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J Neurol Surg B Skull Base 2012; 73 - A163
DOI: 10.1055/s-0032-1312211

Multimodality Treatment Outcomes of Sinonasal Undifferentiated Carcinoma of the Skull Base

Linda N. Lee 1(presenter), Stacey T. Gray 1, William Curry 1, Annie W. Chan 1, John Clark 1, Eric H. Holbrook 1, Daniel G. Deschler 1, Derrick T. Lin 1
  • 1Boston, USA

Objective: To evaluate and update the clinical outcomes of a multimodality treatment approach for sinonasal undifferentiated carcinoma (SNUC) involving the anterior skull base.

Methods: Eleven patients with SNUC treated at the Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center from 1995 to 2008 were analyzed retrospectively. All histologic specimens were reviewed by a single pathologist confirming the diagnosis of SNUC.

Results: Fourteen patients were originally diagnosed with SNUC between January 1995 and July 2008 by review of the medical records of the Massachusetts Eye and Ear Infirmary. After review of the histology by a single, blinded, pathologist, 11 patients were confirmed with SNUC. There were six men and five women in the study with a mean age of 55 years. Seven patients at initial presentation had extensive local disease and were deemed surgically unresectable due to radiographic involvement of either the cavernous sinus or internal carotid artery. Initial treatment for three patients involved chemotherapy and proton beam radiation. Four patients were treated initially with subtotal resection to facilitate postoperative proton beam radiation therapy and chemotherapy. Four patients that were deemed having resectable disease underwent traditional craniofacial resection followed by postoperative chemotherapy and proton beam radiation. All four of these patients had negative histologic margins. All patients received proton beam therapy at some point of their therapy at a dose of 70 to 76 Gy. Overall, 5 of the 11 patients are dead of disease. One patient died during the course of treatment. No patients are currently alive with known disease. Mean follow-up time is 53 months.

Conclusions: For patients with en bloc resectable disease, we recommend surgical resection followed by postoperative chemotherapy and proton beam radiation therapy. Patients with advanced disease who are deemed unresectable may benefit from combined chemotherapy and proton beam radiation therapy for locoregional control.