Endoscopic Resection vs. Open Surgery Combined With Radiotherapy for Locally Advanced Sinonasal Malignancies

Abstract

Purpose/Objective(s)The complete surgical resection combined with postoperative radiotherapy is the mainstay regimen for locally advanced sinonasal malignancies. The clinical value of endoscopic surgery compared with the open resection combined with radiotherapy remains controversial. Therefore, we performed the research to compare the survival outcomes and failure patterns of these two surgical approaches combined with radiotherapy for locally advanced epithelial sinonasal malignancies.Materials/MethodsPatients with locally advanced sinonasal malignancies, who underwent the combined treatment of surgery and radiotherapy from 1999 to 2016, were included. We classified patients into two groups based on the surgical approaches, and performed a propensity score-matched analysis (PSM) with 1:1 matching. The comparison of overall survival (OS) and progression-free survival (PFS) between the endoscopic surgery and open surgery groups was the primary outcome. Secondary outcomes included local control rate.ResultsA total of 295 patients with T3-4b sinonasal epithelial malignancies except olfactory neuroblastoma and mucosal melanoma were eligible. The median age was 52 years. Among them, 68% were males, and 32% were females. 60 (20.3%) cases underwent endoscopic surgery, 235 (79.7%) received open surgery. In the endoscopic and open surgery group, 80% and 57% (P = 0.001) of patients underwent IMRT, and the mean dose of primary tumor or tumor bed was 67.9 Gy and 64 Gy (P = 0.001) respectively. 112 patients were included after matching. Each group consisted of 56 patients with negligible differences in all demographic and clinicopathological features. The median follow-up time was 72 months (IQR 48-105) for the endoscopic surgery group and 98 months (IQR 70-151) for the open surgery group. The propensity-matched cohort analysis demonstrated no statistically significant differences for survival outcomes: 5y-OS was 66.1% and 71.2% in the endoscopic group and open group (HR = 1.15; 95% CI: 0.74-1.78; P = 0.545); 5y-PFS was 57.1% and 52.4% (HR = 0.839; 95% CI: 0.490-1.436; P = 0.522), respectively. The 5-year local control rate was 76.6% vs 60.3 (HR 0.455; 95% CI 0.236-0.874; P = 0.018).ConclusionFor locally advanced sinonasal malignancies, minimally invasive endoscopic resection combined with the higher dose postoperative radiotherapy was associated with a higher rate of local control and an equivalent overall survival compared with the open surgery. The complete surgical resection combined with postoperative radiotherapy is the mainstay regimen for locally advanced sinonasal malignancies. The clinical value of endoscopic surgery compared with the open resection combined with radiotherapy remains controversial. Therefore, we performed the research to compare the survival outcomes and failure patterns of these two surgical approaches combined with radiotherapy for locally advanced epithelial sinonasal malignancies. Patients with locally advanced sinonasal malignancies, who underwent the combined treatment of surgery and radiotherapy from 1999 to 2016, were included. We classified patients into two groups based on the surgical approaches, and performed a propensity score-matched analysis (PSM) with 1:1 matching. The comparison of overall survival (OS) and progression-free survival (PFS) between the endoscopic surgery and open surgery groups was the primary outcome. Secondary outcomes included local control rate. A total of 295 patients with T3-4b sinonasal epithelial malignancies except olfactory neuroblastoma and mucosal melanoma were eligible. The median age was 52 years. Among them, 68% were males, and 32% were females. 60 (20.3%) cases underwent endoscopic surgery, 235 (79.7%) received open surgery. In the endoscopic and open surgery group, 80% and 57% (P = 0.001) of patients underwent IMRT, and the mean dose of primary tumor or tumor bed was 67.9 Gy and 64 Gy (P = 0.001) respectively. 112 patients were included after matching. Each group consisted of 56 patients with negligible differences in all demographic and clinicopathological features. The median follow-up time was 72 months (IQR 48-105) for the endoscopic surgery group and 98 months (IQR 70-151) for the open surgery group. The propensity-matched cohort analysis demonstrated no statistically significant differences for survival outcomes: 5y-OS was 66.1% and 71.2% in the endoscopic group and open group (HR = 1.15; 95% CI: 0.74-1.78; P = 0.545); 5y-PFS was 57.1% and 52.4% (HR = 0.839; 95% CI: 0.490-1.436; P = 0.522), respectively. The 5-year local control rate was 76.6% vs 60.3 (HR 0.455; 95% CI 0.236-0.874; P = 0.018). For locally advanced sinonasal malignancies, minimally invasive endoscopic resection combined with the higher dose postoperative radiotherapy was associated with a higher rate of local control and an equivalent overall survival compared with the open surgery.