xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

∙ Identification of new/alternative strategies, biomarkers, and imaging modalities to more accurately diagnose patients with sinonasal tumors, especially malignancies at an earlier stage. ∙ Development of enhanced imaging modalities that eval uate the extent of involvement of sinonasal tumors, in particular orbital and intracranial involvement. Tumor specific biomarkers may also help to determine early metastases that are not detected with current modalities. ∙ Defining and validating radiographic and histopatho logic signatures of specific tumors, with refinement of tumor biology classification. Multicenter radiomic approaches with external validation could significantly alter this paradigm as seen in other specialties (e.g., mammography). ∙ Development of novel staging systems integrating prog nostically relevant data for specific histopathologies. E Treatment strategies Many of these treatment concepts described here are drawn from the prior ICSB 2019 document (Section XIV.B), which have insightfully highlighted many of these gaps. As we have pushed the boundaries and limits of surgi cal treatment with new techniques and approaches, the same questions remain regarding margin analysis and the balance between efficacy and functional preserva tion. We now recognize that treatment strategies should follow a histopathologic-specific strategy, and the trend toward a precision tumor- and patient-specific approach will continue. IC has shown promise with treating locally advanced tumors and has the potential for orbit and skull base preservation. Immunotherapy has changed our treat ment of mucosal melanoma and may have a role for metastatic disease. Appropriate selection of treatment can didates would be crucial in fitting these modalities into the current paradigm. Finally, as oncologic principles evolve and surgical techniques further develop, there will be gradual convergence of the roles of rhinologists and head and neck surgeons in the surgical management of these patients, with targeted selection of open, endoscopic, and combined approaches, likely in a team-based fashion (e.g., regular joint participation in tumor board conferences). We identify as ongoing research needs: ∙ Development of precision, histopathology-specific, and patient-specific treatment algorithms based on tumor and patient factors. ∙ Identification of methodology for appropriate selection of surgical candidates based on patient and tumor fac tors, and balancing this with nonsurgical treatment options (e.g., chemotherapy and RT).

∙ Refining the understanding of the concept of resectabil ity as surgical advances progress. ∙ Developing well-designed studies comparing onco logically sound endoscopic versus open/combined approaches, particularly for malignancies, to elucidate the impact of approach on survival and QOL. ∙ Tailoring sampling of adequate margins based on histopathology. ∙ Determining the role of induction chemotherapy in the management algorithm for locally advanced and/or metastatic SNM, understanding when organ preser vation should be attempted, and identifying which histopathologies respond best. ∙ Determining the role of immunotherapy in manage ment of various SNM, particularly mucosal melanomas. ∙ Improving the understanding of how RT and/or chemotherapy affects oncologic resection and skull base reconstructive outcomes, with development of algorithms that incorporate these considerations. ∙ Identifying strategies for balancing morbidity related to different modalities of treatment, including different forms of RT. As treatment becomes more effective and patients have a higher likelihood of long-term survival, the issues of survivorship, managing QOL, and surveillance become increasingly important. Unlike for other head and neck cancers, no QOL instruments are specifically validated for sinonasal tumors, and there is an opportunity to enrich our understanding of QOL outcomes before, during, and after treatment. With post-RT patients who survive longer, radiation-related side effects, such as skull base ORN and brain necrosis, will become more prevalent, with a need to develop effective treatment and prevention strate gies whenever possible. Finally, most of the literature on surveillance strategy has been based on nonsinonasal head and neck mucosal tumors. As we deepen our understand ing of sinonasal tumor biology, seldom is “achieving cure” simply based on patients having no evidence of disease for 5 years following treatment completion. Further work into duration and means of long-term surveillance will be crit ical, especially for a class of diseases where symptoms are not the primary means of detection of recurrence. 431 We identify as ongoing research needs in this area: ∙ Consensus identification of suitable generic and disease specific QOL instruments for assessing outcomes in sinonasal tumor patients, and/or design and validation of new instruments for this purpose. F Survivorship, QOL, and long-term care