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ICAR SINONASAL TUMORS

TABLE VIII.4 (Continued)

Clinical endpoints

Author

Year LOE Study design Study groups

Conclusion

Cantu et al. 163

1. 13.1% of patients had orbital apex involvement 2. 60.1% had some form of intracranial involvement 3. 10.7% had frank intradural/brain parenchyma involvement 4. Local recurrence was correlated with orbital apex involvement or dural involvement 5. Intradural spread was not associated with increased local relapse 6. 74% achieved NSM 1. GTR with NSM positively predicts OS 2. Brain parenchymal invasion negatively predicts PFS 1. 5-year OS of 59% for malignant tumors 2. Orbital involvement, brain involvement, and histology were primary predictors of OS 1. All resection types included severing of nerves travelling through orbital apex 2. Advanced tumors requiring resection of the entire cavernous sinus exhibited major morbidity and mortality 1. 6% exhibited frontal lobe tumor infiltration 2. 14% had resectable dural involvement 3. Malignant histology, brain involvement, and orbital involvement portended worse OS

1. DSS 2. OS 3. RFS

2012 4

Retrospective case series

366 patients with

malignant paranasal sinus tumors treated withCFR

Feiz-Erfan et al. 178

2007 4

Retrospective case series

28 patients with cranial base malignancies and transdural spreadwho underwent CFR

1. OS 2. PFS

Howard et al. 175

OS

2006 4

Retrospective case series

308 patients who

underwent CFR for sinonasal neoplasms

Saito et al. 187

1999 4

Retrospective case series

25 malignant skull base tumors with cavernous sinus

N/A

invasion underwent en bloc resection

Lundet al. 176

1. OS 2. DSS

1998 4

Retrospective case series

209 patients who

underwent CFR for sinonasal neoplasms

Abbreviations: CFR, craniofacial resection; DSS, disease-specific survival; GTR, gross total resection; NSM, negative surgical margins; ONB, olfactory neuroblastoma; OS, overall survival; PFS, progression-free survival; PSM, positive surgical margins; RFS, recurrence-free survival; SNM, sinonasal malignancy.

presence of regional or distant metastasis. 199,200 Despite this lack of consensus, when regional or distant metasta sis is identified, treatment options are significantly altered; surgical resection may no longer be recommended, and RT or systemic treatment options not initially considered may become indicated. Palliative therapy may be considered in certain cases to prioritize comfort and to avoid poten tial morbidities associated with treatments with curative intent in the presence of metastatic disease. High-risk histopathology of the primary sinonasal tumor or sus pected nodal metastasis should prompt imaging to rule out regional or distant metastasis. Undoubtedly, presence of

Although head and neck cancer guidelines are well explored and continue to evolve with the growing litera ture in the field of head and neck oncology, recommenda tions for workup of regional and distant metastasis specific to SNM are lacking. This is in part due to the rarity of these tumors, accounting for 3%–6% of all head and neck cancers. 197,198 In addition, regional metastasis in sinonasal tumors ranges between 3% and 33% and distant metastasis occurs in less than 7% of cases. 199 Since the latter is uncom mon even in advanced T stage, there is no agreement on the need for routine imaging, the most ideal imaging modal ity, or its cost-effectiveness at initial staging to identify the