xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

Management of the orbit in ONB Aggregate grade of evidence

Cost

There are no studies investigating cost. Preponderance of benefits over harms.

Benefits–Harms Assessment

C (Level 2: one study; Level 4: three studies)

Value

Current conclusions based on limited high-quality studies. Larger studies are needed.

Benefit

Potential for orbital preservation with induction chemotherapy approaches. Orbital invasion is associated with decreased OS.

judgments

Harm

Policy level Option. Intervention Postoperative adjuvant RT is effective,

Cost

Not evaluated in current studies. Balance of benefits and harms.

especially in cases with positive margins and higher grade or Kadish stage tumors.

Benefits–harm assessment

Value

There are some data to suggest that orbital preservation may be feasible in select cases.

Role of systemic therapy in ONB Aggregate grade of evidence

judgments

C (Level 2: three studies; Level 4: 10 studies)

Policy level Option. Intervention Consider induction chemotherapy for

Benefit

Potential benefit for neoadjuvant chemotherapy in locally advanced or unresectable cases. Possible side effects from systemic therapy. Etoposide may be associated with bone marrow suppression, leading to pancytopenia, while platinum-based agents may lead to renal, neurological, and otologic impairment.

advanced cases with significant local or orbital invasion, especially if high-grade tumors. Further studies are necessary to determine the balance between orbital exenteration and orbital preservation approaches for ONB.

Harm

Unilateral resection and smell preservation in ONB Aggregate grade of evidence D (Level 4: three studies) Benefit Potential for some smell preservation if unilateral structures are preserved. Harm Not achieving a R0 resection given more limited approach. Possibility of smell loss

Cost

Not evaluated in current studies. Balance of benefits and harms.

Benefits–Harms Assessment

Value

There are some data to suggest that neoadjuvant chemotherapy may be of value in select cases. No current ability to select for possible responders before treatment.

judgments

regardless of unilateral approach given contralateral intracranial dissection or RT side effect. Preponderance of benefits over harms if negative margins can be obtained through unilateral resection. Smell preservation must not compromise oncologic resection. There are no studies investigating cost.

Policy level Option. Intervention Consider neoadjuvant chemotherapy for

Cost

locally advanced cases. Further studies are necessary to determine the benefit of other systemic treatment approaches for ONB.

Benefits–Harms Assessment

A major recent paradigm shift is having improved evidence for the role of IC as a means to “bioselect” sinonasal undifferentiated carcinoma (SNUC) patients based on response. Responders may benefit from definitive chemoradiation therapy (CRT), while nonresponders may be offered salvage surgery. Treatment of SNUC Aggregate grade of evidence B (Level 2: three studies; Level 3: six studies; Level 4: 24 studies) Benefit Bimodality, and more so trimodality, therapy is beneficial over single modality. Elective

Value

judgments

Policy level Option. Intervention Unilateral resection in an attempt to preserve

olfactory function may be an option in select cases of limited extent unilateral tumors with negative margin resections.

Role of radiation therapy in ONB Aggregate grade of evidence

C (Level 2: two studies; Level 4: 14 studies)

Benefit

Improved OS at 3 and 5 years when used as adjuvant therapy. Generally safe, especially with newer modalities, with some late toxicities.

neck treatment is associated with lower regional recurrence rates, most commonly with levels I–III. (Continued)

Harm

(Continued)