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191

ICAR SINONASAL TUMORS

TABLE XXI.A.1 Evidence for induction chemotherapy in the treatment of SNSCC.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

1. High percentage of patients had favorable response to induction chemotherapy 2. Response to induction chemotherapy is associated with an improved outcome and good chance of organ preservation Induction chemotherapy should be considered for orbit preservation and for downstaging T stage

1. Response 2. Recurrence 3. Organ preservation 4. Survival 1. Response rate 2. Orbit preservation rate 3. OS 1. Response and toxicity to chemotherapy 2. Definitive treatment received 3. PFS 4. OS

Abdelmeguid et al. 1077

2021 3

Retrospective cohort

123 patients with previously untreated, locoregionally

advanced SNSCC

Ocket al. 1079

2016 4

Retrospective case series

21 patients with SNSCC

In unresectable SCC of the maxillary sinus, induction chemotherapy has minimal toxicity and clinical benefits

Noronha

2014 4

Retrospective case series

41 patients with

et al. 1075

unresectable SCC of the maxillary sinus treated between 2008 and 2011

Hanna et al. 1076

2011

4

Retrospective case series

46 patients with

Oncologic

Better patient survival and possible organ preservation may occur when there is favorable response to induction chemotherapy Combined therapies (neoadjuvant chemotherapy + RT) didnot demonstrate advantage over RT alone

unresectable SNSCC

outcomes

Kimet al. 1074

1. Response rate 2. Patterns of failure

34 patients with

2000 4

Matched control study

unresectable SCC of the maxillary sinus

3. Toxicity 4. Survival

Abbreviations: OS, overall survival; PFS, progression-free survival; RT, radiation therapy; SCC, squamous cell carcinoma; SNSCC, sinonasal squamous cell carcinoma.

oncologic outcomes, with an aggregate grade of evidence ofC. 5 In conclusion, endoscopic resection of SNSCC seems to have comparable oncologic outcomes to open resection. However, a critical factor affecting survival regardless of surgical approach is margin status. The surgical approach that confers the greatest degree of tumor resection and allows the best opportunity for negative margins should be selected on a case-by-case basis, and if negative mar gins are unachievable, nonsurgical treatment should be considered. c Role of adjuvant therapy The most common treatment regimen for SNSCC, particu larly for advanced-stage tumors (pT3-T4, and most pT2), remains surgery followed by adjuvant RT. 30 There is lit tle evidence to support single-modality or dual-modality treatment for T1 SNSCC tumors, as the data are limited. There is some evidence that some histologic subtypes, such as nonkeratinizing SNSCC, may be particularly radiosen

sitive, further supporting the role of adjuvant therapy in these cases. 231 Traditionally, IMRT using photons has been the pre ferred modality. The contralateral nodal basin is consid ered in tumors with midline and bilateral involvements and considered on a case-by-case basis. 231 More recently, intensity modulated particle therapy (IMPT) has been used in an adjuvant setting in the treatment of SNSCC. IMPT offers several theoretical advantages over photon therapy including a sharp dose gradient, high linear energy trans fer, and relative independence of tissue oxygenation. These advantages are theoretically beneficial in areas adjacent to radiosensitive structures such as the skull base. In a series of 54 patients with SNSCC, 37 of which under went postsurgical IMPT and 24 of which underwent IMPT in combination with induction, concurrent, or adjuvant chemotherapy, there were 10 cases of local recurrence, seven cases of regional recurrence, and 11 cases of dis tant failure. The overall 2-year survival was 67%, while the overall 5-year survival was 47%. Toxicities were considered