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343

ICAR SINONASAL TUMORS

TABLE XXXI.A.1 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Bertazzoni et al. 2092

2017 4

Retrospective case series

IP ( n = 59)

SNOT-22

1. Only postoperative data after Sturmann–Canfield procedure (modified endoscopic Denker) 2. Mean and median SNOT-22 scores consistent with general population 3. Rhinologic and sleep subdomains have greatest impact 1. Only postoperative data 2. Postoperative SNOT-22 scores comparable to general population 3. No QOL impact in those undergoing medial maxillectomy compared to standard endoscopic approaches

van Samkar and Georgalas 2091

2015 4

Retrospective case series

IP ( n = 34)

SNOT-22

Abbreviations: ASB-QOL, Anterior Skull Base QO; EQ-5D, European Quality-of-life-5 Dimension; IP, inverted papilloma; QOL, quality of life; SNOT, Sino-Nasal Outcome Test; VAS, visual analog scale.

lary sinus tumors does not significantly impair sinonasal QOL. 2096 Aggregate grade of evidence : C (Level 3: four studies; Level 4: three studies)

Aggregate level of evidence : C (Level 3: five studies; Level 4: two studies)

2 Postoperative QOL Several studies have shown that QOL can improve postop eratively. In Glicksman’s analysis, patients who underwent surgery experienced statistically and clinically signifi cant improvements in total SNOT-22 and subdomain scores 6, 12, and 24 months postoperatively compared to baseline. 2093 While Derousseau’s study described similar total and subdomain SNOT-20 scores at 6 months post operatively when compared to preoperative scores, the SNOT-20 total score and psychological and sleep subdo main scores did improve 1 and 2 years after surgery. 2090 Certain baseline characteristics may predict worse post operative QOL. Phillips et al. showed that less social support, single relationship status, and higher T-stage classification independently predicted more severe post treatment anxiety and depression. 2103 Worse social support also independently predicted lower overall QOL. Smok ing has also been shown to be predictive for diminished postoperative QOL, based on the SNOT-20. 2090 3 Morbidity related to orbital resection or orbitotomy Controversy exists regarding the indications for orbital exenteration and orbital preservation, and management

B Quality of life for malignant neoplasms 1 Baseline QOL

SNM, and its associated surgical interventions, can cause significant morbidity. 14,267,476,1199,2097–2099 With advance ments in surgical technique and multidisciplinary inter ventions, greater focus has been placed on optimiz ing posttreatment QOL and minimizing morbidity while maximizing survival (Table XXXI.B.1). 1513,2054 Patients with SNM can present with variable symptoms, includ ing epistaxis, nasal obstruction, rhinorrhea, seizures, orbital pathology, cranial nerve palsies, and headaches, among others. 267,2097,2098,2100 Overall, QOL research is lim ited by the fact that the questionnaires typically used are validated for clinical conditions other than SNM specifically. 2085,2090,2093,2101–2103 Glicksman et al. calculated a mean baseline total SNOT-22 score of 37 (range 0–110) in patients with SNM, and Derousseau et al. computed a baseline SNOT-20 score of 1.13 (range 0–5) in a cohort of patients with sinonasal and skull base tumors. 2090,2093 Deckard showed that advanced T stage was associated with worse baseline QOL. 2085