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ICAR SINONASAL TUMORS

TABLE XVI.5 Evidence surrounding the role of radiation therapy in management of IP.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

RT should be considered in patients with unresectable disease, multiply recurrent lesions, or papillomas associated with malignancy, given low risk (1/13, 7.6%) of severe complication

1. Recurrence 2.

Rutenberg et al. 700

2013 4

Retrospective case series

Patients with advanced or recurrent IP or cylindrical cell papilloma treated with adjuvant, definitive, or neoadjuvant RT ( n = 13) adjuvant RT ( n = 1) Patients with advanced and/or recurrent IP or cylindrical cell papilloma with or without SCC, treated with adjuvant, definitive, or neoadjuvant RT ( n = 8) Patients with locally advanced IP with or without SCC, Patient with IP undergoing

Complications

Strojan et al. 675

2013 4

Case report

Recurrence

RT was safe and effective following STR

Gomez et al. 698

RT may be considered albeit with high rates of recurrence in IP only (1/1, 100.0% RT only; 2/4, 50.0% surgery with adjuvant RT) and IP with SCC patients (1/1, 100.0% neoadjuvant RT with surgery; 2/2, 100.0% surgery with adjuvant RT) RT effectively controlled locally advanced IP (4/25, 16.0% recurrence) but also led to a high rate of severe adverse events related to treatment (6/25, 24.0%) Although surgery is generally the primary treatment for IP, radiation may be considered for patients with advanced, incompletely resected, or unresectable lesions with low risk for recurrence (1/7, 14.2%) or severe complication (0/7, 0.0%)

1. Recurrence 2.

2000 4

Retrospective case series

Complications

Huget al. 697

1993 4

Retrospective case series

1. Recurrence 2.

Complications

treated with adjuvant or definitive RT ( n = 25)

Guedea et al. 765

1. Recurrence 2.

1991

4

Retrospective case series

Patients with advanced IP or cylindrical cell papillomas treated with definitive or neoadjuvant or adjuvant RT ( n = 7)

Complications

Abbreviations: IP, inverted papilloma; RT, radiation therapy; SCC, squamous cell carcinoma.

that large IP lesions often originated from a narrow pedi cle or unifocal attachments. However, multifocal and large diameter attachments can occur in primary lesions (Table XVI.7). 707 Imaging of the site of attachment in inverted papilloma

Harm

Mild radiation associated with CT imaging as well as contrast burden for CT and MRI images. Associated costs with imaging studies. Preponderance of benefits over harms. Determining site of attachment is imperative for effective surgery and to reduce local recurrence.

Cost

Benefits–harm assessment

Value

judgments

Aggregate grade of evidence

C (Level 3: two studies; Level 4: five studies)

Policy level Recommendation. Intervention Utilize preoperative CT (as evidenced by

Benefit

Imaging is useful for accurate identification of IP pedicle for preoperative planning.

osteitis) with or without MRI for accurate identification of IP attachment site, which can also be used to guide surgical approach.

(Continued)