Outcomes of nonsurgical management of locally advanced carcinomas of the sinonasal cavity. (15th November 2016)

• Record Type: Journal Article
• Authors: Chopra, Shamit; Kamdar, Dev P.; Cohen, David S.; Heilbrun, Lance K.; Smith, Daryn; Kim, Harold; Lin, Ho‐Sheng; Jacobs, John R.; Yoo, George
• Is Part Of: Laryngoscope. Volume 127:Number 4(2017)
• Page Start: 855
• Page End: 861
• Publication Date: 2016-11-15
• Subjects: Carcinoma -- sinonasal -- unresectable -- chemoradiation -- cisplatin; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.26228
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objective: To determine the outcome of definitive concurrent chemoradiation with platinum for locally advanced sinonasal carcinomas. Study Design: Retrospective cohort. Methods: Twenty‐three nonsurgically and definitively treated patients diagnosed between July 1998 and February 2009 were analyzed. Patients with adenoid cystic carcinoma or adenocarcinoma were treated with photons and neutrons; the other histologies received photons alone. The vast majority received chemotherapy. Descriptive statistics were utilized, and Kaplan‐Meier estimates were computed. Results: Female (57%) and Caucasian (74%) preponderance were observed. Eighty‐seven percent were unresectable; the maxillary and nasoethmoid sites were equally prevalent. Intensity‐modulated radiation therapy (IMRT) and photons alone were utilized in 74% and 70%, respectively. Platinum agents were given in 95% of chemotherapy patients. Complete response was observed in 64% of patients. Median progression‐free survival (PFS) and overall survival (OS) were 28.8 and 65.3 months, respectively. Three‐year PFS and OS rates were 44% and 72%, respectively; 5‐year PFS and OS rates were 30% and 60%, respectively. Intensity‐modulated radiation therapy and a maxillary site of origin showed a trend toward superior PFS; higher‐dose regimens were associated with somewhat shorter PFS. Relapse was observed in 59% of patients, predominantly local. There were few unanticipated adverse effects, and no grade IV/V events were reported. Conclusion: Advanced sinonasal carcinomas are chemoradiosensitive tumors, albeit with a high propensity for local relapse. There is a definite indication for IMRT and a potential curative role of platinum‐based chemoradiation regimens. Level of Evidence: 4. Laryngoscope, 127:855–861, 2017