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

317

ICAR SINONASAL TUMORS

although one patient developed an osteogenic sarcoma in the radiation field 32 months after treatment. 1837 Haus dorf et al. reviewed 16 consecutive patients with sinonasal lymphoma and reported that multimodal therapy with CNS prophylaxis improved outcomes as compared with RT alone. 1838 Similarly, Proulx et al. recommend a combined modality approach with locoregional RT and systemic chemotherapy. 1766 In their institutional series, Steele et al. reviewed 18 patients with sinonasal lymphoma and found that a combination of chemotherapy and RT resulted in significantly higher survival rates than chemotherapy alone (OS 70% vs. 29%). 1839 In contrast, Lee et al. performed a retrospective anal ysis of 88 patients with sinonasal DLBCL treated with R-CHOP alone ( n = 59) or R-CHOP with RT ( n = 21). 1836 Despite having higher Ann Arbor stage patients in the R CHOP alone group, there were no significant differences in the response rate or OS between the two groups. 1836 For nasopharyngeal lymphoma, Han et al. found in a cohort of 1119 patients (77.5% BCL) that RT was an independent predictor of survival. 1840 Given these divergent findings, future work should examine the precise indications and potential benefits of RT in B-cell sinonasal lymphoma. Role of radiation therapy: B-cell lymphoma

3 Role of immunotherapy The advent of immunotherapy treatments, most signifi cantly rituximab, an anti-CD20 monoclonal antibody, has dramatically improved survival and related outcomes for sinonasal BCL patients. 1841 Rituximab has a relatively low side effect profile compared to other treatment regimens including CHOP for sinonasal lymphoma. 1841 Nonethe less, there are severe potential side effects including infusion-related reactions, severe skin and mouth reac tions, hepatitis B reactivation, or progressive multifocal leukoencephalopathy. 1842 Vahamurto et al. performed a retrospective cohort study examining 46 sinonasal DLBCL patients. 1843 Twenty two patients received CHOP or CHOP-like chemotherapy and 25 received R-CHOP (CHOP with rituximab). The R-CHOP group had a significantly reduced risk of progres sion (RR 0.368, p = 0.045) and death (RR 0.245, p = 0.032) and translated into better survival (5-year PFS, 67% vs. 38%, p = 0.037; 5-year OS, 81% vs. 48%, p = 0.020). 1843 Erik sen et al. reviewed 205 patients in the Danish National Lymphoma Registry with B-cell sinonasal lymphoma and found that immunotherapy increased survival for DLBCL patients. 1769 Lehrich et al. performed a retrospective review of the NCDB and found that, after 2012, patients receiv ing immunotherapy had significantly improved OS. 1764 In another NCDB analysis, multimodal therapy (e.g., chemotherapy, RT, immunotherapy) was found to offer increased survival in patients with advanced disease. 1844 Further studies are needed to examine the role of other

Aggregate grade of evidence

C (Level 3: one study; Level 4: eight studies)

Benefit

RT may help reduce the disease burden in patients with bulky disease, partial chemotherapeutic response, and extranodal involvement. Some studies have shown improved survival in sinonasal DLBCL patients who received RT in addition to chemotherapy. Potential morbidity from radiation treatment. There are no studies examining the cost of RT in sinonasal BCL. RT should be considered in the treatment of sinonasal lymphoma as an adjunct to chemotherapy in patients with bulky, symptomatic disease, advanced stage, or a partial response to chemotherapy. Patients should be counseled regarding the potential morbidity of RT as well as the uncertain impact on survival. Balance of benefits and harms.

immunotherapeutics in sinonasal lymphoma. Role of immunotherapy: B-cell lymphoma

Harm

Cost

Aggregate grade of evidence

B (Level 3: two studies; Level 4: two studies)

Benefits–harm assessment

Benefit

The addition of rituximab to CHOP treatment regimens significantly improves survival for patients with sinonasal BCL. Potential morbidity, including infusion-related reactions and severe skin and mouth reactions, from the addition of immunotherapy to chemotherapeutic treatment regimens. There are no clinical studies addressing the cost of immunotherapeutics in the treatment of sinonasal lymphoma. Preponderance of benefits over harms.

Value

judgments

Harm

Cost

Policy level Option. Intervention The addition of RT to chemotherapeutic regimens should be considered for

Benefits–harm assessment

sinonasal BCL patients with symptomatic (i.e., cranial nerve palsies), bulky disease or advanced stage.

(Continued)