xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

TABLE XXI.B.3 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

1. HPV mRNA present in all specimens but found in < 1%of cells in 58% of them 2. Two of 19 had HPV DNA 3. Transcription of HPV may play a role in the pathogenesis of IP 1. Activating EGFR mutations in 88% of IPs and 77% of IP-SCCs 2. EGFR mutation not found in DN-SCC 3. Important role of EGFR mutations in IP and IP-SCC 1. Carcinoma ex-IP or ex-EP exhibits increased Ki-67; > 50%is

Stoddard et al. 1137

2015 4

Retrospective case series

16 IPs, 3 IP-SCCs

Presence of HPV DNAand mRNA

Udager et al. 659

2015 4

Retrospective case series

50 IPs with 12 matched IP-SCCs, 10 IP-SCCs, 20 DN-SCCs

EGFR

mutational status

Nudell et al. 653

1. Ki-67 status 2. p53 expression 3. HPV status

2014 4

Retrospective case series

17 cases of malignant transformation from

IP and exophytic papilloma ( n = 3) more likely associated with severe dysplasia or carcinoma 2. p53 overexpression is correlated withKi-67 3. HPV is uncommon 4. Large series needed to validate findings Abbreviations: DN-SCC, de novo squamous cell carcinoma; HPV, human papillomavirus; IP, inverted papilloma; IP-SCC, inverted papilloma associated squamous cell carcinoma; SNSCC, sinonasal squamous cell carcinoma.

up to 40% of cases and partial response in the remaining cases. 1151 Therefore, P53 functionality analysis may be used to identify the subgroup of chemoresponsive tumors that should be selected for IC and by the same mechanism pre dict outcomes, since patients with good response to IC are generally those with the best prognosis. 17 B Role of surgery There is general agreement in the literature that surgery still plays a significant role in the treatment for sinonasal ITAC, and it should be performed according to the oncolog ical principle of complete excision with negative margins. In the last 25 years, surgical treatment has evolved con siderably due to impressive advances in technologies and instruments, together with refinements in radiological diagnosis. Indications for minimally invasive endoscopic assisted approaches have expanded over time, making it now possible to obtain negative margins for resection of selected cases of pT4b sinonasal ITAC. 293,1151 Current avail able data suggest that EEA, with or without expanded resection of the ethmoidal roof and dura of the ASB (endo scopic resection with transnasal craniectomy, ERTC), rep resents the surgical technique most used for excision of sinonasal ITAC. Several reports have demonstrated that this approach is oncologically safe, effective, and associ

ated with limited complications, while reducing impact on QOL. 16,293,1146 In selected cases with dural extension over the orbital roof or significant intracranial extension, EEA can be combined with an external transcranial approach (cranioendoscopic resection). 293 The extent of surgical resection as compared to the local extent of the tumor still remains a matter of debate. His torically, the multifocal pathogenesis of ITAC prompted surgeons to perform a bilateral ethmoid resection in all cases, regardless of the extent of the tumor, with the aim of removing any microscopic areas of ITAC or synchronous precancerous lesions that might potentially have resulted from occupational exposure to carcinogenic agents in both ethmoids. 1152 However, bilateral ethmoid resection inevitably leads to significant olfactory dysfunction and increased morbidity. Recently, some authors have reported adequate oncological outcomes even with unilateral endo scopic resection in selected cases. 374,1153 According to preliminary experiences, ITACs with unilateral extension and without invasion to the contralateral nasal fossa, if ruled out by preoperative imaging and intraoperative assessment with frozen sections, can be safely managed with unilateral ERTC, which provides shorter hospitaliza tion, preservation of some olfactory functions, and, most importantly, oncological outcomes comparable to bilat eral ERTC. 16,374,1153 Therefore, current evidence does not support the routine use of bilateral ethmoid resection in