Outcomes in Locoregionally Advanced Sinonasal Squamous Cell Carcinoma

Objective: Survival outcomes remain poor in patients with advanced sinonasal squamous cell carcinoma (SCC) involving the skull base. Currently treatment is combination multimodal therapy with surgery, chemotherapy, and radiation. Further investigation of outcomes and factors that affect outcomes is warranted as the literature on this patient population is limited.

Methods: We retrospectively reviewed the medical records of 46 patients who were treated for locoregionally advanced squamous cell carcinoma of the paranasal sinuses and skull base. Clinical information gathered included: patient demographics, tumor characteristics, treatment modalities, margin status, tumor markers, and clinical outcomes. The primary endpoints were overall survival and disease-free survival calculated from the time of first curative intent intervention. Kaplan–Meier survival curves were created and differences in curves were compared using Log-rank tests. Tumor staging was based on AJCC 7th edition criteria.

Results: Of the 46 patients, 6 were lost to follow-up prior to undergoing definitive chemoradiotherapy after endoscopic debulking of tumor and were excluded. Of the remaining 40 patients, 57.5% were male; mean age at diagnosis was 61.4 ± 12.5 years (standard deviation). 5 patients had T3 disease, 11 had T4a disease, and 24 had T4b disease. The most common subsite of origin was the nasopharynx followed by the sphenoid sinus. 13 patients were treated definitively with surgical therapy and 27 patients were treated with definitive chemoradiotherapy. Median overall survival for all patients was 35.9 months and median disease-free survival was 35.2 months; 5-year overall survival was 41.9% and 5-year disease-free survival was 29.9%. Disease severity demonstrated significant differences in overall survival on a Log-rank test for trend when comparing T3, T4a, and T4b disease. Margin-negative surgical resection and definitive chemoradiotherapy with complete response were associated with significantly better overall survival than margin-positive surgical resection or definitive chemoradiotherapy with incomplete response. The subsite of disease origin did not appear to significantly affect survival outcomes in locoregionally advanced disease.

Conclusion: Locoregionally advanced squamous cell carcinoma of the paranasal sinuses and skull base is a rare disease with poor outcomes. Higher T-stage disease was associated with worse overall survival likely due to greater involvement of critical neurovascular structures over which disease cannot be safely cleared. Margin-negative surgical resection or definitive chemoradiotherapy with complete response when possible are prognostic factors for improved survival. More work is required to fully elucidate prognostic factors and optimal treatment strategies.

Publication History

Article published online:
15 February 2022