Abstract
BackgroundSinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck. Cavernous sinus invasion from sinonasal adenoid cystic carcinoma and its related management have rarely been investigated. This study evaluated the relationship between treatment outcome and cavernous sinus involvement in addition to other parameters.MethodsA retrospective case series study was conducted at a tertiary referral center. The medical records of 47 patients diagnosed with primary sinonasal adenoid cystic carcinoma between 1984 and 2015 were retrospectively reviewed. The survival impact of the primary treatment modalities and the anatomic sites of tumor involvement were analyzed.ResultsCavernous sinus invasion was observed in 8 patients (17%), of whom 7 had ACC tumors originating from the maxillary sinus. The results of univariate analysis revealed that tumor stage, primary surgery, and the absence of skull-base and infratemporal fossa invasion were associated with better overall survival (P = 0.033, P = 0.012, P = 0.011, and P = 0.040, respectively) and better disease-free survival (P = 0.019, P = 0.001, P = 0.017, and P = 0.029, respectively). Multivariate analysis identified primary surgery as the only independent prognostic factor for disease-free survival (P = 0.026). Cavernous sinus invasion by sinonasal adenoid cystic carcinoma was not associated with worse overall survival or disease-free survival (P = 0.200 and P = 0.198, respectively).ConclusionsBecause maxillary adenoid cystic carcinoma is associated with a higher rate of cavernous sinus invasion, such cases warrant caution during preoperative planning. Primary surgery as the initial therapy provides better locoregional control and survival for patients with sinonasal adenoid cystic carcinoma. Cavernous sinus invasion did not significantly impact survival; thus, it should not be regarded as a contraindication for curative treatment.
Highlights
Sinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck
KaplanMeier survival analysis showed that primary surgery as the initial treatment provided better overall survival (OS) and diseasefree survival (DFS), and the results of multivariate analysis indicated an association with a better DFS
Cavernous sinus invasion was observed in approximately 17% of our patients with sinonasal Adenoid cystic carcinoma (ACC), and patients with maxillary ACC had a higher rate of cavernous sinus invasion
Summary
Sinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck. Cavernous sinus invasion from sinonasal adenoid cystic carcinoma and its related management have rarely been investigated. Adenoid cystic carcinoma (ACC), arising from the salivary glands, is the fourth most common malignant tumor in the sinonasal tract [1, 2]. Cavernous sinus involvement of sinonasal ACC often occurs via perineural spread [6,7,8,9,10]; the incidence and treatment outcomes of cavernous sinus invasion by these tumors have never been addressed or analyzed. This study investigates the incidence and management of cavernous sinus invasion by sinonasal ACC in a single tertiary referral hospital. The primary outcome of this study is to clarify the prognosis of cavernous sinus involvement in patients with ACC upon presentation. Prognostic factors, treatment modalities, outcomes, and survival of patients with sinonasal ACC tumors were analyzed
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