xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

Role of adjuvant therapy in sinonasal SCC Aggregate grade of evidence C (Level 4: four studies) Benefit

other important considerations regarding management of sinonasal SCC that were not discussed in ICSB 2019. 5 Definitive management entails surgical resection with the goal to obtain negative margins, followed by adjuvant therapy for advanced-stage disease and poorly differen tiated tumors. Induction chemotherapy (IC) for locally advanced sinonasal SCC is an option, especially for orbit preservation. Elective neck treatment should be consid ered for patients with advanced-stage tumors, particularly maxillary sinus primaries. IP-transformed sinonasal SCC is biologically distinct from de novo sinonasal SCC and appears to be associated with improved prognosis. Role of induction/neoadjuvant chemotherapy in sinonasal SCC

Surgery followed by postoperative RT demonstrate improved LRC and OS compared to patients treated with definitive radiation therapy (RT)/chemoradiation therapy (CRT) or surgery alone. Associated with treatment-specific toxicities. Insufficient data to make recommendation regarding long-term costs of adjuvant therapy. Preponderance of benefits over harms. The stage of tumor at presentation, the specific histologic subtype, and the goals of the patient should be carefully considered. poorly differentiated histologies would benefit from postoperative RT. The role of CRT is not clearly defined specifically for SNSCC but should be considered when positive margins or extranodal extension is present.

Harm

Cost

Benefits–harm assessment

Value

judgments

Policy level Recommendation. Intervention Patients with locally advanced disease or

Aggregate grade of evidence

C (Level 3: one study; Level 4: four studies)

Benefit

Patients who respond to induction chemotherapy demonstrate improved OS andDFS. There are systemic toxicities related to neoadjuvant therapy. Selective intraarterial neoadjuvant chemotherapy seems to reduce the rate and severity of toxicity. outcomes. Progression of disease during the neoadjuvant treatment period may lead to less favorable outcomes. Insufficient data to make recommendation regarding long-term costs of neoadjuvant therapy. The stage of tumor at presentation and the goals of the patient with respect to orbit preservation should be carefully considered. It is important to consider that negative margin resection remains the primary goal with most cases of SNSCC. Additionally, inappropriate patient selection may lead to less favorable Balance of benefits and harms.

Harm

Role of definitive chemoradiotherapy in sinonasal SCC Aggregate grade of evidence C (level 4: four studies) Benefit In cases of unresectable tumors, nonsurgical therapies offer an alternative to palliative

Cost

treatments. Additionally, in early-stage cancers, nonsurgical therapy may confer equivalent outcomes as compared to surgery ± adjuvant therapy. There are systemic and local toxicities related to nonsurgical therapies. Insufficient data to make recommendation regarding long-term costs of adjuvant therapy.

Benefits–harm assessment

Harm

Value

judgments

Cost

Benefits–harm assessment

Balance of benefits and harms.

Policy level Option. Intervention Patients with locally advanced disease (i.e.,

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orbit or intracranial invasion) may have benefit from neoadjuvant chemotherapy. Response to neoadjuvant chemotherapy offers prognostic information.