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ICAR SINONASAL TUMORS

TABLE XXXII.1 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Sharma et al. 490 2020 4

1. 17 patients (63%) had impaired cognitive function in at least one

1. Neurocognitive function 2. Brain abnormalities onMRI 3. QOLas

Retrospective case series

27 patients previously treated with IMRT for SNM without recurrence

domain; the most affected domains were sustained attention and delayed verbal recall

2. Three participants had structural changes on MRI, all of whom had RT doses to the brain > 60Gy 3. Sleep deprivation and fatigue were the dominant factors for QOL deterioration 4. For self-reported cognitive function, memory was most affected

measured by various scales

Abbreviations: ALHR, Atkinson Life Happiness Rating; ASBQ, Anterior Skull Base Questionnaire; CES-D, Center for Epidemiological Studies Depression Scale; EORTC QLQ-BN20, EORTC QOL Questionnaire: Brain Tumor Module; EQ-5D VAS, EuroQOL 5 Dimension Visual Analogue Scale; FACT-HN, Functional Assess ment of Cancer Therapy: Head and Neck; FACT-NP, Functional Assessment of Cancer Therapy: Nasopharynx; HADS, Hospital Anxiety and Depression Scale; IMRT, intensity modulated radiation therapy; MDASI, MD Anderson Symptom Inventory; MDS, Midface Dysfunction Score; QOL, quality of life; RT, radiation therapy; SNM, sinonasal malignancy; UW-QOL, University of Washington QOL Score; VAS, visual analog scale.

B Morbidity following surgical treatment

Harm

SNM treatment affects multiple aspects of QOL, including physical aspects, such as sinonasal symptoms, as well as emotional aspects, with increased rates of mental health disorders and neurocognitive deficits. Most studies show that QOL is worse in the first several months after treatment but improves with time. Cost comparison analyses have not been undertaken. Preponderance of benefits over harms. Treatment of SNM does cause long-term side effects and decreased QOL; however, most symptoms improve with time after treatment. Most patients have persistently decreased sinonasal QOL, as well as a long-term elevated risk of mental health disorders and neurocognitive deficits. treatment for SNM, and treating providers should counsel patients on this accordingly. Patients should expect to have worse symptoms, particularly with regard to sinonasal symptoms, in the first several months, but these should gradually improve with time. Providers should be aware of increased rates of cognitive deficits and mental health disorders in this population.

Surgery is the cornerstone of treatment for most SNM, and its accompanying morbidity is at the forefront for survivorship (Table XXXII.2). A multicenter collaborative retrospective study by Ganly et al. found a 36% rate of acute postoperative complications and 5% mortality after open CFR. 2056 A recent single-institution study of primarily open surgery for SNM revealed a 14% rate of Clavien– Dindo complication (grade ≥ 3) and 30-day mortality rate of 2%. 2054 Gray et al. found that 17 out of 31 patients under going open CFR experienced delayed complications, most commonly orbital. 2122 However, the applicability of these and similar studies may be limited by recent technological and treatment innovations. 185,2114,2123 Endoscopic and combined resection are thought to reduce morbidity of the surgical approach. With the increased adoption of endoscopic surgery, its side effect profile has come under critical review. A review by Su et al. concluded that endoscopic surgery is associated with decreased complications and faster recovery. 1084,2056 A more recent multi-institutional cohort study by Beswick et al. found that open resection was associated with a threefold odds of complication compared to endoscopic resection. 14 On the other hand, endoscopic resection has been associated with increased nasal morbidity, including hyposmia, nasal crusting, thick nasal discharge, epistaxis, and postnasal drip. 2088 In addition, many patients expe-

Cost

Benefits–harm assessment

Value

judgments

Policy level Recommendation. Intervention QOL is expected to decrease following