xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

Role of immunotherapy: B-cell lymphoma

Harm

Risks of morbidity from chemotherapeutic regimens, including R-CHOP for three or six cycles, and any potential morbidity from CNS prophylaxis regimens. There have been no clinical studies examining the cost of chemotherapy in the treatment of sinonasal lymphoma. Preponderance of benefits over harms. When considering chemotherapeutic treatment, clinicians should have a detailed conversation with their patients about the risks and benefits of the treatment along with a realistic discussion of potential treatment outcomes. CNS prophylaxis may be considered, and some studies have shown a potential survival benefit.

Cost

Aggregate grade of evidence

B (Level 3: two studies; Level 4: two studies)

Benefit

The addition of rituximab to CHOP treatment regimens significantly improves survival for patients with sinonasal BCL. Potential morbidity, including infusion-related reactions and severe skin and mouth reactions, from the addition of immunotherapy to chemotherapeutic treatment regimens. There are no clinical studies addressing the cost of immunotherapeutics in the treatment of sinonasal lymphoma. Preponderance of benefits over harms. Patients should be counseled on the risks of rituximab treatment as well as the potential benefits including improved OS.

Benefits–harm assessment

Value

Harm

judgments

Cost

Policy level Recommendation. Intervention Chemotherapy is the preferred option in the

Benefits–harm assessment

treatment of sinonasal BCL. The most common regimens include CHOP or CHOP-like therapy.

Value

judgments

Policy level Recommendation. Intervention Rituximab should be added to CHOP for the treatment of sinonasal BCL given survival benefits.

Role of radiation therapy: B-cell lymphoma Aggregate grade of evidence

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

Benefit

RT may help reduce the disease burden in patients with bulky disease, partial chemotherapeutic response, and extranodal involvement. Some studies have shown improved survival in sinonasal DLBCL patients who received RT in addition to chemotherapy. Potential morbidity from radiation treatment. There are no studies examining the cost of RT in sinonasal BCL. RT should be considered in the treatment of sinonasal lymphoma as an adjunct to chemotherapy in patients with bulky, symptomatic disease, advanced stage, or a partial response to chemotherapy. Patients should be counseled regarding the potential morbidity of RT as well as the uncertain impact on survival. Balance of benefits and harms.

Role of chemotherapy: Extranodal NK/T-cell lymphoma

Aggregate grade of evidence

C (Level 4: 24 studies)

Benefit

Chemotherapy is a cornerstone to ENKTL treatment, and current evidence suggests a survival benefit with treatment. Chemotherapeutics are known to be toxic with common side effects including hematologic disturbances (e.g., pancytopenia), which can be severe and life-threatening. Cost of treatment is significant, especially if several cycles of therapy are required for effect. Preponderance of benefits over harms. In patients with severe comorbidities, RT alone or enrollment in clinical trials can be considered.

Harm

Cost

Harm

Benefits–harm assessment

Value

judgments

Cost

Benefits–harm assessment

Value

judgments

Policy level Option. Intervention The addition of RT to chemotherapeutic

Policy level Recommendation. Intervention Chemotherapy, as the first-line treatment, should be offered to patients with ENKTL if they are able to tolerate treatment, despite its known toxicities.

regimens should be considered for sinonasal BCL patients who are symptomatic (i.e., cranial nerve palsies), have bulky disease, or are in an advanced stage.