Role of Radiation Therapy in Management of Nasal and Sinonasal Squamous Cell Carcinomas

Abstract

Purpose/Objective(s)To compare outcomes of primary radiation therapy (RT) vs primary surgery (Sx) for squamous cell carcinoma (SCC) of nasal cavity (NC) and paranasal sinus (PNS).Materials/MethodsA retrospective review was conducted of a prospectively assembled cohort of SCC of NC and PNS managed with either primary RT or Sx between 2000 and 2012. SCC of nasal vestibule was excluded. Overall survival (OS) and cause specific survival (CSS) were determined using the Kaplan-Meier Method and compared using log-rank test. Cumulative local control (LC), regional control (RC), distant control (DC), and late toxicity were determined using competing risk method. Multivariate analysis was performed for variables predictive of OS.ResultsA total of 68 SCC eligible cases were included, 49 managed with primary RT (NC: 17 PNS: 32) and 19 managed with surgery (NC: 10 PNS: 9). Concurrent chemotherapy (cisplatin) was given to 36/49 (73%) of RT cases. Most patients were treated with once daily 2 Gy fractions delivering 70 Gy to gross disease. Patients managed with Sx received radiation either pre-op (10/19) (53%) or postop (9/19) (47%). Median follow-up was 48 months. For the RT vs Sx groups there were 20/49 (40%) vs 6/19 (31%) local, 7/49 (14%) vs 0/19 (0%) regional, and 5/49 (10%) vs 3/19 (15%) distant failures. For the RT vs Sx groups there was no statistically significant difference in the 5-year OS (51% vs 66%, p = 0.41), (CSS 66% vs 72%, p = 0.61), LC (62% vs 60%, p = 0.68), RC (90% vs 100%, p = 0.15), DM (90% vs 83%, p = 0.53), late toxicity (0.38% vs 0.32%, p = 0.86). G-tube dependency at 1 year was 2% in the RT group and 5% in the surgery group, P = 0.14. MVA confirmed age (every 5 year increment) (HR, p<0.001) and PNS vs NC subsite (HR, p = 0.001) were associated with increased risk of death.ConclusionsThis small non-randomly assigned cohort study revealed comparable disease control and survival between primary Sx vs primary RT. Both groups have similar rates of long term G-tube dependency. Purpose/Objective(s)To compare outcomes of primary radiation therapy (RT) vs primary surgery (Sx) for squamous cell carcinoma (SCC) of nasal cavity (NC) and paranasal sinus (PNS). To compare outcomes of primary radiation therapy (RT) vs primary surgery (Sx) for squamous cell carcinoma (SCC) of nasal cavity (NC) and paranasal sinus (PNS). Materials/MethodsA retrospective review was conducted of a prospectively assembled cohort of SCC of NC and PNS managed with either primary RT or Sx between 2000 and 2012. SCC of nasal vestibule was excluded. Overall survival (OS) and cause specific survival (CSS) were determined using the Kaplan-Meier Method and compared using log-rank test. Cumulative local control (LC), regional control (RC), distant control (DC), and late toxicity were determined using competing risk method. Multivariate analysis was performed for variables predictive of OS. A retrospective review was conducted of a prospectively assembled cohort of SCC of NC and PNS managed with either primary RT or Sx between 2000 and 2012. SCC of nasal vestibule was excluded. Overall survival (OS) and cause specific survival (CSS) were determined using the Kaplan-Meier Method and compared using log-rank test. Cumulative local control (LC), regional control (RC), distant control (DC), and late toxicity were determined using competing risk method. Multivariate analysis was performed for variables predictive of OS. ResultsA total of 68 SCC eligible cases were included, 49 managed with primary RT (NC: 17 PNS: 32) and 19 managed with surgery (NC: 10 PNS: 9). Concurrent chemotherapy (cisplatin) was given to 36/49 (73%) of RT cases. Most patients were treated with once daily 2 Gy fractions delivering 70 Gy to gross disease. Patients managed with Sx received radiation either pre-op (10/19) (53%) or postop (9/19) (47%). Median follow-up was 48 months. For the RT vs Sx groups there were 20/49 (40%) vs 6/19 (31%) local, 7/49 (14%) vs 0/19 (0%) regional, and 5/49 (10%) vs 3/19 (15%) distant failures. For the RT vs Sx groups there was no statistically significant difference in the 5-year OS (51% vs 66%, p = 0.41), (CSS 66% vs 72%, p = 0.61), LC (62% vs 60%, p = 0.68), RC (90% vs 100%, p = 0.15), DM (90% vs 83%, p = 0.53), late toxicity (0.38% vs 0.32%, p = 0.86). G-tube dependency at 1 year was 2% in the RT group and 5% in the surgery group, P = 0.14. MVA confirmed age (every 5 year increment) (HR, p<0.001) and PNS vs NC subsite (HR, p = 0.001) were associated with increased risk of death. A total of 68 SCC eligible cases were included, 49 managed with primary RT (NC: 17 PNS: 32) and 19 managed with surgery (NC: 10 PNS: 9). Concurrent chemotherapy (cisplatin) was given to 36/49 (73%) of RT cases. Most patients were treated with once daily 2 Gy fractions delivering 70 Gy to gross disease. Patients managed with Sx received radiation either pre-op (10/19) (53%) or postop (9/19) (47%). Median follow-up was 48 months. For the RT vs Sx groups there were 20/49 (40%) vs 6/19 (31%) local, 7/49 (14%) vs 0/19 (0%) regional, and 5/49 (10%) vs 3/19 (15%) distant failures. For the RT vs Sx groups there was no statistically significant difference in the 5-year OS (51% vs 66%, p = 0.41), (CSS 66% vs 72%, p = 0.61), LC (62% vs 60%, p = 0.68), RC (90% vs 100%, p = 0.15), DM (90% vs 83%, p = 0.53), late toxicity (0.38% vs 0.32%, p = 0.86). G-tube dependency at 1 year was 2% in the RT group and 5% in the surgery group, P = 0.14. MVA confirmed age (every 5 year increment) (HR, p<0.001) and PNS vs NC subsite (HR, p = 0.001) were associated with increased risk of death. ConclusionsThis small non-randomly assigned cohort study revealed comparable disease control and survival between primary Sx vs primary RT. Both groups have similar rates of long term G-tube dependency. This small non-randomly assigned cohort study revealed comparable disease control and survival between primary Sx vs primary RT. Both groups have similar rates of long term G-tube dependency.