J Neurol Surg B Skull Base 2016; 77 - A088
DOI: 10.1055/s-0036-1579876

NEOADJUVANT RADIATION IMPROVES MARGIN STATUS COMPARED TO ADJUVANT RADIATION AMONG PATIENTS WITH NON-SQUAMOUS CELL CARCINOMA SINONASAL MALIGNANCIES

Terence S. Fu 1, Christopher J. Chin 2, Wei Xu 3, Jiahua Che 3, Yazeed Alghonaim 2, Shao Hui Huang 4, Jolie Ringash 5, Ian J. Witterick 5
  • 1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Faculty of Medicine, University of Toronto; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
  • 3Dalla Lana School of Public Health, University of Toronto; Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
  • 4Faculty of Medicine, University of Toronto; Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada,
  • 5Faculty of Medicine, University of Toronto; Department of Otolaryngology-Head & Neck Surgery, University of Toronto; Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada

Background: Non-squamous cell carcinoma sinonasal malignancies (NSCCSM) represent a rare group of tumors with heterogeneous histopathology. Treatment typically involves a combination of surgical resection and adjuvant radiotherapy (RT). Neoadjuvant RT to a surgically unperturbed target area has been used in our institution for selected cases to facilitate subsequent oncologic resection.

Objective: To report treatment outcomes of patients with NSCCSM and to determine if neoadjuvant RT results in improved overall survival and better margin control.

Methods: A retrospective chart review was conducted for consecutive patients with NSCCSM treated with surgery with or without RT between 2000 and 2011 in our institution. Margin status, overall survival (OS), cause-specific survival (CSS) and disease-free survival (DFS) were compared between neoadjuvant and adjuvant RT subgroups.

Results: One-hundred and fifty six patients were reviewed. The most common histopathologies were malignant melanoma (29, 19%), olfactory neuroblastoma (26, 17%), adenoid cystic carcinoma (25, 16%), adenocarcinoma (24, 15%), and sinonasal undifferentiated carcinoma (21, 13%), which together accounted for 125/156 (80%) of patients. Median follow-up was 4.6 years. The five-year OS, CSS, and DFS were 45%, 61%, and 33%, respectively. There were no significant differences in any oncologic outcomes between patients receiving neoadjuvant versus adjuvant RT (5-year OS: 58% versus 52%, p = 0.56; 5-year CSS: 75% versus 64%, p = 0.30; 5-year DFS: 42% versus 39%, p = 0.58). However, negative margins were achieved in a higher proportion of patients treated with neoadjuvant versus adjuvant RT (83% versus 41%, p = 0.003). Additionally, controlling for age and presence of metastasis on multivariate analysis showed that the odds of positive margins were 78% lower among patients treated with neoadjuvant RT compared with those receiving adjuvant RT (OR = 0.22, 95% CI 0.06 to 0.85, p = 0.03).

Conclusions: Our data suggest that neoadjuvant RT is associated with negative margins among patients with NSCCSM treated with combined surgery and RT. Future studies with larger and more homogenous populations are needed to confirm the significance of these findings and clarify optimal treatment strategies.