xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

Treatment of metastatic NPC: Radiation therapy Aggregate grade of evidence B (Level 1: one study; Level 2: one study) Benefit Systemic chemotherapy with locoregional RT improves survival and disease control in patients with metastatic NPC. Harm Systemic chemotherapy with locoregional RT has no significant increase in severe adverse events. Cost Combination of locoregional RT increases the time needed for radiotherapy planning. Cost comparison analyses have not been undertaken. Benefits–harm assessment Preponderance of benefits over harms. Value judgments Addition of locoregional RT to nasopharynx and/or neck could be considered in metastatic NPC. Policy level Recommendation. Intervention Systemic chemotherapy plus locoregional RT could be considered for disease control in patients presenting with previously untreated metastatic NPC. Treatment of metastatic NPC: Immunotherapy Aggregate grade of evidence B (Level 1: one study; Level 2: seven studies; Level 3: one study)

Policy level Recommendation. Intervention Immunotherapy with GP should be

considered as first-line treatment for metastatic NPC in patients who are refractory to first-line treatment. Immunotherapy as monotherapy may be considered as first-line therapy in patients who cannot tolerate platinum-based combination chemotherapy.

B Low-grade nasopharyngeal papillary adenocarcinoma Low-grade nasopharyngeal papillary adenocarcinoma (LGNPPAc) is a rare malignancy accounting for only 0.5% of tumors originating from the nasopharynx (Table XXV.10). 1715 The reported age range at diagnosis is between 11 and 64 years, with no sex predilection. 1716 In 1988, Wenig et al. 1716 first referred to a primary nasopha ryngeal papillary adenocarcinoma arising from the surface mucosal epithelium as an LGNPPAc, because this entity was found to have the biological potential of low-grade malignancy. Most LGNPPAcs of mucosal origin have a papillary configuration, are of low grade, and can be identified by their light microscopic appearance. 1717 These tumors are known to express thyroid transcription factor-1 (TTF-1) but are negative for thyroglobulin (TG) expression. 1718 The pathogenesis of LGNPPAc remains controversial. While NPC is often associated with EBV, there is no known association between LGNPPAc and EBV. 1719–1721 Patients often present with complaints of nasal obstruc tion, bloody rhinorrhea, and epistaxis. 1716,1717,1722 Main symptoms of LGNPPAc are secondary to involvement of the nasopharynx and compression of surrounding struc tures. In some patients, snoring, hearing loss due to middle ear effusion, and swallowing dysfunction can be present. 1722–1724 Typically, LGNPPAc presents as a polypoid or pedun culated mass on the roof of the nasopharynx. LGNPPAc was mostly localized on the roof of the nasophar ynx, posterior margin of the nasal septum, and lat eral wall (i.e., torus tubarius). 1718,1722,1724–1728 Most cases are early stage (T1, with no evidence of metastases) at diagnosis. 1715–1717,1719,1721,1722,1729,1730 CT typically shows a round mass in the nasopharynx or posterior margin of the nasal septum. MRI demonstrates moderate T1 signal, high T2 signal, and contrast enhancement. 1722 Treatment of LGNPPAc usually involves surgery, with generally favorable prognosis. 1716 Early-stage tumors can be directly resected by endoscopic endonasal nasopharyngectomy. 1731,1732 Adjuvant RT can reduce

Benefit

Immunotherapy improves survival parameters when being used as first-line therapy, in combination with chemotherapy. Immunotherapy also provides satisfactory disease control when being used as monotherapy in first-line treatment. Use of immunotherapy may lead to drug-related adverse events especially immune-related adverse events. Cost comparison analyses have not been undertaken. Preponderance of benefits over harms. Immunotherapy would improve the survival in patients who are refractory to first-line platinum-based combination chemotherapy, with no significant increase in grade 3 or above adverse events. However, immunotherapy caused more immune-related events compared with traditional treatment. In light of this, survival benefits justify the possibly increased cost and short-term morbidities during treatment. (Continued)

Harm

Cost

Benefits–harm assessment

Value

judgments