Clinical Characteristics and Long-Term Outcomes following Surgery Combined with Adjuvant Radiotherapy for Patients with Frontal Sinus Malignancies

Abstract

Objectives Primary frontal sinus malignancies (FSMs) are the rarest sinonasal cancers. This study aimed to determine clinicopathologic characteristics of primary FSMs and provide long-term survival outcomes.

Design This study is a retrospective review.

Setting The study was conducted at a tertiary medical center.

Participants Patients who participated in this study were diagnosed with primary FSMs.

Main Outcome Measures Median survival time is the primary outcome measure of this study.

Results In this series, the median age was 48 years (30–53 years) and all patients were male. There were five cases with squamous cell carcinoma and one with osteosarcoma. All cases presented with locally advanced disease without regional lymphatic metastasis, including five cases of stage III and one case of stage II. The two most common pathways of tumor invasion were as follows: local tumor broke posteriorly through bone wall and invaded dura mater, followed by frontal lobe; local tumor infiltrated downward through the floor of frontal sinus into ethmoid sinus, thereafter invaded laterally orbit and orbital contents. All patients received surgery followed by postoperative radiotherapy at the total doses of 50 to 75.95 Gy. Among them, only one patient underwent R0 resection, the rest of patients underwent R1/R2 resection. With a median survival time of 56 months (32–76 months), two patients receiving R1/R2 resection developed treatment failure and died within 5 years, including one case with local recurrence and one with local recurrence, thereafter distant metastasis.

Conclusion The majority of FSMs presented with peripherally invasive progression lesions which led to a high ratio of R1/R2 resection. Surgery combined with postoperative radiotherapy might result in satisfactory efficacy.

Keywords

frontal sinus malignancies - tumor invasion pattern - comprehensive treatment - survival outcomes

Informed Consent

The study was conducted according to the guidelines of the Declaration of Helsinki, and Ethical review and approval were waived for this study, due to the retrospective nature of the study. Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patients or their families to publish this paper.

Publication History

Received: 17 May 2022

Accepted: 03 August 2022

Accepted Manuscript online:
16 August 2022

Article published online:
04 October 2022

• References

• 1 Bhojwani A, Unsal A, Dubal PM. et al. Frontal sinus malignancies: a population-based analysis of incidence and survival. Otolaryngol Head Neck Surg 2016; 154 (04) 735-741
• 2 Dutta R, Dubal PM, Svider PF, Liu JK, Baredes S, Eloy JA. Sinonasal malignancies: a population-based analysis of site-specific incidence and survival. Laryngoscope 2015; 125 (11) 2491-2497
• 3 Vázquez A, Baredes S, Setzen M, Eloy JA. Overview of frontal sinus pathology and management. Otolaryngol Clin North Am 2016; 49 (04) 899-910
• 4 Brownson RJ, Ogura JH. Primary carcinoma of the frontal sinus. Laryngoscope 1971; 81 (01) 71-89
• 5 Yoshida N, Kanekura T, Hashiguchi T, Nagayama T, Hamada H, Kanzaki T. Primary squamous cell carcinoma of the frontal sinus. J Dermatol 2006; 33 (12) 855-857
• 6 Zhang X, Yang C, Kong W, Jiang H, Zhang L, Li M. Osteogenic sarcoma in frontal sinus: one case with literature review [in Chinese]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006; 20 (24) 1130-1131
• 7 Gerlinger I, Gobel G, Tóth E, Szanyi I, Weninger C. Primary carcinoma of the frontal sinus: a case report and a review of literature. Eur Arch Otorhinolaryngol 2008; 265 (05) 593-597
• 8 Ichinose T, Goto T, Motomura H, Terakawa Y, Ohata K. Primary squamous cell carcinoma of the frontal sinus treated with en bloc resection: case report. Neurol Med Chir (Tokyo) 2009; 49 (10) 481-483
• 9 Chu MW, Karakla DW, Silverberg M, Han JK. Primary carcinoid tumor of the frontal sinus: a case report. Ear Nose Throat J 2010; 89 (10) E13-E16
• 10 Madana J, Yolmo D, Gopalakrishnan S, Saxena SK. Primary frontal sinus carcinoma with extradural anterior cranial fossa involvement. Ear Nose Throat J 2011; 90 (10) E4-E7
• 11 Wadhera R, Gulati SP, Garg A, Ghai A, Kumar S. Primary adenocarcinoma of the frontal sinus. Ear Nose Throat J 2011; 90 (10) E23-E25
• 12 Hosokawa S, Okamura J, Sakai N, Mineta H. Primary spindle cell carcinoma of the frontal sinus. J Oral Maxillofac Surg 2012; 70 (11) e674-e678
• 13 Tomovic S, Kalyoussef E, Mirani NM, Baredes S, Eloy JA. Angiosarcoma arising from the frontal sinus. Am J Otolaryngol 2014; 35 (06) 806-809
• 14 Zhang HZ, Li YP, She L. et al. Primary carcinoma of the frontal sinus with extensive intracranial invasion: a case report and review of the literature. Oncol Lett 2014; 7 (06) 1915-1918
• 15 Wang RG, Wang G, Chen L. Three cases of primary squamous cell carcinoma in the frontal sinus [in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 46 (08) 664-668
• 16 Frew I. Frontal sinus carcinoma. J Laryngol Otol 1969; 83 (04) 393-396
• 17 Tirelli G, Capriotti V, Sartori G, Tofanelli M, Marcuzzo AV. Primary adenoid cystic carcinoma of the frontal sinus: case description of a previously unreported entity and literature review. Ear Nose Throat J 2019; 98 (04) E8-E12
• 18 Danesh-Sani SA, Sarafraz A, Chamani M, Derakhshandeh H. Paranasal sinuses malignancies: a 12-year review of clinical characteristics. Med Oral Patol Oral Cir Bucal 2016; 21 (05) e626-e630
• 19 G.Gourin C. J.Terris D. Frontal sinus malignancies. In: E.Kountakis S, A.Senior B, Draf W, eds. The Frontal Sinus. 1st ed. Germany: Springer-Verlag; 2005: 167
• 20 Robin TP, Jones BL, Gordon OM. et al. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123 (16) 3040-3049
• 21 Thorup C, Sebbesen L, Danø H. et al. Carcinoma of the nasal cavity and paranasal sinuses in Denmark 1995-2004. Acta Oncol 2010; 49 (03) 389-394
• 22 Llorente JL, López F, Suárez C, Hermsen MA. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol 2014; 11 (08) 460-472
• 23 Siddiqui F, Smith RV, Yom SS. et al; Expert Panel on Radiation Oncology - Head and Neck Cancer. ACR appropriateness criteria nasal cavity and paranasal sinus cancers. Head Neck 2017; 39 (03) 407-418
• 24 Guntinas-Lichius O, Kreppel MP, Stuetzer H, Semrau R, Eckel HE, Mueller RP. Single modality and multimodality treatment of nasal and paranasal sinuses cancer: a single institution experience of 229 patients. Eur J Surg Oncol 2007; 33 (02) 222-228
• 25 Banuchi V, Mallen J, Kraus D. Cancers of the nose, sinus, and skull base. Surg Oncol Clin N Am 2015; 24 (03) 563-577
• 26 Perkins EL, Brandon BM, Sreenath SB. et al. Transfacial and craniofacial approaches for resection of sinonasal and ventral skull base malignancies. Otolaryngol Clin North Am 2017; 50 (02) 287-300
• 27 Guan X, Wang X, Liu Y, Hu C, Zhu G. Lymph node metastasis in sinonasal squamous cell carcinoma treated with IMRT/3D-CRT. Oral Oncol 2013; 49 (01) 60-65
• 28 Wiegner EA, Daly ME, Murphy JD. et al. Intensity-modulated radiotherapy for tumors of the nasal cavity and paranasal sinuses: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 2012; 83 (01) 243-251