xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.23262, Wiley Online Library on [02/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

316

KUANetal.

TABLE XXVI.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

1. All patients had complete response to treatment 2. One patient developed an osteogenic sarcoma in the

Clinical

Cooper and

1992 4

Retrospective case series

Four consecutive patients with paranasal sinus

Ginsberg 1837

resolution of disease

lymphoma treated with 6 weeks of chemotherapy followed by RT and CNS prophylaxis

radiation field 32 months after treatment

Abbreviations: CRT, chemoradiation therapy; DLBCL, diffuse large B-cell lymphoma; DFS, disease-free survival; DSS, disease-specific survival; ENKTL, extranodal NK/T-cell lymphoma; NCDB, National Cancer DataBase; OS, overall survival; SEER, Surveillance, Epidemiology, and End Results.

treatment of sinonasal lymphoma. Current NCCN guide lines for sinonasal lymphoma chemotherapy regimens have been extrapolated from level 1 evidence in BCLs outside of the sinonasal tract. 1810,1832 Current regimens include R-CHOP for three cycles for nonbulky disease or R-CHOP for five cycles for bulky disease ( ≥ 7.5 cm). 1810 Oprea et al. present a case series of 14 consecutive patients with sinonasal DLBCL treated with CHOP or a CHOP-like regimen. 1833 Ten patients achieved com plete remission and three achieved partial remission. During the 80-month follow-up period, seven relapsed or progressed (with four developing CNS disease). 1833 The authors recommend considering CNS prophylaxis for sinonasal lymphoma. Similarly, Laskin et al. reviewed 44 patients with primary paranasal sinus lymphoma and found that intrathecal chemoprophylaxis, added to a regi men of chemotherapy and local irradiation, was associated with an improved OS from 20% to 50%. 1834 In an analysis of the SEER registry, Varelas et al. found that chemotherapy was associated with an improved prognosis in 1273 cases of sinonasal DLBCL. 1835 Future studies are needed to exam ine additional chemotherapeutic regimens in sinonasal lymphoma treatment. Role of chemotherapy: B-cell lymphoma

Cost

There have been no clinical studies examining the cost of chemotherapy in the treatment of sinonasal lymphoma. Preponderance of benefits over harms. When considering chemotherapeutic treatment, clinicians should have a detailed conversation with their patients about the risks and benefits of the treatment along with a realistic discussion of potential treatment outcomes. CNS prophylaxis may be considered, and some studies have shown a potential survival benefit.

Benefits–harm assessment

Value

judgments

Policy level Recommendation. Intervention Chemotherapy is the preferred option in the

treatment of sinonasal BCL. The most common regimens include CHOP or CHOP-like therapy.

2 Role of radiation therapy The exact role of RT in the management of B-cell sinonasal lymphoma is controversial. Traditionally, in nonsinonasal localized DLBCL, RT has been used in patients with bulky disease, partial chemotherapeutic response, extranodal disease, or unacceptable toxicity from prior chemotherapy. 1836 In sinonasal lymphoma, RT has been used more commonly due to the extranodal disease presence and oftentimes bulky symptomatic tumor. Several studies have found survival benefit in B-cell sinonasal lymphoma patients treated with RT. In their analysis of the SEER registry, Varelas et al. found that RT was associated with improved prognosis in 1273 cases of sinonasal DLBCL. 1835 In another SEER analysis, Kana muri examined 852 patients with sinonasal DLBCL and also found improved survival with RT. 1765 In a series of four patients with sinonasal lymphoma treated with 6 weeks of chemotherapy followed by RT and CNS pro phylaxis, all patients had complete treatment response,

Aggregate grade of evidence

B (Level 3: four studies; Level 4: eight studies)

Benefit

Chemotherapy has been associated with improved survival in patients with sinonasal BCL. Risks of morbidity from chemotherapeutic regimens, including R-CHOP for three or five cycles, and any potential morbidity from CNS prophylaxis regimens.

Harm

(Continued)