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ICAR SINONASAL TUMORS

TABLE XXIII.A.5 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

Outcome

AWD: 30%, NED: 30%, DOD: 20%, LTF: 20%

Montone

2009 4

Retrospective case series

CRT( n = 10), chemo not specified in PM-RMS Entire group: No treatment ( n = 3), surgery and chemo ( n = 2), surgery, RT, andchemo ( n = 1). Chemo not specified in Sinonasal RMS

et al. 1252

Nakhleh

1991

4

Retrospective case series

Outcome

AWD: 33%, DOD: 33%, LTF: 33%

et al. 1253

Abbreviations: AWD, alive with disease; CRT, chemoradiation therapy; DMFS, distant metastasis-free survival; DOD, died of disease; DWD, died with disease; LRC, locoregional control; LRFS, locoregional failure/recurrence-free survival; LTF, lost to follow-up; NED, no evidence of disease; IVAd, ifosfamide + vincristine + dox orubicin; OS, overall survival.

Inductionchemotherapy for sinonasal rhabdomyosarcoma

Value

No direct comparison between different treatment approaches. Low-quality studies demonstrating response with poor long-term survival. Protocols for adult RMS have generally been adapted from pediatric RMS; however, these tumors have different biology, and treatment likely has different side effect profiles.

judgments

Aggregate grade of evidence

C (Level 3: two studies)

Benefit

OS appears to be lower than that of patients treated with non-induction protocols from the same studies. Chemotherapy side effects and additional risk of tumor progression while receiving induction. Cost of chemotherapy administration unlikely to be significantly different from non-induction chemotherapy costs.

Policy level Option. Intervention Further evidence needed to determine role of specific chemotherapy protocols in adult RMS. Consider RT for adults with sinonasal RMS, especially patients with unresectable disease. 7 Induction chemotherapy for sinonasal rhabdomyosarcoma Two trials using induction protocols for PM-RMS were identified. The MMT-84 and MMT-89 trials effectively employed induction approaches for young patients. In MMT-84, patients under 5 years of age with PM-RMS who achieved CR did not receive local RT. 1243 InMMT-89, patients under 3 years of age with PM-RMS who achieved CR did not receive local RT. 1244 Other trials also employed IC protocols; however, PM RMS primaries were not included and instead all received RT. Merks et al. performed a systematic review of clinical trials and showed significant benefit with initial RT treat ment for PM-RMS (results shown in Table XXIII.A.3). 1225 There was one study evaluating induction chemotherapy in CWS trials, but most PM-RMS were excluded from this analysis (Table XXIII.A.6). 1245

Harm

Cost

Benefits–harm assessment

Balance of benefits and harms.

Value

Treatment with induction chemotherapy may identify subset of patients who will or will not benefit from definitive CRT. No direct comparison of induction to other protocols.

judgments

Policy level Option. Intervention Induction chemotherapy protocols for

sinonasal RMS are an option for bulky and locally advanced disease.

B Sinonasal chondrosarcoma and osteosarcoma Chondrosarcoma and osteosarcoma are malignant mes enchymal tumors that originate from cartilage and bone, respectively. Cases arising from soft tissues have been rarely reported. As for any nonepithelial malignancy, defining a tumor of sinonasal origin can be potentially