xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.23262, Wiley Online Library on [02/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

27

ICAR SINONASAL TUMORS

Value

Vast majority of sinonasal RMS are higher risk (Intergroup Rhabdomyosarcoma Study Group 2 or 3) and unlikely to have complete tumor clearance with surgery alone. Failure to show survival benefit with use of whole-brain radiation despite hypothetical benefit of reducing local recurrence.

Cost

Additional costs of surgery, perioperative care, and long-term postoperative care.

judgments

Benefits–harm assessment

Balance of benefits and harms.

Value

Patients treated with upfront surgery or surgery alone are likely to be highly selected for less aggressive, resectable tumors. Most studies do not differentiate between upfront and salvage surgery.

judgments

Policy level Recommendation. Intervention Primary RT, with or without chemotherapy, for pediatric sinonasal RMS is first-line

Policy level No recommendation. Intervention May consider surgery in highly selected patients with resectable tumors and in salvage setting.

therapy. Whole-brain radiation for high-risk parameningeal RMS is not recommended.

Role of chemotherapy in pediatric rhabdomyosarcoma

Role of chemoradiation therapy in adult rhabdomyosarcoma

Aggregate grade of evidence

B (Level 2: six studies; Level 3: nine studies)

Aggregate grade of evidence

C (Level 4: nine studies)

Benefit

Gradual improvement in survival in more recent studies with vincristine– dactinomycin–cyclophosphamide (VAC) or vincristine–dactinomycin–ifosfamide (VAI) protocol. Chemotherapy side effects including pancytopenia and stomatitis. Some studies show higher rates of grade 3 and 4 toxicities with more aggressive chemotherapy regiments. Cost of chemotherapy administration. Preponderance of benefits over harms. There are no direct comparisons between chemotherapy and nonchemotherapy treatments. Failure to show survival benefit with addition of intrathecal chemotherapy.

Benefit

Definitive treatment option for local, regional, and distant disease.

Harm

Acute and long-term CRT side effects.

Cost

Cost of CRT administration. Balance of benefits and harms

Harm

Benefits–harm assessment

Value

No direct comparison between different treatment approaches. Low quality studies demonstrating response with poor long-term survival. Protocols for adult RMS have generally been adapted from pediatric RMS;

judgments

Cost

Benefits–harm assessment

however, these tumors have different biology, and their treatment likely has different side effect profiles.

Value

judgments

Policy level Option. Intervention Further evidence needed to determine role of

Policy level Recommendation Intervention Administer VAC- or VAI-based chemotherapy

specific chemotherapy protocols in adult RMS. Consider RT for adults with sinonasal RMS, especially patients with unresectable disease.

protocols in treatment of sinonasal RMS. Intrathecal chemotherapy for sinonasal RMS is not recommended.

Role of surgery in adult rhabdomyosarcoma

Induction chemotherapy for sinonasal rhabdomyosarcoma

Aggregate grade of evidence

D (Level 4: six studies)

Aggregate grade of evidence

C (Level 3: two studies)

Benefit

Comparable survival between surgical and nonsurgical approaches. Risk of surgical complications including anesthetic risks, blood loss, infection, CSF leak, and orbital injury. Potential disfiguring surgery for locally advanced cases. (Continued)

Benefit

OS appears to be lower than that of patients treated with non-induction protocols from the same studies. Chemotherapy side effects and additional risk of tumor progression while receiving induction. Cost of chemotherapy administration, unlikely to be significantly different from non-induction chemotherapy costs. (Continued)

Harm

Harm

Cost