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

31

ICAR SINONASAL TUMORS

Cost

Immunotherapy is expensive; however, cost comparison analyses have not been undertaken.

Harm

Potential harm of RT includes cost, mucositis, osteoradionecrosis, nasal synechiae, hyposmia, dysgeusia, and diminished vision. Cost comparison analyses have not been undertaken.

Benefits–harm assessment

Balance of benefits and harms.

Cost

Value

OS is likely improved in advanced and metastatic SNMM with adjuvant

Benefits–harm assessment

Balance of benefits and harms.

judgments

immunotherapy, but the duration and clinical significance are not well defined. In addition, the cost and adverse events associated with immunotherapy must be considered.

Value

Adjuvant RT should be considered to improve local control.

judgments

Policy level Option. Intervention Adjuvant RT should be considered for patients with SNMM as part of

Policy level Option. Intervention Adjuvant immunotherapy should be considered as a treatment option in advanced or metastatic SNMM.

multimodality therapy. The benefit to local control should be weighed against the side effects of RT treatment.

Treatment of the neck in sinonasal mucosal melanoma

Nasopharyngeal malignancies Traditionally thought of as a nonsurgical malignancy, nasopharyngeal carcinoma (NPC) is commonly associated with Epstein–Barr virus (EBV), with recurrence and treat ment response able to be monitored through measurement of EBV DNA. There is very high LOE for chemotherapy and RT for NPC, and this remains first-line treatment for NPC. The advent of endoscopic nasopharyngectomy and advanced vascular surgery has provided an additional treatment modality for select recurrent cases. Role of EBV assessment in NPC

Aggregate grade of evidence

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

Benefit

Neck dissection may reduce risk of regional recurrence (low-level evidence) but has not been shown to be associated with OS. Potential harm of neck dissection includes cranial nerve injury, shoulder dysfunction, and vascular injury. Cost comparison analyses have not been undertaken.

Harm

Cost

Benefits–harm assessment

Balance of benefits and harms.

Aggregate grade of evidence

A (Level 1: 10 studies; Level 2: two studies; Level 3: four studies; Level 4: seven studies) A blood test for quantification of circulating EBV DNA is an ideal biomarker for the clinical management of patients with NPC. It has high sensitivity and specificity for the detection of NPC and correlates with tumor burden, patient survival, diagnosis of recurrence/remission, and early prediction of treatment response. Need for repeat blood draws; EBV not associated with every NPC subtype. The EBV DNA blood test has a lower cost than other diagnostic interventions, such as MRI and PET scan. Preponderance of benefits over harms.

Value

Neck dissection for clinically positive lymph nodes may be considered but must be weighed against other options including immunotherapy.

judgments

Benefit

Policy level Option. Intervention Neck dissection for clinically positive cervical

lymph nodes may be considered within the context of the patient’s overall treatment plan.

Harm

Role of radiation therapy in sinonasal mucosal melanoma

Cost

Benefits–harm assessment

Aggregate grade of evidence

C (Level 1: one study; Level 3: two studies; Level 4: eight studies) There is evidence that adjuvant RT improves local control of SNMM; however, RT has not been consistently associated with improved OS. (Continued)

Benefit

(Continued)