xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

candidates, multiply recurrent lesions, or IP associated with malignancy. Role of radiation therapy for inverted papilloma Aggregate grade of evidence C (Level 4: four studies) Benefit Potential for improved disease control in patients in whom surgery has failed or is not possible.

Cost

Clinical charges associated with assessment of risk factors including clinic visits for history and physical, imaging, endoscopy, and operative cost for intra/postoperative risk factor assessment. Preponderance of benefits over harms. Risk factors for recurrence are wide ranging and need to be assessed on a patient-specific basis. Determining presence of recurrence as soon as evident will allow for more timely intervention of a less extensive tumor and potential mitigation of malignant transformation risk. Though endoscopy may be utilized for most surveillance visits, imaging may be considered for specific cases (e.g., maxillary sinus following prelacrimal approach, lateral frontal sinus).

Benefits–harm assessment

Value

judgments

Harm

Nearly all patients experience minor (mucositis, conjunctivitis, xerostomia, epiphora, anorexia) adverse effects from toxicity, some with major (central nervous

system [CNS], radionecrosis, visual changes, etc.) effects that can be life threatening.

Cost

Procedural costs, as well as radiation-associated morbidity. Balance of benefits and harms.

Benefits–harm assessment

Policy level Recommendation. Intervention Recommend identification of evidence-based risk factors that will increase risk of recurrence for IP and prolonged follow-up for surveillance of IP patients due to

Value

Role of RT is well established but limited to specific circumstances in management of IP.

judgments

Policy level Option. Intervention Consider RT for patients who meet limited indications or special conditions such as unresectable disease, poor surgical candidates, multiply recurrent lesions, or IP associated with malignancy. ∙ IP should be under surveillance given its propensity for local recurrence and known risks of malignant trans formation. The optimal timing is variable, but there are now data to suggest that recurrence may occur far after 5 years, which would necessitate longer surveillance periods. Recurrence risk and surveillance in inverted papilloma Aggregate grade of evidence Recurrence: B (Level 2: three studies, Level 3: two studies, Level 4: 14 studies) Surveillance: C (Level 4: six studies) Benefit

propensity for delayed recurrence. Close clinical follow-up for all patients due to risk for recurrence even after 5 years.

Benign vascular neoplasms and lesions This section covers updated evidence surrounding man agement of nasopharyngeal angiofibroma (formerly juve nile nasopharyngeal angiofibroma [JNA]) since ICSB 2019, 5 as well as sinonasal vascular malformations, heman giomas, and paragangliomas. Open versus endoscopic approaches for JNA Aggregate grade of evidence B (Level 2: one study; Level 4: seven studies) Benefit Endoscopic approaches demonstrate

comparable and possibly reduced tumor recurrence rates along with lower patient morbidity and intraoperative bleeding. Endoscopic approach is associated with low complication rates and morbidity. Endoscopic management is associated with favorable costs when compared to costs from open surgery. Preponderance of benefits over harms.

Prognosis for recurrence can be determined by identification of risk factors (multifocal attachment, prior surgery, high-risk HPV, STR such as disease overlying carotid, etc.). Prolonged surveillance allows for prompt identification of IP recurrence. Potential for under- or oversurveillance and early discharge from surveillance, which would preclude detection of later recurrences. (Continued)

Harm

Cost

Benefits–harm assessment

Harm

(Continued)