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DOI: 10.1055/s-0036-1579876
NEOADJUVANT RADIATION IMPROVES MARGIN STATUS COMPARED TO ADJUVANT RADIATION AMONG PATIENTS WITH NON-SQUAMOUS CELL CARCINOMA SINONASAL MALIGNANCIES
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.