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193

ICAR SINONASAL TUMORS

TABLE XXI.A.2 Evidence for the role of (chemo)radiotherapy in the treatment of SNSCC.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Ackall et al. 414

OS

1. Surgery followed by adjuvant RT had improved OS compared to surgery alone

1074 patients with SNSCC; 15.5%

2021

4

Retrospective database review (NCDB)

surgery alone, 25.2% RT alone, 16.5% definitive CRT, 13.9% surgery + adjuvant CRT, 24.4% surgery + adjuvant RT SNSCC treated with IMPT; 70% with T4 disease

Toyomasu et al. 559

2017 4

Retrospective case series

59 patients with

1. PFS 2. OS

5-year PFS 34.7% and OS 41.6%

Robin et al. 159

1. OS

1. RT and chemotherapy alone had worse OS than surgery + RT 2. OS did not differ between definitive CRT and surgery alone 3. Neoadjuvant RT was associated with improved OS 1. Adjuvant cohort: 5-year 58% LRC rate and 55% OS 2. Definitive cohort: 5-year 55% LRC rate and 53% OS

6039 patients with SNSCC; RT alone versus chemotherapy alone,

2017 4

Retrospective database review (NCDB)

surgery + adjuvant RT, surgery alone

Kimet al. 1105

2015 4

Retrospective case series

30 patients with SNSCC; 50%

1. LRC 2. OS

surgery + adjuvant therapy (adjuvant cohort), 50% primary CRT (definitive cohort)

Abbreviations: LRC, local–regional control; OS, overall survival; PFS, progression-free survival; RT, radiation therapy; SNSCC, sinonasal squamous cell carcinoma.

maxillary gingiva to the submandibular nodes through the buccal nodes, while another drainage pathway runs from the nasal floor to the upper jugular nodes through the retropharyngeal and parapharyngeal nodes. 1093 In a review of 6448 cases of SNSCC from the NCDB, nodal metastasis was seen in 13.2% of patients at the time of presentation. 42 However, subsite of tumor origin is critical—as initial nodal involvement rate for nasal cavity SCC was only 9.3%, while maxillary sinus SCC was 20.7% in a large meta-analysis of 1283 patients with SNSCC. 1094 Ultimately, it is estimated that up to one third of patients may develop nodal disease during the course of follow-up, which confers worse prognosis. 1095 While the recommended management of a clinically positive neck is surgery if the initial management of the primary tumor is also surgery, the management of the cN0 neck is not clearly defined. The decision to adopt watchful waiting of the neck or to perform elective treatment— whether it be in the form of neck dissection or neck radiation—has been understudied. In a systematic review of 26 articles encompassing 1320 patients with sinonasal carcinoma, Galloni et al. identified 1178 cases of cN0 patients. Of these, 407 patients underwent elective neck

Cost

Insufficient data to make recommendation regarding long-term costs of adjuvant therapy.

Benefits–harm assessment

Balance of benefits and harms.

Value

Definitive CRT/RT could be considered in the setting of unresectable tumors, for patients who are poor surgical and chemotherapy candidates, and in patients who decline surgery. Additionally, for early-stage tumors, definitive CRT/RT can be considered, although there are limited studies evaluating this.

judgments

Policy level Option. Intervention Patients with unresectable or early-stage disease, patients who are poor surgical

candidates, and patients who do not desire surgery may be considered for definitive CRT/RT.

e Management of the neck Nodal involvement of SNSCC at the time of presentation is rare. This is thought to be due to a paucity of lymphatic drainage pathways. One drainage pathway runs from the