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91

ICAR SINONASAL TUMORS

TABLE XI.2 Evidence surrounding orbital preservation versus orbital exenteration.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

1. OS 2. DSR

1. Benign tumors allow for invariable orbital sparing 2. Malignant tumors allow for orbital sparing pending the extent of infiltration and the grading of the tumor 3. Multimodal therapy is typically required in malignant tumors 1. Orbital exenteration is not necessary with bone erosion alone, optional in cases of periorbital involvement 2. In cases of limited soft tissue involvement, can consider orbital preservation if fat can be macroscopically cleared Orbital exenteration does not increase survival odds, in tumors where there is no full thickness invasion of the periorbita 1. 5-year OS was significantly higher in patients with exenteration compared to those who had orbital preservation with adjuvant radiation 2. Exenteration only recommended if curative intent possible 1. Greater OS in patients treated with surgery than those who did not undergo surgery 2. Similar local and orbital control rates in those undergoing preservation versus exenteration 3. Only patients with grade 2 or lower underwent orbital preservation

Castelnuovo et al. 335

2021

2

Systematic review

21 studies Benign lesions ( n = 84) Malignant lesions ( n = 2449)

Muscatello et al. 340

2016 2

Systematic review

14 studies ( n = 3146) Group A—Orbital bone erosion Group B: Periorbital involvement Group C: Soft tissue involvement Group A: Orbital bone invasion without Soft Tissue invasion ( n = 37) Group B: Orbital soft tissue invasion ( n = 21) periosteum treated with either exenteration ( n = 29) or preservation with adjuvant radiation ( n = 23) versus nonsurgical treatment ( n = 25) options based on degree of orbital invasion Orbital exenteration Orbital invasion beyond the Surgical ( n = 58)

1. OS 2. DFS

Carrau et al. 323

OS

1999 2

Systematic

reviewand meta analysis with retrospective case series

Safi et al. 343

2017 3

Retrospective cohort

OS

Lisan et al. 339

1. LR 2. OS 3. Distant

2016 3

Retrospective cohort

metastases 4. Functional orbital and globe

outcomes, including diplopia, epiphora, and visual loss

versus orbital preservation dictated by radiographic examination for orbital invasion

Imolaand

2002 3

Retrospective cohort

Orbital preservation cohort ( n = 54) versus orbital exenteration cohort ( n = 12)

1. OS 2. LR 3. Eye function in preservation cohort

1. Long-term survival outcome was mostly related to tumor histology, and not related to type of orbital surgery 2. Local recurrence and eye functionality were not affected by orbital preservation (Continues)

Schramm 338