xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

The role of RT as a primary treatment modality is not well defined. Reports in the literature mainly describe primary RT as a modality to treat unresectable or metastatic disease. Several studies have shown that pri mary RT has little effect on OS or PFS in patients with SNMM. 400,1477,1503,1509,1577–1579 On the other hand, primary proton beam RT for SNMM has been described in a mul ticenter phase II study. Thirty-two patients were enrolled and received 60 Gy in 15 fractions and the median follow up time was 36 months. The 3-year OS was 46.1% and 3-year PFS was 36.4%; 15 patients developed metastatic disease during the 36-month follow-up. 1580,1581 The role of proton beam RT compared to traditional RT modalities has not been well studied. The role of RT in unresectable or metastatic mucosal melanoma has also been investigated in combination with systemic immunotherapy. In a multicenter retrospective study of 225 patients with unresectable or metastatic mucosal melanoma patients (all sites; 57% in the head and neck region), patients were divided into treatment groups including PD1 inhibitor therapy (PD1) alone ver sus PD1 + RT versus PD1 + CTLA4 inhibitor therapy (CTLA4) + RT. All groups had similar baseline character istics with regard to tumor site and stage. In this study, there was no difference in OS or PFS between the PD1-only cohort versus PD1 + RT cohort or the PD1-alone cohort versus PD1 + CTLA4 + RT cohorts. Subsequent Cox mul tivariate analysis indicated that the addition of RT to PD1 or PD1 + CTLA4 did not have a positive impact on OS or PFS. 1582 Role of radiation therapy in sinonasal mucosal melanoma

Intervention Adjuvant RT should be considered for patients with SNMM as part of

multimodality therapy. The benefit to local control should be weighed against the side effects of RT treatment.

XXV NASOPHARYNGEAL MALIGNANCIES A Nasopharyngeal carcinoma

NPC is a special type of cancer in the sinonasal tract that has a wide geographical variation in incidence. The can cer has the highest incidence in South China and areas of high concentration of migrants from South China. 1587,1588 NPC has been proposed to have a multifactorial etiol ogy, including genetic susceptibility, EBV infection, and environmental factors. 1589,1590 The histological subtype of cancer in the high-risk population (endemic NPC) is of a poorly differentiated or undifferentiated type, and is invariably associated with EBV. 17 NPC in the nonendemic region is more likely well-differentiated SCC. Endemic NPC is highly sensitive to RT, and is primarily treated with nonsurgical therapy. Surgery has a role in endemic NPC in salvage of radiation failures, recurrence, and second primary tumors. Surgery has a more significant role for other rare non-nasopharyngeal histological subtypes (e.g., malignant salivary gland tumors) that are generally more radioresistant. There has been significant improvement in the prognosis of NPC, driven by advances in imag ing, RT, and chemotherapy. Emerging RT techniques such as adaptive radiotherapy and heavy particle radiotherapy have theoretical advantages in the treatment of NPC, espe cially in advanced-stage disease. However, there is limited availability for those newer radiation techniques and a lack of randomized clinical trials comparing those to stan dard radiotherapy techniques. There have been many trials evaluating various chemotherapy regimens over the last 20 years. Direct comparison of different agents in different regimens on a large scale through phase III trials is very challenging. The use of network meta-analyses provides indirect comparison of various chemotherapy regimens. WHO subtypes Despite the existence of several histomorphological clas sification systems for NPC and their terminology differ ences, these classifications correlate with the tumor’s bio logical behavior, etiology, clinical prognosis, and response to treatment. EBV has long been known to be impli cated in tumorigenesis in endemic countries, 1591 whereas 1

Aggregate grade of evidence

C (Level 1: one study; Level 3: two studies; Level 4: eight studies) There is evidence that adjuvant RT improves local control of SNMM; however, RT has not been consistently associated with improved OS. Potential harm of RT includes cost, mucositis, osteoradionecrosis, nasal synechiae, hyposmia, dysgeusia, and diminished vision. Cost comparison analyses have not been undertaken.

Benefit

Harm

Cost

Benefits–harm assessment

Balance of benefits and harms.

Value

Adjuvant RT should be considered to improve local control.

judgments

Policy level

Option.

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