Neoadjuvant chemotherapy for locoregionally advanced squamous cell carcinoma of the paranasal sinuses-Is it worthwhile?

Abstract

Listen

Translate article

We have read the article entitled “Neoadjuvant Chemotherapy for Locoregionally Advanced Squamous Cell Carcinoma of the Paranasal Sinuses” by Abdelmeguid et al1 with great interest, and we wish to congratulate the authors for this retrospective study. It has one of the largest homogeneous cohort of patients with squamous cell carcinoma of the paranasal sinus (n = 123) retrospectively reviewed over 3 decades. Although this study has shed valuable insight into the role of neoadjuvant chemotherapy in squamous cell carcinoma, we would like to seek a few clarifications to better understand its results. The management of patients with orbital involvement has been a conundrum for clinicians involved in therapeutic decision-making for such patients. The question surrounding the limits of orbital preservation assumes prime importance, especially in those with a functional globe preoperatively. Orbital exenteration criteria for paranasal sinus tumors have undergone a paradigm shift over the years, with orbital preservation being attempted even in the presence of orbital fat invasion.2 The latter is feasible with the availability of intraoperative frozen sections and high-definition endoscopic assistance.3 Other strategies that have been used with the intent of orbital preservation include preoperative radiotherapy and neoadjuvant chemotherapy.4 Clinicoradiological grading of the extent of orbital involvement has been provided by many authors.5 The most frequently used staging system is the Iannetti and Valentini classification.6 On the basis of this staging system, Turri-Zanoni et al7 provided a management algorithm for orbital involvement in paranasal sinus cancer. Orbit-sparing surgery was advocated for patients with involvement up to extraconal fat. Induction chemotherapy was considered for grade 1 to 3 orbital involvement based on high-grade histology (sinonasal undifferentiated carcinoma, grade 3 squamous cell carcinoma, neuroendocrine carcinoma, grade 4 olfactory neuroblastoma, or p53 wild-type intestinal-type adenocarcinoma). With this management paradigm, an orbital preservation rate of 76.6% was reported. Ultimate survival with a functional orbit was seen for 96% of patients who had undergone the orbit preservation approach. However, squamous cell carcinomas composed only 26.4% of the entire cohort. The study by Abdelmeguid et al1 is unique in that a homogeneous cohort of patients with locally advanced paranasal sinus squamous cell carcinoma was evaluated to study the efficacy of neoadjuvant chemotherapy. The authors reported an excellent orbit preservation rate of 81.5%. It would be of immense benefit to the readers if the authors could clarify the candidacy criteria with respect to the extent of orbital invasion that can be appropriately considered for neoadjuvant chemotherapy. No specific funding was disclosed. The authors made no disclosures.