients with SNUC, adding induction chemotherapy is noninferior to primary surgical resection or concurrent administration of chemoradiotherapy for disease-specific survival, local control, and distant metastasis free survival and organ preservation rates. Future studies are needed to compare induction chemotherapy followed by concurrent chemoradiotherapy and primary concurrent chemoradiotherapy.