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ICAR SINONASAL TUMORS

TABLE XXIV.A.4 Evidence surrounding management of the orbit in ONB.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

Wuet al. 1355

OS

1. For ONB with orbital invasion, median duration of survival was 124.0 months and 5-year OS was 67.1% 2. Patients with orbital invasion and lymph node metastasis had worse outcomes demonstrated lymph node status, orbital invasion, and the combination of surgery and RT to be independent prognostic factors Model of multiple tumor history, orbital invasion, carotid canal invasion, modified Kadish stage, delivery sequence of RT and 1. 5-year OS was 80.0% 2. Multivariate analysis surgery, and sequence of chemotherapy and surgery predicted outcome better than conventional staging systems Invasion of either the extraocular muscles or the eye globe was not a contraindication for eye-sparing surgery with RT or surgery/RT

22 studies; N = 104 ONB with orbital invasion

2022 2

Systematic

reviewand meta analysis

Songet al. 1385

2020 4

Retrospective case series

N = 217 patients with ONB

OS

Yanget al. 1382

2020 4

Retrospective case series

N = 154 patients with ONB

OS

Li et al. 495

2019 4

Retrospective case series

N = 60ONBwith orbital invasion

OS

Abbreviations: ONB, olfactory neuroblastoma (esthesioneuroblastoma); OS, overall survival; RT, radiation therapy.

association was observed in this study with orbital invasion and DFS or DMFS. 1351 The field as a whole has gravitated toward orbital preser vation treatment where oncologically safe. However, due in part to the rare nature of ONB, there are few studies addressing orbital preservation. Furthermore, the ability to achieve disease control in the setting of orbital preser vation may depend on the degree of orbital involvement. A retrospective review of 16 cases of ONB identified six patients with periorbital or lacrimal sac involvement at the time of surgery. In these cases, the periorbita was resected and the orbit was spared without evidence of decreased survival. 1356 IC has been proposed by some groups for ONB with significant local invasion including the orbit. 1357,1358 Su et al. reported their experience with IC in 15 cases of advanced ONB and reported success in orbital preservation in three cases, and a higher chemotherapy response rate was observed in Hyams grade III and IV tumors. Lastly, another retrospective study of 60 ONB patients with orbital invasion reported an orbital preservation approach using RT with or without orbit-preserving surgery. 495 However, patients with more significant orbital involvement (grade II/III vs. grade I) were noted to have worse OS and PFS. 495 In this study, grade I was defined as bone wall invasion,

Intervention In a node-positive neck, the role of surgical treatment and adjuvant radiation for ONB patients is well established. However, in patients with a clinically N0 neck and high Hyams grade (III/IV) or Kadish C/D stage,

ENI should be considered. Long-term surveillance ( > 5 years) of the neck is recommended.

4 Management of the orbit ONB has a propensity for invasion of adjacent structures including the orbit (Table XXIV.A.4). Indeed, multiple studies have reported rates of orbital invasion in ONB ranging from 10% to 38%. 412,1351,1355 Orbital invasion has repeatedly been demonstrated to be a negative prognos tic factor. A multi-institutional international retrospective study of 404 patients with ONB reported orbital invasion to be associated with worse OS and DFS (HR 2.9 and 3.1, respectively) on univariate Cox regression analysis. 15,412 Another single-institution study of 143 patients treated from 1960 to 2020 also reported an association with orbital invasion and worse OS (HR 3.2, p = 0.02). 1351 However, no