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

36

KUANetal.

with both acute and late toxicities, with radiation necro sis being an important consideration in patients with sinonasal tumors, particularly those involving the skull base. Chemotherapy-related adverse events (AEs) are highly common, with up to half of patients having severe events during treatment. General QOL following multimodality treatment

Harm

Surgical treatment of SNM has been found to cause long-term sinonasal symptoms and decreased sinonasal-specific QOL. Sinonasal symptoms are worst in the first month after surgery but improve with time, back to or exceeding the presurgical baseline. Cost comparison analyses have not been undertaken. Surgical treatment of SNM is associated with long-term side effects and morbidity. While overall serious complications and morbidity are lower with the endoscopic approach, the endoscopic approach does cause increased sinonasal morbidity, which has been shown to affect sinonasal-specific and general QOL. Recommendation to attempt endoscopic surgical approach when feasible in order to preserve QOL. Preponderance of benefits over harms.

Cost

Benefits–harm assessment

Value

Aggregate level of evidence

C (Level 1: one study; Level 3: six studies; Level 4: two studies) Treatment of SNM is critical to long-term survival and disease control. SNM treatment affects multiple aspects of QOL, including physical aspects, such as sinonasal symptoms, as well as emotional aspects, with increased rates of mental health disorders and neurocognitive deficits. Most studies show that QOL is worse in the first several months after treatment but improves with time. Cost comparison analyses have not been undertaken. Preponderance of benefits over harms. Treatment of SNM does cause long-term side effects and decreased QOL; however, most symptoms improve with time after treatment. Most patients have persistently decreased sinonasal QOL, as well as a long-term elevated risk of mental health disorders and neurocognitive deficits. treatment for SNM, and treating providers should counsel patients on this accordingly. Patients should expect to have worse symptoms, particularly with regard to sinonasal symptoms, in the first several months, but these should gradually improve with time. Providers should be aware of increased rates of cognitive deficits and mental health disorders in this population.

judgments

Benefit

Harm

Policy level

Recommendation to anticipate the QOL implications of surgical treatment when treating SNM. Intervention Endoscopic surgical resection of SNM is

Cost

associated with decreased postoperative QOL, particularly in sinonasal domains. Open surgical resection is associated with higher rates of serious postoperative complications. QOL tends to improve with time after surgery and returns to baseline in many studies.

Benefit–harm assessment

Value

judgments

Morbidity following radiation treatment including osteoradionecrosis

Policy level Recommendation. Intervention QOL is expected to decrease following

Aggregate level of evidence

C (Level 2: one study; Level 3: 12 studies; Level 4: six studies) RT is associated with improved disease control for most pathologies and stages of SNM. Proton beam may reduce RT morbidity, but data are mixed. SNM RT is associated with both early and late toxicities, including mucositis, dermatitis, nasal morbidity, xerostomia, and dysphagia. Severe side effects, such as blindness and brain necrosis, are proportional to the volume and dose of RT, and the morbidity of RT is intensified in the re-irradiation setting. Skull base osteoradionecrosis (ORN) is rare and management is primarily surgical. Cost comparison analyses have not been undertaken.

Benefit

Harm

Morbidity following surgical treatment

Aggregate level of evidence

C (Level 2: one study; Level 3: 13 studies; Level 4: four studies) Endoscopic surgical approaches are associated with decreased postoperative complications and faster recovery compared to open surgical approaches.

Cost

Benefit

(Continued)

(Continued)