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KUANetal.

TABLE XIII.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

Onoet al. 433

1. SS for locally persistent or recurrent maxillary sinus cancer is a feasible treatment 2. Patients with positive surgical margins are more prone to local relapse

1. LRC 2. DFS 3. OS

2019 4

Retrospective case series

Patients with maxillary carcinoma who received SS ( n = 14) versus chemotherapy or palliative care ( n = 10) after failing primary CRT followed by sequential RADPLAT( n = 60) or maxillectomy ± neck dissection ( n = 16)

Abbreviations: CRT, chemoradiation therapy; DFI, disease free interval; DFS, disease-free survival; LOS, length of stay; LRC, locoregional control; LRFS, locore gional failure/recurrence-free survival; MRI, magnetic resonance imaging; ONB, olfactory neuroblastoma; OS, overall survival; PFS, progression-free survival; PNI, perineural invasion; RT, radiation therapy; SNM, sinonasal malignancy; SS, salvage therapy.

Aggregate grade of evidence : C (Level 2: two studies; Level 3: two studies; Level 4: four studies)

examples of this include improvement of nasal obstruction and subjective breathing, epistaxis control, decompression of neurovascular structures, or pain. 6 Of all the treat ment modalities, RT is the best studied in this setting and has been shown to have a role in alleviating cra nial nerve dysfunction and trigeminal pain due to skull base involvement by malignant tumors (metastases, recur rence, or advanced disease). However, the magnitude of its effect and associated morbidity requires further study (Table XIII.4). 445–450 The role of palliative surgery and chemotherapy for recurrent SNM is less clear. One case series describing the role of surgical palliation in head and neck cancer included eight patients with chronic bleeding due to maxillary cancer ulceration, requiring reg ular admissions and blood transfusions. These patients were successfully managed with total maxillectomy, which reduced their rates of hospital admission and need for transfusions. 451 Recently, Farber et al. published their review of the NCDB aimed at assessing the impact of palliative treat ment on survival in SNM. 452 In their review of 380 patients undergoing palliative therapy for SNM, they reported superior OS in patients undergoing palliative surgery. Specifically, 1-year OS (74.7% vs. 35.3%) and median OS were significantly higher in surgery compared to pain management (22.8 vs. 4.6 months). It should be noted that, of all patients analyzed, only 37 patients (9.7%) had palliative surgery as the sole treatment, with RT and mul timodality treatments more commonly performed. Fur thermore, the study did not assess QOL or report on the clinical decision-making behind choice of treatment, mak ing it difficult to draw firm conclusions on the superiority of different palliative treatments.

C Role of re-irradiation Although several studies have assessed the role of reirra diation regimens for the treatment of local recurrences of various head and neck tumors, few are specific for recur rent SNM (Table XIII.3). 438–444 The heterogeneity of the studies in terms of tumor site, histology, and the use of reirradiation alone or as an adjuvant therapy to salvage surgery, as well as the short follow-up, makes it difficult to draw meaningful conclusions. From the limited data available, reirradiation of local SNM recurrences appears to be feasible, but it is typically associated with a signifi cant rate of toxicity, reaching above 20% of grade 3 or higher toxicities. 439,440 This may limit its use for recurrent SNM. To better understand the role of reirradiation for recur rent SNM, further studies are needed with longer term follow-up. Focus purely on tumors of the sinonasal cav ity with analysis according to histological subtype based on different radiosensitivities is required. Aggregate grade of evidence : C (Level 3: two studies; Level 4: five studies) D Role of palliative therapies Studies evaluating the role of palliative therapy for recur rent SNM are few and of low-level evidence. Of the studies reported, most are concerned with the effect of palliative therapy on symptom control and QOL. Cited