xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

B Clinical and outcomes research opportunities Collaborative research is a major cornerstone of study of oncologic outcomes, as the joint efforts of diverse backgrounds can bring about synergistic insights, espe cially for rare and complex tumors like those originat ing from the sinonasal tract. Thus, there is a pressing need for motivated investigators to spearhead prospec tive, multi-institutional, and multidisciplinary registry based research that provides not only highly granular but also consistent, comparable, and compatible data. Clear definitions of outcome measures, treatment modal ities, and independent variables (e.g., tumor involvement and primary site) are paramount, facilitating statistical reporting and meta-analyses. Additionally, the design of outcome studies should strive to balance appropriate representation of patient populations such as biologic sex, race/ethnicity, and socioeconomic factors. A strong effort should be made toward developing clinical tri als with the same scientific rigor as those developed by the medical and radiation oncology communities. Sev eral early examples of this type of innovative research have recently surfaced. 14–16,1564,2210–2215 With multiple spe cialties involved in the care of these complex patients, the sinonasal oncologic community can leverage diver gent backgrounds and expertise to drive the field forward. We identify as ongoing research needs in a tumor-specific manner: ∙ Increasing well-balanced clinical trials across all treatment modalities (surgery, chemotherapy, RT, immunotherapy), especially for rarer pathologies. ∙ Creation of evidence-based practice guidelines backed by high-level clinical studies (e.g., RCTs). ∙ Improvement of data granularity, consis tency/compatibility across studies, reproducibility (e.g., core outcome measures), and precision. C Public health/policy As sinonasal tumors are rare, the thrust of care generally lies at the level of referral centers and subspecialists. Due to the ability of sinonasal tumors to expand within the nasal cavity and paranasal sinuses with only vague and nonspecific presenting signs and symptoms, most tumors are discovered at an advanced stage. Thus, there is a major opportunity to educate first-line providers, thereby increasing their awareness of these conditions. This could, in turn, result in prompt referrals and possibly workup whenever “danger signs” are identified. For specific condi

tions with higher prevalence and well-defined risk factors, enactment of evidence-based screening protocols may be feasible. An example of this is NPC screening for first degree relatives of patients in Hong Kong, where the disease is endemic. 2216 Finally, further research in the areas of disparities and differences in outcomes and access to care based on sex, race/ethnicity, and socioeconomic status is needed to create unique specific screening and treatment plans for patients of various backgrounds. We identify as ongoing research needs in a tumor-specific manner: ∙ Methods for education of providers in various specialties and points of care (e.g., primary care, emergency depart ment) regarding concerning signs/symptoms and “red flags” that may be suspicious for sinonasal tumors, thus prompting earlier referral and/or workup/intervention. ∙ Determination of streamlined, informative, and cost effective means to screen, diagnose, and stage SNM patients. ∙ Improved understanding of healthcare disparities in sinonasal tumor care, as well as differences in incidence, prognosis, presentation, access to care, and treatment strategies based on sex, race/ethnicity, socioeconomic status, and other social determinants of health. D Diagnosis, workup, and staging To date, comprehensive workup of the patient is confined to assessing signs and symptoms, endoscopic examina tion, and radiographic studies. Despite this multimodal approach, it remains highly challenging to diagnose sinonasal tumors, and there are very few disease-specific indicators that provide clinically meaningful information upfront, with clinicians requiring tissue analysis to guide therapy. Novel applications of imaging have been reported, such as the use of 68 Gallium-DOTATATE for detection of ONB. 2217,2218 The WHO will likely continue to refine their tumor classification system based on new insights in molecular/genomic analytics, biomarkers, and tumor biology (e.g., SNUC as stratified into multiple diseases through DNA methylation-based classification). 2219 Tradi tional staging systems also may not capture all meaningful prognostic information, and there is a need to rethink and potentially redesign informative staging systems that integrate these critical features (e.g., Hyams grade in ONB, mutational burden). With the rise of artificial intelligence applications in medicine as a whole, system atic assessment of unique indicators of tumor behavior based on radiology and pathology may emerge. 2220–2222 We identify as ongoing research needs in a tumor-specific manner: