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KUANetal.

TABLE VIII.5 Evidence surrounding resectability of tumors involving the pterygopalatine fossa or infratemporal fossa.

Clinical endpoints

Author

Year LOE Study design Study groups

Conclusion

Konig et al. 193

Survival

1. Retromaxillary involvement portended worse 2-, 5-, and 10-yearOS 2. PSM associated with worse survival 1. 68% achieved NSM 2. 3- and 5-year OS for malignancy were 82% and 66%, respectively 1. 56.2% achieved NSM 2. Close or positive surgical margins portended worse 5-year RFS PPF and ITF extension were not associated with worse 5-year OS or LRC compared to T4b tumors 1. 70% achieved NSM. 2. Median OS of 40 months and 3-year survival of 59.6%

2020 3

Prospective cohort

72 patients treated for SCC of the paranasal sinuses

outcomes

Yafit et al. 189

2019 4

Retrospective case series

63 patients with

1. Margins 2. OS

tumors involving the ITF

He et al. 191

1. Margins 2. OS

2015 4

Retrospective case series

80 patients with malignancies

involving PPF or ITF who underwent resection

Kanoet al. 194

2014 4

Retrospective case series

118 patients with

1. OS 2. LRC

locally advanced maxillary sinus cancer

Givi et al. 190

1. Margins 2. OS

2013 4

Retrospective case series

43 patients who underwent anterolateral

approach to tumors with ITF resection

Hentschel et al. 192

2010 4

Retrospective case series

52 patients with

Patient

1. 77% achieved GTR 2. 2- and 5-year OS of 81% and 53%, respectively

anterolateral skull base neoplasms (75% involving ITF)

demographics, tumor charac teristics, treatment, and outcomes

Abbreviations: ITF, infratemporal fossa; GTR, gross total resection; LRC, locoregional control; NSM, negative surgical margins; OS, overall survival; PSM, positive surgical margins; RFS, recurrence-free survival; SCC, squamous cell carcinoma.

metastatic disease has significant therapeutic implications for the individual patient and may therefore warrant rou tine radiographic imaging, such as PET/CT or CT neck and chest, which are most commonly used in clinical practice. A Retropharyngeal lymphadenopathy Physical exam with neck palpation of patients diagnosed with SNM should always be performed. Although this was not a main research focus and was stated in only three of the included articles, findings of enlarged cer vical nodes on examination raise the suspicion of more advanced disease, are associated with worse prognosis, and prompt further investigation by imaging to rule out regional and distant metastasis. 199 Retropharyngeal lymph nodes (RPLNs) may be encountered for several SNM. In contrast to cervical lymphadenopathy, enlarged RPLNs are not easily identifiable on physical exam. They are also more difficult to treat surgically due to their location, and their presence may therefore lead to a change in treatment

for these patients. In addition, metastatic RPLNs have been reported in as high as 30.6% of patients with sinonasal cancers. 201,202 Six articles report the incidence of patho logic RPLNs, including 30.6% in a heterogeneous group of sinonasal carcinomas, 0% specific to adenocarcinoma, 8.2% for ONB, 16% for a mix of maxillary sinus carcino mas, and 20.6% for maxillary sinus SCC. 201–205 One study identified that 43% of patients with ONB who had positive cervical nodes had enlarged RPLNs as well, and there fore recommended evaluation for RPLN involvement in all patients with this histopathological diagnosis. 206 With the potentially high rate of RPLN and the difficulty of iden tifying these on physical exam, it is important to look for the presence of enlarged RPLN on imaging. Two studies suggested CT with contrast to detect RPLN, one of which specifies < 5-mm cuts. 205,207 More recent studies suggest MRI as a superior modality to identify RPLN. 201,202 MRI accuracy in the measurement of axial diameters of RPLN ≥ 5 mm was reported as 94.1% in one study. 202 Neverthe less, despite a trend toward MRI as a superior modality, there are insufficient data to recommend one modality