Outcomes for Endoscopic Endonasal Resection of Adenocystic Carcinoma of the Sinonasal Cavity and Skull Base

Background: Sinonasal adenocystic carcinoma (ACC) accounts for 25% of all head and neck ACC. It is notable for perineural spread, significant skull base involvement, and intracranial extension. Endoscopic endonasal surgery (EES) has become an increasingly used modality for the treatment of sinonasal malignancy. Current literature on oncological outcomes is predominantly based on open approaches. We report the experience of endoscopic management of ACC over a 12-year period.

Methods: We retrospectively reviewed all patients undergoing EES for sinonasal adenocystic carcinoma performed at the University of Pittsburgh Medical Center from 1999 to 2011. Demographic, clinical, and pathological data and oncologic outcomes were collected. Kaplan-Meier methods were used for survival analysis.

Results: Twenty-two patients were identified (11 men, 11 women), with median age of 53 years (range, 22-87 years). The tumors were located in the nasopharynx (in 6 patients), maxillary sinus (6), ethmoid sinus (4), sphenoid sinus (3), frontal sinus (1), septum (1), and nasal cavity (1). Eleven patients presented with primary tumors and 11 patients with recurrences after initial treatment elsewhere. All but four patients had T4 disease. Twenty-one patients were treated with curative intent. Seventeen patients underwent endoscopic tumor resection only and five patients had combined endoscopic and open procedures. Seventeen patients received postoperative radiation therapy. Mean follow-up was 28.6 months (range, 1-89 months). The 3- and 5-year overall survival was 79.3%. The 3- and 5-year loco-regional control was 75.4% and 56.5%, respectively.

Conclusions: Endoscopic endonasal resection of adenocystic carcinoma of the sinonasal cavity and skull base provides oncologic results that are comparable to open surgery.