Paranasal Research Articles

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity.

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity. Keywords: Runny nose, nasal obstractions , nasal pruritis, stuffy nose

Chondroblastic osteosarcoma of the paranasal sinuses: case report

Chondroblastic osteosarcoma of the paranasal sinuses: case report

Endoscopy-assisted medial canthus incision for olfactory neuroblastoma: a case report

Sinonasal malignant tumors are a group of uncommon malignancies that account for less than 1% of all tumors. These tumors often involve the maxillary sinus and nasal cavity, with less cumulative incidence in the ethmoidal sinus, sphenoidal sinus, and frontal sinus. The lack of consensus on the management of sinonasal malignancies is due to their rarity, diagnostic challenges, and the heterogeneity of treatments. In this paper, we present a case of endoscopic-assisted medial canthus incision combined with radiotherapy in the treatment of sinonasal malignant tumors, with the aim of providing valuable insights to clinicians on the management of these tumors.

Treatment Strategy for the Retention Cyst of the Maxillary Sinus

Retention cysts are commonly found in the maxillary sinus and are discovered incidentally on imaging studies. Obstruction of the ducts of the seromucous glands of the paranasal sinus lining is thought to induce the development of retention cysts. Since retention cysts are asymptomatic and tend to degenerate, they do not require definite treatment. However, in clinical practice, surgical treatment is often performed without clear indications. Retention cysts need to be surgically managed when accompanied with relevant clinical symptoms or with obstruction of the natural ostium, or when involving the ostiomeatal complex or the infraorbital nerve. Endoscopic sinus surgery has become the surgical procedure of choice for removing retention cyst. Therefore, it is important for rhinologists to understand the nature and behavior of this pathology so that unnecessary surgical intervention could be avoided.

Inter Palatovaginal Canal corridor- Proposing a Safe Landmark to Approach Clival Region of Sphenoid Sinus.

Internal carotid artery injury is one of the most feared intraoperative complications of endoscopic sinus surgery and endoscopic skull base surgery. Vidian canal is used as a landmark to identify laceral genu of ICA. But, this structure leads to the lateral aspect of the genu and so, there is still a possibility of injuring the genu, if we blindly follow this landmark. So, to find out a more reliable landmark to locate ICA, we conducted a computed tomography-based study in our institution. The aim was to evaluate the anatomical variations in position of palatovaginal canal in relation to laceral genu of ICA. The primary objective was to know the anatomical relation of medial opening of PVC to laceral genu of ICA, and the secondary objective was to measure the distance between these two structures. CT paranasal sinus images of 105 patients were collected and axial cuts evaluated to find out the anatomical relation between PVC and ICA. In 97.1% of the scans, laceral genu of ICA was found lateral to medial opening of PVC, and in the rest 2.9%, both structures were found to lie in the same line. In 62.9% of the patients, the distance between the two structures was found to be between 3.1 and 6mm. The inter-palatovaginal canal corridor can possibly be considered as a safe corridor to clival region of sphenoid sinus. This corridor can be easily identified intraoperatively during endoscopic skull base surgeries So, if the surgeon limits the instrumentation to the inter-palatovaginal canal corridor, iatrogenic injury to ICA, one of the most dreaded complications, can be avoided, while working in the clival region of sphenoid sinus.

Closure of oroantral fistula using platelet rich fibrin with endoscopic middle meatal antrostomy

BackgroundOroantral fistula (OAF) involves pathological, epithelialized, and unnatural communication between the maxillary sinus and oral cavity. Recently, functional endoscopic sinus surgery has provided minimally invasive treatment options with fewer postoperative complications. The aim of the study was to evaluate the one-stage endoscopic middle meatal antrostomy (EMMA) technique with the application of a platelet-rich fibrin membrane (PRF) for OAF closure and maxillary sinusitis relief.Patients and methodsPatients who suffered from OAF with odontogenic sinusitis were included in this study. Complete excision of the epithelial tract and any necrotic tissue was performed with proper curettage. Then, EMMA was performed with simultaneous closure of the OAF by the application of PRF membranes that were fixed by sutures and covered with an acrylic splint. Patients were clinically evaluated for OAF closure, pain level, and symptom relief. Additionally, the size of the bone defect was measured with the aid of computed tomography (CT) preoperatively and after 24 weeks postoperatively.ResultsThis study included nine eligible patients with a mean age of 38 years. The data were collected, tabulated, and statistically analyzed. Soft tissue healing and bone formation occurred in all patients who achieved maxillary sinusitis relief without any complications. Additionally, pain was significantly lower on the 7th postoperative day than on the 1st postoperative day, according to the statistical analysis of the results (p < .001).ConclusionsOne-stage EMMA with the application of PRF membranes and acrylic splint represents a reliable alternative technique for OAF closure and maxillary sinusitis relief that is associated with a lower incidence of complications and minimal postoperative pain.Trial registrationThe trial was registered on 28/02/2024, at clinicaltrials.gov (ID: NCT06281873).

Three-dimensional changes and influencing factors of tent space following osteotome sinus floor elevation without grafting: A 48-month retrospective radiographic study.

To analyze the three-dimensional stability and morphologic changes of tent space after the osteotome sinus floor elevation (OSFE) procedures without bone grafts. Forty-six implants placed using the OSFE technique with simultaneous implant placement without bone grafts were included in this retrospective study. Cone-beam computed tomography (CBCT) scans of the augmented sinuses were obtained pre- and postoperatively up to 48 months of follow-up. The maxillary sinus cavity profiles were outlined using three-dimensional virtual reconstruction and superimposition of CBCT scans. The three-dimensional changes in the tent space were measured. A generalized estimating equation (GEE) was used to explore potential factors. The implant survival rate was 97.8%. The mean volume of remaining tent space immediately after surgery was 96.8 ± 70.5 mm3, shrinking to 31.0 ± 24.9 mm3 after 48 months, while the mean percentage of remaining tent space volume decreased to 29.1 ± 20.7%. The tent space volume and the percentage of residual tent space volume only decreased significantly within 12 months after surgery (p = .008, .013). GEE results indicated positive correlations between the percentage of remaining tent space volume and implant protrusion length (p = .000) and apical height (p = .000), with a negative correlation between the sinus floor area immediately after surgery (p = .002) and the healing time (p = .022). The volume of the tent space rapidly shrank after OSFE without bone grafts. Several factors might influence the tent space stability. Long-term clinical trials with larger sample sizes are necessary to further validate the results.

Avoiding Sinus Floor Elevation by Placing a Palatally Angled Implant: A Morphological Study Using Cross-Sectional Analysis Determined by CBCT.

Tooth loss in the posterior maxilla often necessitates dental implant placement, but the maxillary sinus anatomy poses challenges, especially during sinus floor elevation. Mesially angled implants are an alternative for total edentulism, but for single tooth deficiencies, palatally angled implants may offer a solution. This study evaluates the prevalence of avoiding sinus floor elevation by placing palatally angled implants in cases with a single missing tooth. A retrospective study at Ahmet Keleşoğlu Faculty of Dentistry involved 100 participants with a single missing tooth and prior CBCT scans. Virtual implants were placed using OnDemand3D (version 1.0.7462) software. On CBCT sections, implants were angled palatally to avoid sinus or nasal cavity perforation. Statistical analysis was conducted using R and MedCalc (version 4.3.2) software. Of the participants (60% female, average age 50.45), 76 edentulous regions required sinus elevation. The implant placeability rates varied across zones (second molar: 39.3%, first molar: 63.1%, second premolar: 78.5%). Implant placement at a palatal angle was significantly higher in the second premolar and first molar regions. Statistically significant differences were observed in the implant placeability between regions. This study supports the feasibility of avoiding sinus floor elevation through palatally angled implants in specific cases, reducing the associated complications.

Radiographic Association of Maxillary Sinus Volume in Patients with Deviated Nasal Septum: A Systematic Review and Meta-analysis.

The nasal septum, composed of bone and cartilage, maintains nasal alignment and airflow. Deviation, common but potentially problematic, can lead to symptoms like congestion and sinusitis. Maxillary sinus, a key paranasal sinus, influences airflow and drainage. Nasal septum deviation can alter maxillary sinus volume, affecting airflow dynamics and drainage. Cone beam computed tomography (CBCT) and CT imaging are essential for assessing these conditions accurately, providing detailed 3D images and aiding in diagnosis and treatment planning. The study aims to review the radiographic association of maxillary sinus volume in patients with deviated nasal septum. The present review has been registered with PROSPERO-An international prospective register of systematic review CRD42023467988. Eligibility criteria: Studies from 2013 to 2022, in English, on maxillary sinus volume in deviated nasal septum patients. Exclusions: Animal studies, case reports, non-English articles. The Meta-analysis found that consistent association between nasal septum deviation and reduced maxillary sinus volume and no publication bias. The radiographic association of maxillary sinus volume in patients with deviated nasal septum was found to be statistically meaningful.

Long term results of a randomized phase III study of nimotuzumab in combination with concurrent radiotherapy and cisplatin versus radiotherapy and cisplatin alone, in locally advanced squamous cell carcinoma of the head and neck.

LBA6092 Background: The addition of nimotuzumab to weekly cisplatin as a radiosensitizer had improved progression-free survival (PFS) in a phase 3 study in locally advanced head and neck squamous cell carcinoma (LA HNSCC). However, whether it leads to an improvement in long-term OS is unknown. Hence this analysis was performed to evaluate the efficacy (in terms of OS) and late-term adverse events of the addition of nimotuzumab to concurrent chemoradiation in LA HNSCC. Methods: This was an open-label, investigator-initiated, phase 3 randomized trial conducted from 2012 - 2018. 536 adult patients with LA HNSCC, fit for radical chemoradiation were randomly assigned. Primary sites in the nasopharynx, salivary gland, nasal cavity, and paranasal sinus were excluded. Randomized 1:1 to either radical radiotherapy (66-70 Gy) with concurrent weekly cisplatin (30 mg/m2) (CRT) or the same schedule of chemoradiation with weekly nimotuzumab (200 mg) (NCRT). The primary endpoint was a 10-year OS; the key secondary endpoint was late adverse events. Intent to treat analysis was performed. OS was defined as the time from randomization till death. Kaplan Meier method will be used for the estimation of OS. Landmark analysis was performed to compare 10 OS between the 2 arms. COX proportional hazard model will be used for the calculation of hazard ratio (HR). The adverse events between the 2 arms were compared using a Fisher's test. A p-value of 0.05 will be considered as significant. Results: The median follow-up was 8.86 years (95% CI 8.59-9.16). The primary site of the primary was the oropharynx (269,50.2%) and only 24 cases were HPV positive. The 10-year OS was 22.5% (95% CI 16.7-28.8) versus 33.5% (95% CI 27.6-39.4) in the CRT and NCRT arm respectively (Hazard ratio=0.811; 95%CI 0.664-0.995, P=0.044). The median OS was 2.78 years (95% CI 2.31-3.69) versus 3.69 years (95% CI 2.90-4.49) in the CRT and NCRT arm respectively (P value by log-rank test=0.04). The median OS in HPV negative oropharynx was 1.8 years (95% CI 1.51-2.09) versus 2.48 years (95% CI 1.79-3.16) in the CRT and NCRT arm respectively (P value by log-rank test=0.02; HR 0.724 95%CI 0.546-0.959). Long-term adverse events were captured in 380 patients. There was no statistically significant difference in late-term adverse events between the 2 arms and will be presented at the conference. Conclusions: The addition of nimotuzumab to weekly cisplatin leads to improvement in long-term overall survival in locally advanced HNSCC without any additional increase in late-term adverse events. These results are largely applicable in HPV-negative patients. Clinical trial information: CTRI/2014/09/004980 .

Abstract B028: Expression of NOTCH1 in head and neck tumours at selected hospitals in Ghana

Abstract Head and neck tumors (HNT) are of paranasal sinuses origin (the salivary glands and the upper aerodigestive tract). It constitutes the sixth most common tumors. Studies have shown that, factors such as tobacco and alcohol intake and viral infections may increase the relative risk to the tumor. Notch1 pathways are frequently altered in many tumors, however, the clinical significance of NOTCH1dysregulation in head and neck tumors is poorly understood. METHOD: The aim of this study was to investigate the expression NOTCH1 in head and neck tumor and also to elucidate the various anatomical pattern of the head and neck tumors in selected hospitals in Ghana. NOTCH1 expression were analyzed using quantitative real-time PCR (qRT-PCR) and immunohistochemical staining on tissue samples from a consecutive series of head and neck tumor patients resections over a four-year period. RESULTS: The percentage of low expression of Notch1 were 71.4% in the malignant tissue (n=98) and 76.9% (n=52) in the benign tissue. The anatomical site with high of low expression of the NOTCH1 was found in oral cavity (37.1%) followed by respiratory (27.1%) followed by mandible (14.3%). CONCLUSION: There were low expression of NOTCH1 in head and neck tumour tissues suggesting that NOTCH1may be a tumor suppressor gene. We further propose that, NOTCH1 offers a potential tool as a target molecule in the development of therapies for head and neck tumors. Citation Format: Precious Barnes, Roland Osei Saahene. Expression of NOTCH1 in head and neck tumours at selected hospitals in Ghana [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Expanding and Translating Cancer Synthetic Vulnerabilities; 2024 Jun 10-13; Montreal, Quebec, Canada. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(6 Suppl):Abstract nr B028.

Preliminary study on AI-assisted diagnosis of bone remodeling in chronic maxillary sinusitis

ObjectiveTo construct the deep learning convolution neural network (CNN) model and machine learning support vector machine (SVM) model of bone remodeling of chronic maxillary sinusitis (CMS) based on CT image data to improve the accuracy of image diagnosis.MethodsMaxillary sinus CT data of 1000 samples in 500 patients from January 2018 to December 2021 in our hospital was collected. The first part is the establishment and testing of chronic maxillary sinusitis detection model by 461 images. The second part is the establishment and testing of the detection model of chronic maxillary sinusitis with bone remodeling by 802 images. The sensitivity, specificity and accuracy and area under the curve (AUC) value of the test set were recorded, respectively.ResultsPreliminary application results of CT based AI in the diagnosis of chronic maxillary sinusitis and bone remodeling. The sensitivity, specificity and accuracy of the test set of 93 samples of CMS, were 0.9796, 0.8636 and 0.9247, respectively. Simultaneously, the value of AUC was 0.94. And the sensitivity, specificity and accuracy of the test set of 161 samples of CMS with bone remodeling were 0.7353, 0.9685 and 0.9193, respectively. Simultaneously, the value of AUC was 0.89.ConclusionIt is feasible to use artificial intelligence research methods such as deep learning and machine learning to automatically identify CMS and bone remodeling in MSCT images of paranasal sinuses, which is helpful to standardize imaging diagnosis and meet the needs of clinical application.

Radiologist’s approach in diagnosing fronto-ethmoidal meningoencephalocele in an adult: a case report

BackgroundFronto-ethmoidal meningoencephalocele is an uncommon pathology. Most of the cases present a history of trauma or paranasal surgical intervention. Spontaneous development of such pathology is extremely rare. The aim of this case report was to demonstrate a rare appearance of spontaneous fronto-ethmoidal meningoencephalocele in an adult male with high-quality images in multiple modalities used in radiology.Case presentationThis case report demonstrates an extremely rare pathology of spontaneous development of fronto-ethmoidal meningoencephalocele in a 50-year-old male. The patient complained of swelling involving the nasal bridge, the left side of the nose, and the left cheek for more than 20 years, which was spontaneous without any trauma or surgical intervention. The patient underwent radiological investigations of ultrasonography, computed tomography of the paranasal sinus, and contrast-enhanced magnetic resonance imaging of the brain. The diagnosis of spontaneous development of left fronto-ethmoidal meningoencephalocele abutting the left orbit was made. No other complications of the brain tissue were noted.ConclusionsKnowledge about etiopathogenesis and various types of meningoencephalocele helps manage this pathology.

Regional differences of chronic rhinosinusitis endotypes based on tissue inflammatory and remodeling biomarkers

Objective: To analyze the characteristics of patients with chronic rhinosinusitis (CRS) in the South China region based on pathological tissue biomarkers for regional comparison. Methods: The study population consisted of CRS in-patients in the First Affiliated Hospital of Sun Yat-sen University from October 2019 to June 2022. Among all the 181 cases, 123 of them were male and 58 were female, with an average age of 40. Retrospectively collected clinical data included demographic information, preoperative symptom scores, preoperative endoscopic images, preoperative paranasal sinus computed tomography scanning images, and inflammatory serological features. In addition, 52 variables of pathological tissue biomarkers including cytokines, chemokines and remodeling factors were collected for analysis. Cluster analysis was performed on the integrated data of training set through centroid-based clustering algorithm, and the inflammatory characteristics, post-operation control status, and airway diseases comorbidity of each endotype were analyzed. R project (version 4.2.2) was used in statistical analysis. Results: Cluster analysis divided 181 patients with CRS into 4 endotypes. Cluster 1 (n=101, 55.80%) showed a locally low inflammatory status. Cluster 2 (n=23, 12.71%) showed a mixed type of inflammation with predominantly neutrophilic inflammation and tissue remodeling. Cluster 3 (n=11, 6.08%) was characterized by type Ⅱ inflammation without tissue remodeling. Cluster 4 (n=46, 25.41%) was mainly characterized by type Ⅱ inflammation with tissue remodeling, showing higher comorbidity rate of asthma and allergic rhinitis. This cluster presented more severe symptoms, significant olfactory dysfunction, extensive overall inflammation based on objective examination results, a notable increase in total eosinophil count and proportion in peripheral blood, and the highest uncontrolled rate observed one year post-surgery. In comparison to other regions, the endotype classification of CRS in Southern China was characterized by a predominant pattern of locally low inflammatory status, a moderate level of type Ⅱ inflammation with tissue remodeling, and a lesser presence of neutrophilic inflammation. Conclusion: CRS distribution in Southern China is mainly characterized by low inflammatory endotype and type Ⅱ inflammation with tissue remodeling. The latter shows more severe clinical manifestations and higher uncontrol rate after surgery.

Clinical analysis of 12 cases of solitary fibrous tumors in nasal cavity, sinuses and skull base

Objective:To summarize and analyze the clinical manifestations, diagnosis and management and prognostic features of solitary fibrous tumor（SFT） in nasal cavity, sinus and skull base. Methods:The clinical data of 12 patients with STF from nasal cavity, sinus and cranial base admitted to the Affiliated Hospital of Qingdao University from April 2014 to January 2022 were retrospectively analyzed, including 4 patients admitted to the department of Otolaryngology head and neck surgery and 8 patients admitted to the department of skull base surgery The clinical characteristics, diagnosis, management and prognosis were analyzed. Results:Twelve patients were included in this research, including 7 males and 5 females. All patients received surgical treatment, and 4 patients also received postoperative adjuvant chemoradiotherapy. After follow-up for 12-60 months, 4 patients with adjuvant radiotherapy and chemotherapy had a good prognosis, and among 8 patients who did not receive radiotherapy and chemotherapy, 6 patients had good prognosis and 2 patients showed relapse. Four patients with a history of recurrence of SFT after surgery were admitted to our hospital for surgical treatment, in which 1 patient had relapse after surgery, and none had metastasis. Nasal cavity and sinus to skull base SFT is rare. The most effective treatment for this disease is surgical resection, and postoperative adjuvant chemoradiation and long-term follow-up can achieve a better prognosis. En bloc resection is the key to treatment success.

NUT cancer of nasal cavity and sinuses: a case report and literature review

NUT Carcinoma（NC） is a rare malignant tumor of unknown origin, which is highly aggressive. It is characterized by chromosome rearrangement accompanied by NUTM1 gene. The pathological manifestations were sudden and focal squamous in poorly differentiated or undifferentiated carcinoma. NUTM1gene rearrangement can be used to diagnose NC. The prognosis of NUT cancer is poor. Clinically, there is no established treatment plan. treatment options mainly comprise surgery, radiotherapy and chemotherapy. A 74-year-old patient with NC of the nasal cavity and sinuses was reported. Her clinical presentation was right nasal congestion with facial swelling. Sinus CT and MRI showed soft tissue density in the right nasal cavity and maxillary sinus with bone destruction. After admission, the patient underwent nasal endoscopic biopsy, and the postoperative pathological FISH staining showed BRD4/NUT fusion t（15, 19）. The tumor was significantly reduced after two courses of sequential chemoradiotherapy. Two months later, the patient underwent a partial maxillary resection due to the rapid regrowth of sinusoidal mass, invading the hard palate. The patient died 2 months after surgery due to multiple organ failure resulted from tumor metastasis, with a survival time of 11 months. The clinical characteristics, diagnosis and treatment of this case were reported and related literature was reviewed.

Exosomics integrates digital imaging for head and neck cancer diagnosis

AbstractCancers that can manifest in the oral cavity, nasal cavity, larynx, pharynx, sinuses, and other head and neck areas are collectively called “head and neck cancers” (HNC). HNC can be broadly classified into five types: salivary gland; oral and oropharyngeal; nasal cavity and paranasal sinus; nasopharyngeal, and laryngeal and hypopharyngeal cancers. HNC accounts for one million new diagnoses annually, making it the seventh most common form of the disease globally. Among all HNCs, 90% are head and neck squamous cell carcinoma (HNSCC) which is highly heterogenous, relapsing, and metastatic with poor survival. Despite the availability of new treatments, the five‐year survival rate for HNSCC patients has been reported to be approximately 50%. An early diagnosis may increase the disease management and outcomes, but it is challenging to detect smaller‐sized lesions and differentiate malignant and non‐malignant lesions with the available tools. Current circumstances demand an improvement in existing diagnostic strategies and the advent of novel diagnostic tools.

A phase II trial of neoadjuvant docetaxel/5-FU/cisplatin in combination with prophylactic pegteograstim in unresectable, locally advanced nasal cavity/paranasal squamous cell carcinoma: KCSG HN18-07.

6020 Background: Squamous cell carcinoma (SCC) arising from paranasal sinus and nasal cavity (PNSNC) is often diagnosed at locally advanced stage. Neoadjuvant strategies have been explored to improve prognosis and facilitate organ preservation. The efficacy of triplet neoadjuvant chemotherapy (NAC) has not been established prospectively. We conducted a phase II trial of neoadjuvant docetaxel/5-FU/cisplatin (DFP) combined with prophylactic pegteograstim in unresectable, locally advanced PNSNC (KCT0003377). Methods: Eligible patients had unresectable SCC of PNSNC, were aged 19-75, had an ECOG performance status of 0/1, and demonstrated adequate organ function. Patients with distant metastasis were excluded. Criteria for unresectability included tumor or lymph node fixation, clinical T3/4 stage, or potential compromise of critical organ function (e.g., necessitating eyeball exenteration). NAC comprised three cycles of docetaxel (75mg/m2 on Day 1), cisplatin (75mg/m2 on Day 1, 60mg/m2 for those aged ≥65), and 5-FU (1,000mg/m2 on Days 1-4) administered every 3 weeks. Prophylactic pegteograstim (6mg) was administered on Day 6 or 7. The primary outcome was the overall response rate (ORR), with secondary outcomes including progression-free survival (PFS), the eyeball preservation rate at 24 months, and safety. The study required 28 patients to achieve a power of 80% (P0=0.45, P1=0.70, α-error=0.05, 10% dropout rate). Results: Between 2019 and 2023, 28 patients were screened, and 27 received at least one cycle of NAC. The median age was 58 years (range: 41-71), with 24 males. Seventeen had maxillary sinus origin, and ten had nasal cavity origin. Twenty-two patients had T4 disease, and six had N2 disease. The ORR was 64.3% (5 complete responses, 13 partial responses). Post-NAC treatments included surgery alone (n=2), concurrent chemoradiotherapy (CCRT) (n=15), surgery followed by CCRT (n=2), or radiotherapy (RT) (n=5). Procedures performed were total maxillectomy (n=4), partial maxillectomy (n=3), and endoscopic sinus surgery (n=2). With a median follow-up of 21.5 months (range: 0.1-53.0), the 2-year PFS and eyeball preservation rate were 64% and 100%, respectively. Fourteen patients experienced Grade ≥3 adverse events (AEs): hematologic (46.4%), non-hematologic (14.3%), with Grade 3/4 neutropenia (32.1%) and febrile neutropenia (14.3%). Dose reduction or delay occurred in 9 patients (33.3%). One patient died on Day 6 of cycle 1. Conclusions: DFP NAC demonstrated promising efficacy and an excellent eyeball preservation rate with manageable toxicity. DFP NAC with prophylactic pegteograstim, could be a reasonable option for patients with locally advanced SCC of the PNSNC. Follow-up is ongoing. Clinical trial information: KCT0003377 .

Outcomes for Patients With Head and Neck Sarcoma Treated Curatively With Radiation Therapy and Surgery

Soft tissue sarcomas (STSs) of the head and neck (H&N) are rare malignancies that are challenging to manage. We sought to describe the outcomes of patients treated with curative intent using combined surgery and radiation therapy (RT) for H&N STS. We performed a single-institution retrospective review of patients with nonmetastatic STS of the H&N who were treated from 1968 to 2020. The Kaplan-Meier method was used to estimate disease-specific survival (DSS) and local control (LC). Multivariable analyses (MVAs) were conducted using Cox proportional hazards model. One hundred ninety-two patients had a median follow-up of 82 months. Tumors arose in the neck (n = 50, 26%), paranasal sinuses (n = 36, 19%), or face (n = 23, 12%). Most patients were treated with postoperative RT (n = 134, 70%). Postoperative RT doses were higher (median, 60 Gy; preoperative dose, 50 Gy; P < .001). Treatment sequence was not associated with LC (preoperative RT, 78% [63%-88%]; postoperative RT, 75% [66%-82%]; P = .48). On MVA, positive/uncertain margin was the only variable associated with LC (hazard ratio [HR], 2.54; 95% CI, 1.34-4.82; P = .004). LC was significant on MVA (HR, 4.48; 95% CI, 2.62-7.67; P < .001) for DSS. Patients who received postoperative RT were less likely to experience a major wound complication (7.5% vs 22.4%; HR, 0.28; 95% CI, 0.11-0.68; P = .005). There was no difference in the rate of late toxicities between patients who received preoperative or postoperative RT. H&N STS continues to have relatively poorer LC than STS of the trunk or extremities. We found LC to be associated with DSS. Timing of RT did not impact oncologic or long-term toxicity outcomes; however, preoperative RT did increase the chance of developing a major wound complication.