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KUANetal.

TABLE VIII.1 Evidence surrounding resectability of sinonasal tumors.

Clinical endpoints Conclusion

Author

Year LOE Study design Study groups

Jafari et al. 161

7808 patients with sinonasal SCC

OS

1. Degree of tumor extirpation correlates with OS 2. Macro-PSM did not improve OS compared to nonsurgical therapy 1. NSM were associated with improved OS compared to micro- and macro-PSM 2. T4a and T4b tumors benefited from adjuvant RT 3. Advanced T-stage predicted nonsurgical therapy 1. Adjuvant RT, CRT, and neoadjuvant therapy improved OS compared to surgery alone 2. Neoadjuvant CRT improved the likelihood of NSM 3. Nonsurgical therapy portended worseOS PSM predicted worse OS and DSS

2019 4

Retrospective database (NCDB)

Cracchiolo et al. 160

2018

4

Retrospective database (NCDB)

4770 patients with sinonasal SCC

OS

Robin et al. 159

11,160 patients with SNM

OS

2017

4

Retrospective database (NCDB)

deAlmeida et al. 130

2015

4

Retrospective case series

34 patients with sinonasal SCC

1. DFS 2. OS

treated with EEA

Mine et al. 185

PSM portended worse DFS, OS, and LRC

2011

4

Retrospective case series

32 patients with SNM 1. DFS 2. OS 3. LRC

Abbreviations: DFS, disease-free survival; LRC, locoregional control; NCDB, National Cancer DataBase; NSM, negative surgical margin; OS, overall survival; PSM, positive surgical margin; SCC, squamous cell carcinoma.

advanced SNM were not encountered in this systematic review (Table VIII.1). Therefore, select studies of smaller patient series, studies of nonsinonasal tumor locations, or those evaluating salvage surgeries have been included to illustrate the clinical parameters of resectability. Aggregate grade of evidence : C (Level 4: three stud ies) B Orbital apex involvement Sinonasal tumors that infiltrate the orbital apex surround critical neurovascular structures transcending corridors to the intracranial cavity and cavernous sinus, making nega tive margin resection unfeasible. Studies have shown that orbital invasion, particularly, orbital apex involvement, is independently associated with decreased OS compared to invasion of the anterior two thirds of the orbital compartment. 163–165 In 2015, Sugawara et al. reported their results of 15 patients with recurrent SNM with orbital apex involvement that underwent salvage surgery via extended orbital exenteration. The described technique included an anterior CFR with orbital exenteration followed by middle

fossa exploration and resection of orbital apex and sphe noid disease to achieve negative margins. 166 They noted an OS of 86% at a mean follow-up of 3 years in this limited sample with short follow-up. A retrospective review of 163 patients with sinonasal cancers with orbital invasion found that, even when employing both histologically appropriate neoadjuvant chemotherapy and extended orbital exenter ation, those with orbital apex involvement still exhibited 5-year OS of 14.6% ± 7.5%, DSS of 0%, and 10-year OS of 0%. 165 With the dismal prognosis of tumors involv ing the orbital apex, nonsurgical multimodality therapy is preferred given the low likelihood of obtaining nega tive margins with orbital exenteration, even with extended intracranial dissection, as it does not appear to change survival (Table VIII.2). Aggregate grade of evidence : C (Level 4: three stud ies) C Carotid artery involvement Tumors abutting or encasing the internal carotid artery (ICA) exhibit an overall poor prognosis and carry