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195

ICAR SINONASAL TUMORS

TABLE XXI.A.3 Evidence for elective neck treatment in the management of SNSCC.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Galloni et al. 1095

Regional

34.6% regional recurrence in observation group versus 5.9% regional recurrence in elective neck treatment group

1178 cN0 sinonasal carcinoma; 407 elective neck treatment, 771 observed (encompassing 26 studies) 129 total patients with N0M0SNSCC maxillary sinus (encompassing four studies) T3/T4 cN0 SNSCC; 19.6% underwent END 1220 patients with

2021

2

Systematic

recurrence

reviewand meta analysis

Abu-Ghanem et al. 1097

2014 2

Systematic

Regional

Elective neck irradiation significantly reduces risk of

reviewand meta analysis

recurrence

regional recurrence compared to observation (OR 0.16, p = 0.01)

Crawford et al. 1100

OS

No OS benefit with END in T3/T4 cN0SNSCC

2020 3

Retrospective cohort

Sangal et al. 1096

2018 3

Retrospective cohort

927 N0M0 SNSCC

OS

T3 tumors and > 4 cm require END

maxillary sinus; 146 withENDs

Cantu et al. 1099

2008 4

Retrospective case series Retrospective case series

156 patients with SNSCC 58 patients with

Regional

Consider neck dissection in maxillary sinus T2 Those that did not receive neck radiation were more likely to recur (0% vs. 20%)

recurrence

Le et al. 1098

2000 4

Regional

SNSCC of maxillary sinus, 25 cN0

recurrence

Abbreviations: OS, overall survival; SNSCC, sinonasal squamous cell carcinoma.

rence rate of 42.7% and an aggregative 5-year LRC rate of 42.7%. 1063 Despite this, emerging therapies and bet ter understanding of tumor biology may shift treatment paradigms and improve long-term oncologic outcomes. B Inverted papilloma-transformed squamous cell carcinoma 1 Survival outcomes of IP-SCC versus DN-SCC Sinonasal IP most commonly affects the maxillary sinus, lateral nasal wall, sphenoid, ethmoid, and frontal sinuses, while uncommonly affecting the nasopharynx, Eustachian tube and middle ear, and lacrimal sac. 130,247,1106–1117 It is not uncommon to have more than one contiguous site involved, representing multifocal and/or bilateral disease. Tumors tend to grow to large sizes (average 4 cm), described as papillary, polypoid, and sessile in appearance. 130,1112,1117–1120 Due to large size and extension, tumors often present with a high pathologic or clinical T stage. Accordingly, the symptoms associated with a large space-occupying mass mimic other benign processes, such as nasal polyps, which may delay proper diagnosis and

f Role of immunotherapy In SNSCC, local recurrence is the main mode of treat ment failure. 418 Due to the rarity of SNSCC, and even greater rarity of recurrences, optimal management of locally recurrent SNSCC is not well studied. Locoregional recurrence and distant metastasis may be treated with sys temic therapy. There is emerging evidence that systemic immunotherapy (with nivolumab or pembrolizumab) may have an important role as treatment alternatives in the setting of unresectable recurrent or metastatic SNSCC. 231 While there are little data currently available, Riobello et al. demonstrate that 45% of immune infiltrating SNSCC cells express PD-L1, indicating a potential benefit of immunotherapy. 1103 Additionally, in an analysis of tumor infiltrating lymphocytes (TILs) on 57 samples of SNSCC, Garcia-Marin et al. found that a high level of intratumor CD8 TILs correlated with worse survival. Again, this result suggests SNSCCs are immunogenic tumors, and these patients may benefit from immune checkpoint inhibitor immunotherapies. 1104 Despite advances in multimodality therapy and evi dence for survival benefit with treatment at high volume centers, the overall prognosis is still poor. 1080 In a recent meta-analysis of 41 studies reporting on outcomes of SNSCC, the aggregate 5-year OS was 54.5% with a recur