Impact of Salvage Surgery for Recurrent Sinonasal Cancers with Skull Base and Intracranial Involvement

Introduction: Recurrent sinonasal cancers (RSNCs) often present with extensive involvement of the skull base and exhibit high subsequent recurrence and mortality rates following therapy. The impact of salvage surgery and margin status on progression free survival (PFS) and overall survival (OS) has yet to be demonstrated. The goal of this study was to determine if performing a skull base resection with negative margins (NM) has an impact on outcomes in the recurrent setting.

Methods: A retrospective chart review of 47 patients undergoing surgery for RSNC with skull base invasion between November 1993 and June 2020 was conducted. Clinical records were assessed for the following variables: patient demographics (age and sex), tumor pathology, dural and orbital invasion, number of previous surgeries, prior radiation exposure and induction chemotherapy. Metastatic disease status, surgical approach, margin status and history of postoperative chemotherapy and/or postoperative radiation were noted. The primary and secondary outcomes assessed were PFS and OS, respectively.

Results: The cohort included 30 males (63.8%) and 17 females (36.2%), with a mean age of 54.8 years (SD: 14.4). Thirty-five (74.5%) patients showed disease progression, and 29 (61.7%) patients died during the study period. The mean patient follow-up was 61.8 (SD 64.4) months. Dural invasion was associated with increased mortality HR 2.62 95% CI [1.13, 6.08]. High-risk histopathologies (HR: 3.14 95% CI [1.10, 8.95]) and induction chemotherapy (HR: 2.32 95% CI [1.07, 5.06]) were associated with increased odds of disease progression. When compared to patients with positive margins or gross total resection with unknown margin status, those with negative margins had decreased odds of disease progression (HR 0.30 95% CI [0.14, 0.63]) and decreased mortality (HR: 0.38 95% CI [0.17, 0.85]).

Conclusion: RSNCs show high rates of subsequent disease progression and mortality. This study demonstrates that in carefully selected patients undergoing salvage surgery for RSNC, obtaining NMs is associated with improved PFS and OS.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022