Clinical Characteristics and Patterns of Care in Locally Advanced Paranasal Sinus Cancer: A National Cancer Database Study

Abstract

Paranasal sinus cancer (PSC) is a rare malignancy occurring in approximately 3% of all head and neck cancers. Surgical resection of the primary site followed by adjuvant external beam radiation therapy (RT) is considered the standard of care. However, the incidence of lymph node involvement and the utilization of chemotherapy has not been clearly defined in locally advanced PSC. Using the NCDB, we identified all patients with locally advanced Stage III, IVA and IVB PSC diagnosed between 2004 and 2014. We extracted data regarding various patient and tumor characteristics as well as treatments received, whether surgery, radiation and/or chemotherapy. The incidence of clinical lymph node involvement was identified and the utilization of chemotherapy in node-negative patients was investigated. There were a total of 6,682 patients identified as clinical Stage III, IVA and IVB. The incidence of clinical lymph node involvement in this group was 22% (1,378 patients). 5,087 patients were clinical node-negative and were further analyzed in this study regarding the utilization of chemotherapy. 3,435 (68%) of node-negative patients underwent surgical resection of the primary site. EBRT (median dose of 60 Gy and range of 50-70 Gy) was administered in 3,676 patients, with a majority (65%) of the patients receiving adjuvant therapy. Chemotherapy was administered in 2,156 (42%) of patients, 183 with neoadjuvant intent. The incidence of clinically positive lymph nodes in locally advanced PSC is 22% per NCDB. In patients who were clinically node-negative, surgical resection followed by adjuvant external beam radiation therapy is performed in the majority. While systemic chemotherapy is not considered as standard of care, almost half of these patients received systemic chemotherapy. To investigate further, analysis on the impact of chemotherapy and overall survival will be presented.