xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

Benefits–harm assessment

Balance of benefits and harms.

Harm

There are multiple staging systems with unique criteria, with overlapping and sometimes conflicting prognostic value. There are no studies investigating the costs of ONB staging. Some staging systems (i.e., Kadish) were initially developed in the pre-endoscopic era and may not take into consideration all relevant prognosticators. Newer staging systems have not been fully validated. Preponderance of benefits over harm.

Value

Treatment with induction chemotherapy may identify subset of patients who will or will not benefit from definitive CRT. No direct comparison of induction to other protocols.

judgments

Cost

Benefits–harm assessment

Policy level Option. Intervention Induction chemotherapy protocols for sinonasal RMS is an option for bulky and locally advanced disease. Sinonasal neuroendocrine and neuroectodermal tumors ONB was previously covered in ICSB 2019 5 and an updated review on nonoverlapping topics is presented. There is increasing recognition of the prognostic value of Hyams grading, elective management of the neck, balancing functional/olfactory preservation and oncologic resection, and the limitations of historical staging systems. ONB is also known to demonstrate delayed recurrence, making long-term surveillance a cornerstone of management. Impact of Hyams grade on outcomes

Value

judgments

Policy level Recommendation. Intervention ONB staging systems are a useful measure for describing tumors, prognostication, and

treatment planning, though other important tumor factors (e.g., grade, dural invasion) must also be considered.

Elective management of the N0 neck in ONB

Aggregate grade of evidence

C (Level 2: two studies; Level 4: eight studies).

Aggregate grade of evidence

B (Level 2: three studies; Level 4: five studies)

Benefit

Treatment of clinically positive neck disease assists in disease control. Delayed regional involvement in the neck is common with a median time to recurrence of approximately 5 years. Elective treatment of the neck with irradiation, particularly in patients with high-stage/grade disease, shows significantly reduced evidence of nodal recurrence but does not significantly impact OS. Neck dissection can lead to complications including hematoma, infection, cranial nerve palsies, chyle leak, among others. RT of the neck is associated with xerostomia, skin changes, and long-term toxicity. There are no studies investigating the costs of upfront or delayed treatment of the N0 neck. Preponderance of benefits over harms (N + neck). Balance of benefits and harms (N0 neck). Elective treatment of the N0 neck is likely to prevent long-term regional recurrence in ONB patients with high-stage/grade disease and may lead to improved DFS.

Benefit

Understanding Hyams grade provides prognostic information that may guide adjuvant therapy and treatment of the neck. Grading may be prone to misinterpretation and requires pathologist expertise. There are no studies investigating the costs of histological grading of ONB.

Harm

Cost

Benefits–harm assessment

Preponderance of benefits over harms.

Harm

Value

High-grade tumors appear to have more aggressive biological behavior (more prone to recurrence, nodal metastases) and may require more aggressive upfront treatment.

judgments

Cost

Policy level Recommendation. Intervention Hyams grading should be routinely assessed when sampling tissue for ONB cases, as knowledge of the grade may impact treatment strategies.

Benefits–harm assessment

Value

judgments

Staging systems in ONB

Policy level Recommendation for treating N + neck. Option for treating N0 neck. Intervention In a node-positive neck, the role of surgical

Aggregate grade of evidence

B (Level 2: three studies; Level 4: 13 studies)

Benefit

Staging ONB extent provides prognostic information that may guide adjuvant therapy and allow for ease of communication to multidisciplinary and cross-institutional teams. (Continued)

treatment and adjuvant radiation for ONB patients is well established. However, in patients with a clinically N0 neck and high Hyams grade (III/IV) or Kadish C/D stage, ENI should be considered. Long-term surveillance ( > 5 years) of the neck is recommended.