Long-Term Outcomes of Endoscopic Resection versus Open Surgery for Locally Advanced Sinonasal Malignancies in Combination with Radiotherapy

Abstract

Objective Our objective was to compare the long-term outcomes of endoscopic resection versus open surgery in combination with radiotherapy for locally advanced sinonasal malignancies (SNMs).

Methods Data for continuous patients with sinonasal squamous cell carcinoma and adenocarcinoma who received surgery (endoscopic or open surgery) combined with radiotherapy in our center between January 1999 and December 2016 were retrospectively reviewed. A 1:1 matching with propensity scores was performed. Overall survival (OS), progression-free survival (PFS), and local recurrence rate (LRR) were evaluated.

Results We identified 267 eligible patients, 90 of whom were included after matching: 45 patients in the endoscopy group and 45 in the open group. The median follow-up time was 87 months. In the endoscopic group, 84.4% of patients received intensity-modulated radiotherapy (IMRT), with a mean gross tumor volume (GTV) dose of 68.28 Gy; in the open surgery group, 64.4% of patients received IMRT, with a mean GTV dose of 64 Gy. The 5-year OS, PFS, and LRR were 69.9, 58.6, and 24.5% in the endoscopic group and 64.6, 54.4, and 31.8% in the open surgery group, respectively. Multivariable regression analysis revealed that the surgical approach was not associated with lower OS, PFS, or LRR. The overall postoperative complications were 13% in the endoscopic group, while 21.7% in the open group.

Conclusion For patients with locally advanced SNMs, minimally invasive endoscopic resection, in combination with a higher radiation dose and new radiation techniques such as IMRT, yields survival outcomes similar to those of open surgery in combination with radiotherapy.

Keywords

propensity score analysis - sinonasal malignancies - endoscopic surgery - radiotherapy - outcomes

• References

• 1 Cancer incidence in five continents. Volume IX. IARC Sci Publ 2008; (160) 1-837
• 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70 (01) 7-30
• 3 Youlden DR, Cramb SM, Peters S. et al. International comparisons of the incidence and mortality of sinonasal cancer. Cancer Epidemiol 2013; 37 (06) 770-779
• 4 Llorente JL, López F, Suárez C, Hermsen MA. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol 2014; 11 (08) 460-472
• 5 Ketcham AS, Wilkins RH, Vanburen JM, Smith RR. A combined intracranial facial approach to the paranasal sinuses. Am J Surg 1963; 106: 698-703
• 6 Tajudeen BA, Kennedy DW. Thirty years of endoscopic sinus surgery: what have we learned?. World J Otorhinolaryngol Head Neck Surg 2017; 3 (02) 115-121
• 7 Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 2010; 267 (05) 649-663
• 8 Castelnuovo P, Lepera D, Turri-Zanoni M. et al. Quality of life following endoscopic endonasal resection of anterior skull base cancers. J Neurosurg 2013; 119 (06) 1401-1409
• 9 Nicolai P, Battaglia P, Bignami M. et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008; 22 (03) 308-316
• 10 Suh JD, Ramakrishnan VR, Chi JJ, Palmer JN, Chiu AG. Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base. Ann Otol Rhinol Laryngol 2013; 122 (01) 54-59
• 11 Nakamaru Y, Suzuki M, Kano S. et al. The role of endoscopic resection for selected patients with sinonasal squamous cell carcinoma. Auris Nasus Larynx 2020; 48 (01) 131-137
• 12 Lund VJ, Stammberger H, Nicolai P. et al; European Rhinologic Society Advisory Board on Endoscopic Techniques in the Management of Nose, Paranasal Sinus and Skull Base Tumours. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22: 1-143
• 13 Carlton DA, Beahm DD, Chiu AG. Sinonasal malignancies: endoscopic treatment outcomes. Laryngoscope Investig Otolaryngol 2019; 4 (02) 259-263
• 14 Xiao R, Joshi RR, Husain Q. et al. Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: effect of surgical approach. Head Neck 2019; 41 (10) 3551-3563
• 15 Duprez F, Madani I, Morbée L. et al. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys 2012; 83 (01) 252-259
• 16 Marta GN, Silva V, de Andrade Carvalho H. et al. Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol 2014; 110 (01) 9-15
• 17 Austin PC. Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples. Stat Med 2011; 30 (11) 1292-1301
• 18 Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med 2014; 33 (07) 1242-1258
• 19 Povolotskiy R, Farber NI, Bavier RD, Cerasiello SY, Eloy JA, Hsueh WD. Endoscopic versus open resection of non-squamous cell carcinoma sinonasal malignancies. Laryngoscope 2020; 130 (08) 1872-1876
• 20 Hagemann J, Roesner J, Helling S. et al. Long-term outcome for open and endoscopically resected sinonasal tumors. Otolaryngol Head Neck Surg 2019; 160 (05) 862-869
• 21 Kılıç S, Kılıç SS, Baredes S. et al. Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients. Int Forum Allergy Rhinol 2018; 8 (03) 421-434
• 22 Farquhar D, Kim L, Worrall D. et al. Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes. Laryngoscope 2016; 126 (08) 1724-1729
• 23 Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis. Int Forum Allergy Rhinol 2011; 1 (04) 255-261
• 24 Rawal RB, Farzal Z, Federspiel JJ, Sreenath SB, Thorp BD, Zanation AM. Endoscopic resection of sinonasal malignancy—a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2016; 155 (03) 376-386
• 25 Meccariello G, Deganello A, Choussy O. et al. Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: a pooled-analysis of 1826 patients. Head Neck 2016; 38 (Suppl. 01) E2267-E2274
• 26 Grosjean R, Gallet P, Baumann C, Jankowski R. Transfacial versus endoscopic approach in the treatment of woodworker's nasal adenocarcinomas. Head Neck 2015; 37 (03) 347-356
• 27 Kotelnikov VM, Coon JS IV, Haleem A. et al. Cell kinetics of head and neck cancers. Clin Cancer Res 1995; 1 (05) 527-537
• 28 Umeda M, Nishimatsu N, Masago H. et al. Tumor-doubling time and onset of pulmonary metastasis from adenoid cystic carcinoma of the salivary gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88 (04) 473-478
• 29 Abdelmeguid AS, Raza SM, Su SY. et al. Endoscopic resection of sinonasal malignancies. Head Neck 2020; 42 (04) 645-652
• 30 Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 2012; 34 (06) 877-885
• 31 Torabi SJ, Spock T, Cardoso B. et al. Margins in sinonasal squamous cell carcinoma: predictors, outcomes, and the endoscopic approach. Laryngoscope 2020; 130 (06) E388-E396
• 32 Robin TP, Jones BL, Gordon OM. et al. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123 (16) 3040-3049
• 33 Farris M, Lucas Jr JT, Soike M. et al. Impact of treatment paradigm and elective nodal coverage on resection status and failure patterns in paranasal sinus tumors. Int J Radiat Oncol Biol Phys 2015; 93 (03) E339-E340
• 34 Wang Z, Qu Y, Wang K. et al. The value of preoperative radiotherapy in the treatment of locally advanced nasal cavity and paranasal sinus squamous cell carcinoma: a single institutional experience. Oral Oncol 2020; 101: 104512
• 35 Yi J, Huang X, Xu Z. et al. Phase III randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Oncotarget 2017; 8 (27) 44842-44850
• 36 Zhang ZM, Tang PZ, Gang XZ, Fa QY, Zh XG. Significance of different preoperative radiotherapy doses in combined therapy for hypopharyngeal squamous cell carcinoma. Chin J Radiat Oncol 2004; 13 (01) 1-3
• 37 Zhang ZM, Tang PZ, Xu ZG, Li ZJ. [Squamous cell carcinoma of naso-ethmoid sinus: analysis of 146 cases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010; 45 (07) 555-559
• 38 Wiegner EA, Daly ME, Murphy JD. et al. Intensity-modulated radiotherapy for tumors of the nasal cavity and paranasal sinuses: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 2012; 83 (01) 243-251
• 39 Fan M, Kang JJ, Lee A. et al. Outcomes and toxicities of definitive radiotherapy and reirradiation using 3-dimensional conformal or intensity-modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies. Cancer 2020; 126 (09) 1905-1916
• 40 Hoppe BS, Stegman LD, Zelefsky MJ. et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting–the MSKCC experience. Int J Radiat Oncol Biol Phys 2007; 67 (03) 691-702
• 41 Eloy JA, Vivero RJ, Hoang K. et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope 2009; 119 (05) 834-840
• 42 Fu TS, Monteiro E, Witterick I. et al. Costs and perioperative outcomes associated with open versus endoscopic resection of sinonasal malignancies with skull base involvement. J Neurol Surg B Skull Base 2017; 78 (05) 430-440