Malignant Sinonasal Tumors Research Articles

Medium-term oncological outcome endoscopic surgery malignant tumors of the nasal cavity and paranasal sinuses

Introduction. Transnasal endoscopic resection of sinonasal tumors is currently used in many clinics around the world. Short- and long-term oncological outcomes primarily depend on tumor histology. However, most currently existing studies are based on a small number of observations due to the rarity and heterogeneity of sinonasal malignancy.Aim. To evaluate short- and medium-term oncological outcomes of treatment of malignant sinonasal tumors. Materials and methods. The study is based on retrospective analysis of 95 patients who underwent endoscopic surgery for sinonasal malignancy between 2014 and 2023 at the N.N. Blokhin National medical Research Center of Oncology. Squamous cell carcinoma was diagnosed in 27 (28.4 %) patients, olfactory neuroblastoma in 13 (13.7 %), mucosal melanoma in 30 (31.6 %), adenocarcinoma in (6.3 %), adenoid cystic carcinoma in 7 (7.3 %), sarcomas in 12 (12.7 %). Results. In the study group, 2-years overall survival and recurrence-free survival were 81.3 and 61.4 % respectively, survival without local recurrence was 87.5 %. The outcomes significantly depended on tumor histology.Conclusion. Oncological outcomes of endoscopic resections of sinonasal tumors significantly depend on tumor histology, but in general they allow to achieve good local control. Small number of observations, variety of histological forms, and short follow-up periods do not allow to accurately evaluate the effectiveness of this approach for each tumor type. further research in large populations is needed to establish risk factors.

The role of endoscopic endonasal surgery in the management of sinonasal malignant tumors with skull base involvement

Sinonasal malignant tumors (SNMTs) represent a rare and heterogeneous group of tumors. SNMTs often present late which can lead to complex, patient-specific treatment decisions. Over the last two decades, endoscopic endonasal surgery (EES) has become a more frequently utilized surgical approach to removing these tumors. Increasingly, studies have compared the outcomes of this approach to traditional open approaches for different SNMTs. Differences in histology and extent of invasion impact the utility of EES. Negative margins are critical for improving survival; however, skull base involvement can add anatomical challenges for achieving negative margins during EES. This paper reviews the literature on outcomes of EES for SNMTs with skull base involvement and presents evidence supporting the utility of EES for select patients. EES is a safe and effective treatment in patients with less invasive SNMTs or less aggressive histology and can provide patients with fewer complications and morbidity than traditional open approaches. As such, it plays a key role in surgical management, providing either sole access or a critical avenue for SNMT removal. EES plays a key role in the multimodal oncological approach to the treatment of different SNMT histologies.

OTHR-16 UNVEILING THE GAMUT OF SKULL TUMORS: A CALL FOR COLLABORATIVE ONCOLOGICAL CARE IN SUB-SAHARAN AFRICA

Abstract INTRODUCTION Primary and metastatic tumours of the skull are relatively rare and have variable histological characteristics. They have been reported to represent 0.8 to 1% of all bone tumours and majority were malignant with attendant morbidity and mortality. With the current advances in neurosurgical techniques, neuroimaging and improvement in histopathological diagnosis more cases are expected to be diagnosed and treated successfully. Only few studies in literature focused on the profile and outcome of skull tumours especially in sub-Saharan Africa. This study aims to unravel the spectrum of skull tumors and describe the profile and outcome of management of skull tumours in our centre. METHODOLOGY We retrospectively reviewed cases of skull tumours managed in our centre between July 2015 to March 2024. Clinical parameters and histological diagnoses were noted. Data analysed using spss version 25.0 IBM. RESULTS We found 69 cases of skull tumours, 21 (30.4%) were benign and 48 (69.6%) were malignant. Majority (54/69, 78.2%) were males, the mean age of presentation was 28 and 50 years for benign and malignant tumours respectively. 95.6% of cases were adults. All benign tumours were osteoma, the commonest primary malignant tumour was osteosarcoma (9/48) followed by fibrosarcoma (6/48), while the most common histological subtype of metastatic tumours was adenocarcinoma. There were 4 cases of malignant sino-nasal tumours invading the frontal skull. Tumours were mostly located in the vault (66/69). All benign tumour had good post-operative recovery and malignant were managed in conjunction with plastic surgeons and radio-oncologist. No post-operative mortality recorded. CONCLUSION Majority of skull tumours were malignant and were seen in adult males, cranial vault was more affected compared to skull base. Synergy in oncological care will improve outcomes of care of malignant skull tumors.

Development and validation of a prediction model for malignant sinonasal tumors based on MR radiomics and machine learning.

This study aimed to utilize MR radiomics-based machine learning classifiers on a large-sample, multicenter dataset to develop an optimal model for predicting malignant sinonasal tumors and tumor-like lesions. This study included 1711 adult patients (875 benign and 836 malignant) with sinonasal tumors or tumor-like lesions from three institutions. Patients from institution 1 (n = 1367) constituted both the training and validation cohorts, while those from institution 2 and 3 (n = 158/186) made up the test cohorts. Manual segmentation of the region of interest of the tumor was performed on T1WI, T2WI, and contrast-enhanced T1WI (CE-T1WI). Data normalization, dimensional reductions, feature selection, and classifications were performed using ten machine-learning classifiers. Four fusion models, namely T1WI + T2WI, T1WI + CE-T1WI, T2WI + CE-T1WI, and T1WI + T2WI + CE-T1WI, were constructed using the top ten features with the highest contribution in feature selection in the optimal models of T1WI, T2WI, and CE-T1WI. The Delong test compared areas under the curve (AUC) between models. The AUCs of training/validation/test1/test2 datasets for T1WI, T2WI, and CE-T1WI were 0.900/0.842/0.872/0.839, 0.876/0.789/0.842/0.863, and 0.899/0.824/0.831/0.707, respectively. The fusion model from T1WI + T2WI + CE-T1WI had the highest AUC. The AUCs of training/validation/test1/test2 datasets were 0.947/0.849/0.871/0.887. The T1WI + T2WI + CE-T1WI model demonstrated a significantly higher AUC than the T2WI + CE-T1WI model in both cohorts (p < 0.05) and outperformed the T2WI model in test 1 (p = 0.008) and the T1WI model in test 2 (p = 0.006). This fusion model based on radiomics from T1WI + T2WI + CE-T1WI images and machine learning can improve the power in predicting malignant sinonasal tumors with high accuracy, resilience, and robustness. Our study proposes a radiomics-based machine learning fusion model from T1- and T2-weighted images and contrast-enhanced T1-weighted images, which can non-invasively identify the nature of sinonasal tumors and improve the performance in predicting malignant sinonasal tumors. Differentiating benign and malignant sinonasal tumors is difficult due to similar clinical presentations. A radiomics model from T1 + T2 + contrast-enhanced T1 images can identify the nature of sinonasal tumors. This model can help distinguish benign and malignant sinonasal tumors.

Sinonasal Tumors: Clinical and Morphological Characteristics and Differential Diagnosis

Malignant sinonasal tumors are rare and account for 1% of all neoplasms. Most of these carcinomas are poorly differentiated or undifferentiated tumors. Due to overlapping features, both young and experienced physicians encounter difficulties in their diagnosis. We present 2 cases of 2 tumors of the sinonasal tract, which belong to small round blue cell tumors: sinonasal small cell neuroendocrine tumor and esthesioneuroblastoma.

Morbidity of multimodal treatments including endoscopic surgery for sinonasal malignancies: Results of an international collaborative study on 940 patients (MUSES).

In the management of sinonasal malignancies treatment-induced morbidity and mortality is gaining relevance both for surgical approaches (endoscopic and open resection) and non-surgical therapies. The aim of this multicenter study is to assess complications associated with endoscopic surgery and non-surgical treatments (neoadjuvant and/or adjuvant) for malignant sinonasal tumors. All patients with nasoethmoidal malignancies treated with curative intent with endoscopic or endoscopic-assisted surgery at three referral centers with uniform management policies were included. Neo- and/or adjuvant (chemo)radiotherapy was administered according to histology and pathological report. Demographics, treatment characteristics, and complications related both to the surgical and non-surgical approaches were retrieved. The data were analyzed with univariate and multivariate statistics to assess independent predictors of complications. Nine hundred and forty patients were included, 643 males (68%) and 297 females (32%). A total of 225 complications were identified in 187 patients (19.9%): cerebrospinal fluid (CSF) leak (3.5%), mucocele (2.3%), surgical site bleeding (2.0%), epiphora (2.0%), and radionecrosis (2.0%) were the most common. Treatment-related mortality was 0.4%. Variables independently associated with complications at multivariate analysis were principally dural resection (OR 1.92), cranioendoscopic or multiportal resection (OR 2.93), dural repair with multilayer technique with less than three layers (OR 2.17), and graft different from iliotibial tract (OR 3.29). Our study shows that modern endoscopic treatments and radiotherapy for sinonasal malignancies are associated with limited morbidity and treatment-related mortality. CSF leak and radionecrosis, although rare, remain the most frequent complications and should be further addressed by future research efforts.

Nasal Cavity and Paranasal Sinus Cancer: Diagnosis and Treatment.

The purpose of this review is to analyze the diagnosis and treatments of the sinonasal malignant tumors throw systematic reviewed literature. The systematic review of the literature was performed according to PRISMA guidelines. Total 11,653 cases of five article were analyzed. The cohort of 3824 cases received appropriate treatment. The most frequent histotype of the group of sinonasal malignancies was squamous cell carcinoma. Squamous cell carcinoma was represented by 54%. The other histopathological subtypes were esthesioneuroblastoma with 9,9%, melanoma 9,8%, adenocarcinoma 7,5%, sarcoma 7,3%, adeno cystic carcinoma 7,1%, sinonasal undifferentiated carcinoma 3,9%, sinonasal neuroendocrine carcinoma 2,8% respectively.All 772 cases of total 3824 were treated only surgically. All 62 cases of total 3824 were treated without surgery, 20 cases with proton technique and SFUD, and 42 cases with proton technique and IMRT. The other 2990 cases of total 3824 were treated with multimodality treatment. The diagnosis and treatment of sinonasal cancers require a interdisciplinary approach and multimodality treatment.

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.

Phase II study of enasidenib in IDH2-mutated malignant sinonasal and skull base tumors.

TPS3183 Background: Advanced sinonasal malignancies are rare and heterogeneous cancers with limited therapeutic options. Tumor types include olfactory neuroblastoma (ONB), sinonasal undifferentiated carcinoma (SNUC) and large cell neuroendocrine carcinoma (LCNEC), chondrosarcoma, and sinonasal adenocarcinoma (SNAC). Pathogenic driver mutations in isocitrate dehydrogenases 1 and 2 ( IDH1 and IDH2) were identified first in glioma and myeloid malignancies. IDH1/2 enzymatic activity catalyzes conversion of isocitrate and NADP+ to α-ketoglutarate (α-KG) and NAPDH, which are critical for cellular metabolism and for α-KG-dependent dioxygenases; mutant IDH1/2 catalyze conversion of α-KG to the oncometabolite 2-hydroxyglutarate (2-HG), a competitive antagonist of α-KG in regulating dioxygenases activity, with subsequent impact on DNA histone methylation and cellular differentiation. R172S or R172T IDH2mut have been detected in up to 80% of SNUCs and in a minority of ONB, chondrosarcoma, LCNEC and SNAC. Enasidenib is an oral small molecule inhibitor of the mutant IDH2 protein which prevents 2-HG accumulation and releases cancer cells from the differentiation block. It is currently approved for relapsed/refractory IDH2mut myeloid malignancies with proven clinical efficacy. Methods: This is a phase 2, single arm clinical trial conducted at the Center for Cancer Research (CCR) of the National Cancer Institute. The trial investigates the activity of enasidenib in adult patients with histologically or cytologically confirmed locally advanced or metastatic IDH2mut sinonasal cancers (SNUC, ONB, LCNEC, chondrosarcoma, SNAC). Participants must have RECIST 1.1 measurable disease and must have progressed following at least one prior systemic treatment line administered in the recurrent/metastatic setting; those with locally advanced disease must not be amenable to potentially curative approaches. Participants must also have ECOG performance status ≤ 2, be 18 years old or higher, and have adequate organ function. Participants with active, either new or progressive brain metastases or leptomeningeal disease are excluded. Enasidenib will be given continuously at a fixed dose of 100 mg orally daily in a 28-day cycle, until disease progression, unacceptable toxicity, or consent withdrawal. Imaging will be performed every 8 weeks. Baseline and on-treatment research biopsies will be mandatory, where clinically feasible. The trial aims to accrue a total of 25 participants. The primary end point is progression free survival. Secondary outcomes include safety, overall survival, and clinical benefit rate, defined as complete response, partial response and stable disease (per RECIST 1.1) lasting above 4 months. Correlative studies include evaluating changes in 2-HG plasma levels during treatment, and transcriptomic profiling. The study has just started enrolling in the CCR. Clinical trial registry: NCT06176989. Clinical trial information: NCT06176989 .

Interdisciplinary Management of Skull Base Tumors.

Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education. A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions. Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications. Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.

The Management of Nasal Cavity and Paranasal Sinuses Cancers: Experience of Radiation Oncology Department of Mohamed VI Teaching Hospital of Marrakech

Primary sino-nasal malignant tumors are uncommon, accounting for less than 3% of upper aerodigestive tract tumors. They affects mostly young adults, and they are often diagnosed late due to the silent symptomatology in early stages. Squamous cell carcinoma and adenocarcinoma are the most frequent histological type. the therapeutic armoury involves a variety of modalities including surgery, radiotherapy and chemotherapy. The proximity of nasal and paranasal cavities to critical skull base structures makes the local management of those malignancies very challenging. The aim of our study is to describe the indications and therapeutic outcomes of radiotherapy in the management of sinonasal cancers, through a retrospective descriptive study that involved 24 patients followed for primary nasal cavity or paranasal sinuses cancers in the radiation oncology department of Mohammed IV teaching Hospital of Marrakech, over a period of 4 years between January 2016 to December 2019.The majority of our patients were males, with a sex ratio M/F= 1,4. the mean age was 57 years. squamous cell carcinoma was the frequent histological type. Maxillary sinus was the predilection location for sino nasal cancers. 63% of cases presented with a stage III. 9 patients (37.5%) were managed with Neoadjuvant chemotherapy followed by concurrent radiochemotherapy, 8 patients underwent surgery followed by adjuvant radiotherapy, 4 cases (16.6%) received exclusive concurrent radiochemotherapy, and 3 patients (12.5%) received exclusive radiotherapy.

Enhancing Frontal Sinus Surgery: Assessing the Long-Term Impact of Free Grafts and Flaps in Draf III Procedures.

The frontal sinus medial drainage -Draf Type III (modified endoscopic Lothrop) procedure, has become a cornerstone in frontal sinus surgery over the last three decades. Despite its widespread acceptance, challenges such as restenosis and neo-ostium closure persist, prompting the exploration of various preventive techniques. In this retrospective study, we analyzed data from 111 patients who underwent the Draf III procedure between November 2015 and November 2023, with a mean follow-up period of 3 years and 11 months. Approximately two-thirds of patients (64%) had undergone previous sinus surgery and 16% a previous Draf III. Over half of the patients had inflammatory conditions, with the majority being chronic rhinosinusitis with nasal polyps (CRSwNP) (46%), while 15% were diagnosed with malignant sinonasal tumors, and 23% with benign sinonasal tumors, of which the commonest was osteoma, accounting for 14 cases. The mean follow-up period was 3 years and 11 months. We focused on evaluating the efficacy of mucosal flaps and free grafts in preventing neo-ostium closure. Although it appears that there is no statistically significant correlation between flap usage and the need for revision surgery or ostium patency maintenance overall, subgroup analysis highlighted the benefits of flap reconstruction in patients with chronic rhinosinusitis with nasal polyps. In this subgroup, the use of flaps or grafts reduced the rate of neo-ostium stenosis from 20% to 0% (p < 0.05). Overall revision rate was 11.7%-however this was 8% in patients without acute inflammation at the time of surgery and went up to 31% in the presence of pus in the frontal recess (p = 0.02). This study contributes to the existing literature by providing insights into long-term outcomes, the enduring effectiveness of interventions in frontal sinus surgery, and especially the importance of taking into account the underlying pathology when assessing long-term outcomes.

Research progress of sinonasal malignant tumors based on SEER database

Research progress of sinonasal malignant tumors based on SEER database

The Profile of Sinonasal Tumors with Orbital Involvement in Dr. M. Djamil General Hospital, Padang, Indonesia: A 10-Year Overview

Background: Sinonasal tumors are rare tumors, either malignant or benign, that vary greatly based on the origin and primary tumor location in the sinonasal tract. The close anatomical relationship between the sinonasal tract and the orbital cavity makes orbital involvement very common (50%-80%) in sinonasal tumors, and this indicates a negative prognostic factor in sinonasal malignancy. The purpose of this study is to demonstrate the profile of sinonasal tumors with orbital involvement in our center.&#x0D; Methods: Retrospective study from oncology subdivision files and medical records from January 2011 – December 2020. Collected data including age, gender, the clinical manifestations of orbital involvement, primary location, histopathology, and management of sinonasal tumors.&#x0D; Results: There were 35 patients examined by the oncology subdivision either directly came or consulted from the ENT department, consisting of 18 (51.4%) males and 17 (48.6%) females. The age of patients ranged from 11 to 83 years old. with the most common age groups being 41-50 and 51-60 (25.7% in each age group). The majority of the patients (77.1%) had presented with proptosis. Maxillary sinus was the most common (45.7%) primary site of tumors, and squamous cell carcinoma was the most common (51.4%) histopathology found. Most of the patients (37.1%) were treated with a combination of chemotherapy and radiotherapy.&#x0D; Conclusion: Orbital involvement commonly occurs in malignant sinonasal tumors with proptosis as a major clinical presentation. A combination of chemotherapy and radiotherapy was the most common practice management because the tumors were unresectable at the time of presentation.

Case Report: Cytodiagnosis of primitive neuroectodermal tumor (PNET) of sinonasal tract

Malignant sinonasal tumors are rarely encountered in the practice of oncology as they constitute only 1% of total body tumors. The occurrence of primitive neuroectodermal tumor (PNET) in the sinonasal tract is even more uncommon. The PNET belongs to Ewing sarcoma family and forms the differential diagnosis of a large group of lesions generally described as malignant round cell tumors. The unique pathogenetic chromosomal alteration in this lesion is the EWS FLI1 fusion gene. This case report describes the unusual occurrence of PNET for its cytomorphological diagnosis along with its clinical features, radioimaging findings and immunohistochemistry. Such case reports are scarce in literature and cytodiagnosis of PNET in sinonasal tracts warrants its sharing with medical fraternity as such diagnoses are stumbled along rarely in clinical practice.

A Clinical Study of Malignant Sino-Nasal Tumors.

The sino-nasal cavities represent an anatomical region affected by a variety of tumors with clinical, etiological, genetic and pathological features, which are distinct from tumors commonly encountered in the area of head and neck cancers. We have undertaken this study with the aim of assessing clinical profile, various treatment modalities and outcome of patients with malignant sino-nasal tumors. In this prospective study of two years, done in a rural tertiary care hospital of India, 40 patients with malignant neoplastic tumors of nasal cavity, sinuses and nasopharynx were analyzed for their clinic-pathological and radiological profile and surgical management. The age range found was 10-78years. There was a significant male preponderance with 23 (57.5%) male patients. Most common histological type seen in our study was Squamous cell carcinoma amongst 32 (80%) of cases. Maximum number of patients were managed with combination therapy of Surgery and Radiotherapy i.e. in 21 patients (52.5%). Multimodality treatment has been deemed the most efficacious choice of treatment which would improve disease free survival for the patients.

Acute presentation of locally advanced squamous cell carcinoma of frontal sinus—imaging findings of a rare entity: case report

BackgroundThe squamous cell carcinoma is the most common subtype of malignant sinonasal tumours, predominantly involving the maxillary sinuses and nasal cavities in 70 to 80% of cases, and the frontal sinus is extremely rarely involved, in less than 1% of cases. Early clinical and radiological diagnosis is difficult due to overlap of findings with inflammatory sinonasal disease.Case presentationA 55-year-old Caucasian male patient had presented to the emergency department with three-month history of progressive right frontal swelling, acute frontal pain, recent exacerbation of right eye vision impairment and new lid swelling. There was no recent history of trauma and no neurological deficit on examination. Contrast-enhanced CT head was performed which demonstrated large bony destruction of frontal sinus with partly enhancing necrotic-looking tumour within the sinus. There was further intraorbital and intracranial extension of disease. Subsequent MRI confirmed these findings with better demonstration of intracranial and intraorbital component of the disease. The PET imaging did not reveal any avid disease elsewhere. Histopathology confirmed squamous cell carcinoma.ConclusionsFrontal sinus squamous cell carcinoma is a rare and the least common site within the paranasal sinuses. Early clinical and imaging diagnosis could be challenging; however, the index of suspicion should be high with indeterminate imaging findings. CT and MRI are the complimentary imaging techniques.

A multi-institutional retrospective study of 340 cases of sinonasal malignant tumor

ObjectiveSinonasal malignant tumors (SNMT) are relatively rare among head and neck malignant tumors. Most are squamous cell carcinomas, and malignant melanomas, olfactory neuroblastomas, adenoid cystic carcinomas, sarcomas, and others also occur. The most common primary site of nasal sinus squamous cell carcinoma is the maxillary sinus.In recent years, a decrease in incidence of maxillary sinus squamous cell carcinoma (MSSCC) has been reported along with a decrease in the incidence of sinusitis. MSSCC is treated with a combination of surgery, radiation, and chemotherapy. Treatment decisions are made according to the progression of the disease, the patient's general condition, and the patient's own wishes. There are variations in treatment policies among facilities due to the specialty of staff and cooperation with other departments at each facility. We conducted a multi-institutional retrospective study to compare outcomes by treatment strategy. MethodsIn this study, 340 patients with SNMT who were treated at 13 Hospitals (Head and Neck Oncology Group (Kyoto-HNOG) ) during the 12-year period from January 2006 to December 2017 were included. There were 220 patients with squamous cell carcinoma, 32 with malignant melanoma, 21 with olfactory neuroblastoma, and 67 with other malignancies. Of the squamous cell carcinomas, 164 were of maxillary sinus origin. One hundred and forty cases of MSSCC that were treated radically were included in the detailed statistical analysis. ResultsThere were 5 cases of cStage I, 9 cases of cStage II, 36 cases of cStage III, 74 cases of cStage IVa, and 16 cases of cStage IVb. There were 92 cases without clinical lymph node metastasis (cN(-)) and 48 cases with clinical lymph node metastasis(cN(+)).Primary tumors were treated mainly by surgery in 85 cases (Surg) and by radical radiation therapy (with or without chemotherapy) of 6-70 Gy in 55 cases(non-Surg).The 5-year overall/disease-free survival rate (OS/DFS) for MSSCC was 65.1%/51.6%. Old age, renal dysfunction, and clinical T progression were independent risk factors for OS, and renal dysfunction was an independent risk factor for DFS.In cN(-) patients, OS and DFS were significantly better in Surg group than in non-Surg group. In cN(+) patients, there was no significant difference in OS and DFS between Surg and non-Surg groups. ConclusionFor patients with MSSCC without lymph node metastasis, aggressive surgery on the primary tumor contributes to improved prognosis.

Diagnostic performance of MRI for the assessment of extraocular muscle invasion in malignant sinonasal tumors.

Preoperative assessment of extraocular muscle invasion is essential for therapeutic strategies and prognostic evaluation. The aim of this study was to assess the diagnostic accuracy of MRI for evaluation of extraocular muscle (EM) invasion by malignant sinonasal tumors. Consecutively, 76 patients of sinonasal malignant tumors with orbital invasion were included in the present study. Preoperative MRI imaging features were analyzed by two radiologists independently. The diagnostic performances of MR imaging features for detecting EM involvement were evaluated by comparing imaging findings to histopathology data. A total of 31 extraocular muscles were involved by sinonasal malignant tumors in 22 patients, including 10 medial rectus muscles (32.2%), 10 inferior rectus muscles (32.2%), 9 superior oblique muscles (29.1%), and 2 external rectus muscles (6.5%). The EM involved by sinonasal malignant tumors usually showed relatively high signal intensity on T2-weighted images, indistinguishable from the tumor, nodular enlargement and abnormal enhancement (p = 0.001, < 0.001, < 0.001 and < 0.001, respectively). Using a combination of EM abnormal enhancement and indistinguishable from the tumor in multivariate logistic regression analysis, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for detecting orbital EM invasion by sinonasal tumors were 93.5, 85.2, 76.3, 96.3and 88%, respectively. MRI imaging features show high diagnostic performance for the diagnosis of extraocular muscle invasion by malignant sinonasal tumors.

Temporal evolution of quality of life in patients endoscopically treated for sinonasal malignant tumors.

The aim of our study is to assess which factors may affect the quality of life (QoL) and its fluctuation over time in adult patients who received endonasal endoscopic oncologic sinus surgery (EOSS) for sinonasal malignancies (SNM) in our center. We analyzed EOSS cases for primary SNM from January 2015 to June 2020. For each patient, we have recorded the age at treatment, gender, smoking habits, use of psychotropic drugs for mood disorders, stage, histotype, type of surgical resection, need for skull-base reconstruction, development of postoperative major complications, and the use of adjuvant intensity-modulated radiotherapy (IMRT). We evaluated the patient's performance status pre-treatment using the ECOG scale. Quality of life was measured using three questionnaires (SNOT-22; ASK-9; EORTC QLQ-C30 version 3). Fifty-five patients were enrolled in our study, of whom thirty-two (58.18%) received adjuvant IMRT. Overall, a significant improvement in all QoL outcomes was observed at eighteen months, while, female sex, higher ECOG scores, advanced stage of disease, and adjuvant IMRT were associated with worse QoL. After 18 months the delta in QoL between women and men worsened (in SNOT-22 and EORTC QLQ-GLOBAL) while if only the most fragile patients according to ECOG are considered, this difference was reduced for both tools. Our analysis revealed that IMRT is the element that has the greatest impact on patient's quality of life, in association with the female sex, ECOG &gt;2, and advanced stage of the disease.