xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

Role of radiation therapy: Extranodal NK/T-cell lymphoma

ments that have been used to assess outcomes for sinonasal tumors, though no specific instrument has been developed solely for sinonasal tumors. Assessment of QOL in sinonasal tumors

Aggregate grade of evidence

C (Level 4: 24 studies)

Benefit

RT has been demonstrated to improve LRC and recommended for almost all treatment paradigms outside clinical trials. RT has significant potential morbidity in terms of damage to adjacent tissue, including risks of vision loss and brain necrosis in extreme cases. There is significant cost to the intervention including institutional costs for equipment and patient time and morbidity from treatment. Preponderance of benefits over harms. Patients who have received previous head and neck radiation deserve careful consideration of the morbidity of reirradiation given increased side effects.

Aggregate level of evidence

B (Level 1: two studies; Level 2: eight studies; Level 3: nine studies; Level 4: one study) QOL outcomes for patients with sinonasal tumors have been studied with reliable instruments that have been validated for sinonasal disorders or head and neck malignancies. No consensus has been made for the best instrument for assessing QOL in sinonasal tumors. Time (interviewer, patient, data entry, and data analysis); survey fatigue especially with multiple instruments Preponderance of benefits over harms. Since there is no well-defined superior metric, multiple metrices may be needed for full evaluation of QOL outcomes. More studies directly comparing QOL metrics should be performed specific to sinonasal tumor outcomes. management of patients with sinonasal tumors to monitor patient outcomes, as they have the potential to provide valid and reliable information on outcomes for patients with sinonasal tumors.

Benefit

Harm

Cost

Harm

Cost

Benefits–harm assessment

Value

Benefits–harm assessment

judgments

Value

judgments

Policy level Recommendation. Intervention RT should be offered to all patients

undergoing treatment for ENKTL for LRC benefits.

Policy level Recommendation. Intervention QOL surveys should be utilized during the

Metastatic tumors Metastatic tumors to the sinonasal tract are rare. The most common primary tumor is renal cell carcinoma. Although systemic therapies play a dominant role in treatment of metastatic disease, surgical resection or targeted RT to a solitary lesion may be an option for palliation. Section 4: Morbidity, QOL, and surveillance Risk factors for surgical complications ∙ Advanced age, comorbidities, history of RT, and advanced stage have been previously cited as risk fac tors for complications; however, there is no consensus based on the literature. ∙ The endoscopic approach is associated with shorter recovery times as compared to the open approach and may have a lower complication profile. ∙ Salvage surgery seems to be associated with higher morbidity and complication risk than primary surgery. Quality of life instruments With improved survival, consideration of morbidity and secondary outcomes such as QOL becomes increasingly important. There are numerous validated QOL instru

Quality of life for benign and malignant neoplasms ∙ QOL scores tend to improve from baseline after treat ment. Benign tumors are associated with higher QOL at baseline when compared to malignancies. QOL after treatment of SNM may be modified by adjuvant therapy (i.e., RT). ∙ Extended maxillary sinus approaches do not seem to worsen long-term QOL. ∙ Overall rates of orbital preservation in the literature, when attempted, are high (60%–90%). Intradural resec tion tends to mainly affect olfaction-related QOL. Morbidity/QOL following multimodality treatment All treatment modalities carry the risk of complications, morbidity, and negative impact on QOL. QOL is gen erally worst in the first few weeks following treatment, but improves and stabilizes over time. RT is associated