Impact of tumour volume on prediction of progression-free survival in sinonasal cancer

Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors

Simple Summary

Tumors of the nasal cavity and paranasal sinus are rare. Most are discovered at a locally advanced stage and require multimodal treatment consisting of surgery and radiotherapy with concomitant chemotherapy. Tumor localization between the eyes and near the brain makes treatment planning difficult due to the necessary consideration of both critical normal tissue with high protection priority and the curative aim of the best radiotherapy dose deposit. Thus, it is noteworthy how tumor volumes impact the five-year survival outcome. Therefore, we investigated initial tumor volumes before any therapy. Patients with larger mean initial tumor volumes of more than 75 cm³ had worse outcomes. There was no additional benefit of upfront surgery. Especially for patients with large tumor burdens of the nasal cavity or paranasal sinus, an interdisciplinary case discussion with the patient is essential in the process of shared decision-making.

Abstract

Purpose: We report the outcome of a mono-institutional retrospective study of sinonasal carcinoma with the primary focus on GTV (gross tumor volume) and the effect of radiotherapy. Methods: 53 patients with sinonasal carcinoma and that of the nasal cavity, paranasal sinus or both except lymphoma were included. All patients were treated between 1999 and 2017. For tumor volume delineation, all pre-therapeutic images were fused to the planning CT (computed tomography). Results: The median follow-up was 17 months [0.3–60], the median age 60 years, 35 males and 18 females were included. Squamous cell carcinoma (SCC) (60.4%) was the predominant histology, followed by adenocarcinoma (15.1%). The mean composite OS (overall survival) time was 33.3 ± 3.5 months. There was no significant difference in the 5 y composite OS between tumor localization or radiotherapy setting. The simultaneous integrated boost concept showed a trend towards improving five-year composite OS compared to the sequential boost concept. The only factor with a significant impact on the 5 y composite OS rate was the pre-therapeutic GTV (cutoff 75 cm³; p = 0.033). The GTV ≥ 100 cm³ has no effect on the 5 y composite OS rate for SCC. Conclusions: The pre-therapeutic GTV is a prognostic factor for five-year composite OS for the entire group of patients with sinonasal tumors, influencing the outcome after completion of all treatment strategies. The GTV seems to not influence five-year composite OS in SCC. For this rare tumor entity, an intensive, multidisciplinary discussion is essential to finding the best treatment option for the patient.

Prognostic role of primary tumor, nodal neck, and retropharyngeal GTVs for unresectable sinonasal cancers treated with IMRT and chemotherapy

Background:

We evaluated the prognostic role of gross tumor volumes (GTVs) of primary tumor and positive lymph nodes on overall survival (OS) and progression-free survival (PFS) in locally advanced unresectable sinonasal cancer (SNC) treated with definitive intensity-modulated radiotherapy (IMRT) with or without chemotherapy.

Methods:

Primary tumor GTV (GTV-T), pathologic neck nodes GTV (GTV-N), and positive retropharyngeal nodes GTV (GTV-RPN) of 34 patients with epithelial nonglandular SNC receiving IMRT with or without chemotherapy were retrospectively measured. The GTV variables were analyzed in relation with OS and PFS. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test. We also estimated the crude cumulative incidence of locoregional relapses only. The optimal volume cutoff value was determined using an outcome-oriented method among the observed values.

Results:

GTV-T was significantly associated with decreased OS ( P=0.003) and PFS ( P=0.003). Moreover, patients with disease total volumes (GTV) smaller than 149.44 cm³ had better OS and PFS than patients with higher volumes ( P<0.0001 for both). Neck nodal metastasis impacted on OS and PFS ( P=0.030 and P=0.033, respectively), but GTV-N did not ( P=0.961; P=0.958). Retropharyngeal nodes metastasis was not associated with prognosis (OS: P=0.400; PFS: P=0.104). When GTV-RPN was added to GTV-N (GTV-TN), a relation with PFS ( P=0.041) and a trend toward significance for OS ( P=0.075) were found.

Conclusions:

Our results show that tumor volume is a powerful predictor of outcome in SNC. This could be useful to identify patients with worse prognosis deserving different treatment strategies.

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

OBJECTIVE

Outcomes of locally advanced epithelial sinonasal cancers remain unsatisfactory; moreover, only limited and heterogeneous data exist on prognostic factors.

METHODS

We reviewed all consecutive patients with American Joint Committee Cancer stage III to IV epithelial sinonasal cancers treated with platinum-based induction chemotherapy (IC) followed by locoregional treatment between 1996 and 2015.

RESULTS

We identified 69 patients treated with a multimodal approach (IC, surgery, radiotherapy). Overall, 44 patients recurred (64%). Of those, 19 patients received salvage surgery, but only four remained disease-free. Median overall survival (OS) was 62.5 months. Sinonasal neuroendocrine and small cell histotypes (P = 0.0085), neuroendocrine differentiation (P = 0.006), and lack of response to IC (P = 0.03) were associated with worse OS. In patients who recurred, median OS was 13 months since recurrence. Survival was longer in patients submitted to salvage surgery (44%) than in those receiving chemotherapy alone at recurrence (29.5 vs. 4.6 months). Patients with a clinical benefit after palliative chemotherapy had a longer median OS than those with disease progression (29.2 vs. 4.4 months; P < 0.0001).

CONCLUSION

Globally, the prognosis of locally advanced epithelial sinonasal cancers is dismal, with worse outcomes for neuroendocrine lesions. In the recurrent setting, feasibility of salvage surgery and clinical benefit from palliative chemotherapy are associated with longer OS. A multimodal treatment strategy with IC seems to offer improved OS when compared with other retrospective series not employing such a therapeutic tool.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:857-865, 2020.

Prediction of survival with combining quantitative 18 F-FDG PET/CT and DW-MRI parameters in sinonasal malignancies

BACKGROUND

We aimed to establish the prognostic value of ¹⁸ F-fluoro-deoxy-glucose positron emission/CT (¹⁸ F-FDG PET/CT) and diffusion-weighted (DW) MRI in determining overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) of sinonasal malignancies.

METHODS

Sixty-eight patients with sinonasal cancer who underwent both pretreatment ¹⁸ F-FDG PET/CT scan and head-neck MRI from January 2009 through August 2017 were retrospectively reviewed. Kaplan-Meier survival analysis of ¹⁸ F-FDG PET/CT and DW-MRI parameters were performed for OS, PFS, and DMFS.

RESULTS

Cox regression analysis determined that all the quantitative ¹⁸ F-FDG PET/CT and DW-MRI parameters were independently correlated with PFS, DMFS, and OS (P < .05). After controlling for imaging variables, perineural invasion (P = .02) and ill-defined margin (P = .02) were found to be significantly correlated with shorter OS; while the perineural invasion was significantly correlated with shorter PFS (P = .02).

CONCLUSIONS

The pretreatment DW-MRI and ¹⁸ F-FDG PET/CT parameters could be substantial surrogate markers for sinonasal malignancies.