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249

ICAR SINONASAL TUMORS

TABLE XXIV.A.6 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

Li et al. 164

OS

1. 5-year OS of 63.5%; 46 received surgery plus RT, with a 5-year OSof 70.7% 2. Invasion of either the extraocular muscles or the eye globe was not a contraindication for eye-sparing surgery with RT or surgery/RT Patients who received platinum-based CRT did not exhibit improved survival compared to surgery/RT alone Recurrence rate was 80% in surgery alone group, which decreased to 43.7% if surgery was supplemented with other modalities Adjuvant RT decreased mortality (HR0.53, p < 0.01) 5-year OS was 85% versus 53% versus 29% for primary surgery, RT, and chemotherapy 1. OS was associated with Kadish stage, grade, treatment sequence, margin status, Charlson/Deyo score, age, and gender 2. Surgery with RT had lower risk of death compared to surgery alone (OR 0.61; 95% CI: 0.40–0.95)

2019 4

Retrospective case series

N = 60 ONB with orbital invasion

Miller et al. 1389

2019 4

Retrospective case series

N = 38 patients with ONB

OS

Singh et al. 1347

2019 4

Retrospective case series

N = 21 patients with ONB

Recurrence

Orton et al. 1365

2018 4

Retrospective database study (NCDB) Retrospective database study (NCDB)

N = 931 patients with ONB

OS

Carey et al. 1383

N = 1225 patients with ONB

OS

2017 4

Abbreviations: DMFS, distant metastasis-free survival; DSS, disease-specific survival; LRC, locoregional control; NCDB, National Cancer DataBase; ONB, olfactory neuroblastoma (esthesioneuroblastoma); OS, overall survival; PFS, progression-free survival; RT, radiation therapy; SEER, Surveillance, Epidemiology, and End Results.

platinum-based regimens combined with etoposide or other agents. As an adjuvant treatment, two recent SEER database studies over a 40-year time period did not detect an improvement in OS with the addition of chemotherapy. 1371 This finding was further corroborated by a large international multi-institutional retrospective study of 404 cases with an HR of 1.07 for OS and 1.40 for DFS. 15 When combined with RT as definitive treat ment, chemotherapy may have some benefit in adult patients; however, this is particularly true for pediatric ONB that is regarded as chemosensitive. 1335,1372,1373 In a multi-institutional retrospective review of 24 cases of pediatric ONB ( < 21 years of age), an 84% objective response rate was observed in patients who received neoadjuvant chemotherapy. 1373 In an NCDB study of 1411 ONB patients, 45 of which were pediatric ( < 18 years of age), use of chemotherapy was more common and the

pediatric group had an 87% 10-year OS compared to 66% for adults. However, due to low patient numbers and variable treatment paradigms, the full impact of chemotherapy in pediatric ONB remains unknown. 1335 Neoadjuvant chemotherapy has recently been advo cated by several groups for locally advanced or unre sectable disease. 1357,1358 One retrospective study reported that this approach aided in achieving a negative margin resection in 80% of patients (4/5) for which a negative mar gin resection was not initially believed to be attainable. Additionally, of a series of 15 patients who underwent IC, a 78% response rate (7/9 patients) in the high Hyams grade group compared to 50% (3/6 patients) in the low Hyams grade group was observed. 1357 Seven patients had a com plete response and three patients were able to avoid orbital exenteration using this approach. 1357 Although these are low patient numbers, these results suggest that neoadju-