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ICAR SINONASAL TUMORS

TABLE XI.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Essig et al. 337

1. Most common pretreatment symptoms were motility issues, afferent defects, and eyelid malposition 2. Using functional scale previously established, 35 patients of the 36 available for long-term follow-up retained functional vision with mild impairment Orbital exenteration demonstrates improved local control and OS rate in patients with grade 3 orbital invasion

Visual and oph thalmologic outcomes pre and postsurgery

2007 4

Retrospective case series

All patients underwent craniofacial resection of sinonasal tumor with orbital

preservation and preop RT with or without chemotherapy ( n = 59)

Iannetti et al. 324

2005 4

Retrospective case series

Ethmoidal sinus

1. OS 2. DSR

tumors ( n = 29): Grade 1: Orbital bone erosion Grade 2: Invasion of periorbital fat Grade 3: Invasion of EOMs or orbital apex abutting the orbit but did not erode or thin the bone ( n = 8) Group B: Orbital bone erosion without globe displacement ( n = 5) Group C: Orbital bone erosion with globe displacement but no periorbital invasion ( n = 13) Group A: Tumor

McCary et al. 325

1. OS 2. LR

Selective periorbital resection with preoperative radiotherapy ± adjuvant chemotherapy is an acceptable alternative to orbital exenteration, in Groups A–C

1996 4

Retrospective case series

Group D: Tumor

invading the orbit with periorbital invasion. ( n = 7)

Abbreviations: CRT, chemoradiation therapy; DFS, disease-free survival; DSR, disease specific recurrence; EOM, extraocular muscle; LR, local recurrence; LRFS, locoregional failure/recurrence-free survival; MRI, magnetic resonance imaging; OS, overall survival; PFS, progression-free survival.

involvement or if extraconal fat can be macroscopically cleared from neoplastic pathology. 335,340 Additionally, as noted by Turri-Zanoni et al., neoadjuvant chemotherapy or RT can often downstage some locally advanced SNM and may impact consideration for orbital preservation. 165 Lastly, it should be highlighted that MRI can often over estimate or upstage orbital invasion, particularly in cases of prior surgery or CRT. 220,336 Thus, it is very important to clinically assess orbital involvement at the time of surgery in situations where the indications for orbital exenteration are not fully clear based upon preoperative imaging. 220,336 To date, there are no randomized controlled trials (RCTs) evaluating orbital clearance versus orbital preservation

surgery and its impact on locoregional recurrence, OS, and eye function. Future directions for research could be tar geted at reaching consensus, through multi-institutional collaborative study, on a single grading schema for orbital invasion that would drive consistent surgical and non surgical management. The present literature suggests that significant consideration should be given to orbital preser vation surgery based on both clinical and radiographic parameters, and that multimodal therapy is critical given its impact on modifying orbital invasion staging in the perioperative setting. Aggregate grade of evidence : C (Level 2: three studies; Level 3: three studies; Level 4: seven studies)