Role of Adjuvant Treatment in Sinonasal Mucosal Melanoma

Moran Amit; Samantha Tam; Ahmed S. Abdelmeguid; Michael E. Kupferman; Shirley Y. Su; Shaan M. Raza; Franco DeMonte; Ehab Y. Hanna

doi:10.1055/s-0037-1604350

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2017; 78(06): 512-518
DOI: 10.1055/s-0037-1604350

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Role of Adjuvant Treatment in Sinonasal Mucosal Melanoma

Moran Amit^*

¹Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

,

Samantha Tam^*

¹Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

,

Ahmed S. Abdelmeguid

¹Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

²Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Mansoura University, Egypt

,

Michael E. Kupferman

¹Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

,

Shirley Y. Su

¹Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

,

Shaan M. Raza

³Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

,

Franco DeMonte

³Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

,

Ehab Y. Hanna

¹Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

› Author Affiliations

Abstract

Purpose Sinonasal mucosal melanoma (SNMM) is a locally aggressive tumor. This study aimed to define the role of adjuvant treatment and its association with survival outcomes of SNMM.

Methods This retrospective study investigated 152 patients with SNMM treated between 1991 and 2016 in MD Anderson Cancer Center. Patients were divided into the following treatment groups: surgery alone, surgery with postoperative radiotherapy (PORT), surgery with postoperative chemoradiation (POCRT), and induction chemotherapy followed by surgery and PORT. Overall survival (OS), disease-specific survival, and relapse-free survival were compared. Survival between the groups was compared using univariate and multivariate analyses.

Results The median follow-up was 28 months (range: 2–220 months). Five-year OS rates were 39, 42, 47, and 27% for the surgery only, PORT, POCRT, and neoadjuvant chemotherapy groups, respectively (log rank p = 0.73). Distant metastasis was the most common form of treatment failure and occurred in 59 (39%) patients. Five-year distant metastasis rates were 51, 45, and 58% for patients treated with surgery alone, PORT, and POCRT, respectively (log rank p = 0.21) but unable to be estimated in the neoadjuvant chemotherapy group due to low OS rates. Multivariate analysis demonstrated tumor site (hazard ratio [HR] = 2.32, 95% confidence interval [CI] = 1.24–4.15) and smoking status (HR = 1.77, 95% CI = 1.02–3.1) to be significant prognostic factors for survival.

Conclusion Tumor site and smoking status were significant prognosticators in SNMM. A high rate of distant metastatic disease suggests that further investigation into novel, systemic therapies is required to improve outcomes in this disease entity.

Keywords

mucosal - melanoma - sinonasal - skull base - recurrence - chemotherapy - radiation - survival

Full Text

References

References
1 Sun CZ, Li QL, Hu ZD, Jiang YE, Song M, Yang AK. Treatment and prognosis in sinonasal mucosal melanoma: a retrospective analysis of 65 patients from a single cancer center. Head Neck 2014; 36 (05) 675-681
2 Manolidis S, Donald PJ. Malignant mucosal melanoma of the head and neck: review of the literature and report of 14 patients. Cancer 1997; 80 (08) 1373-1386
3 Gal TJ, Silver N, Huang B. Demographics and treatment trends in sinonasal mucosal melanoma. Laryngoscope 2011; 121 (09) 2026-2033
4 Moreno MA, Roberts DB, Kupferman ME. , et al. Mucosal melanoma of the nose and paranasal sinuses, a contemporary experience from the M. D. Anderson Cancer Center. Cancer 2010; 116 (09) 2215-2223
5 Li W, Yu Y, Wang H, Yan A, Jiang X. Evaluation of the prognostic impact of postoperative adjuvant radiotherapy on head and neck mucosal melanoma: a meta-analysis. BMC Cancer 2015; 15: 758
6 Ahn HJ, Na II, Park YH. , et al. Role of adjuvant chemotherapy in malignant mucosal melanoma of the head and neck. Oral Oncol 2010; 46 (08) 607-611
7 Bartell HL, Bedikian AY, Papadopoulos NE. , et al. Biochemotherapy in patients with advanced head and neck mucosal melanoma. Head Neck 2008; 30 (12) 1592-1598
8 Shiga K, Ogawa T, Kobayashi T. , et al. Malignant melanoma of the head and neck: a multi-institutional retrospective analysis of cases in northern Japan. Head Neck 2012; 34 (11) 1537-1541
9 Group Pn. Guidelines for the examination and reporting of head and neck cancer specimens. Yorkshire: Cancer Network: LEEDS 2007; 17 (12) 1-12
10 Edge SB, Fritz AG, Byrd DR, Greene FL, Trotti A, Compton CC. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010
11 Temam S, Mamelle G, Marandas P. , et al. Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 2005; 103 (02) 313-319
12 Owens JM, Roberts DB, Myers JN. The role of postoperative adjuvant radiation therapy in the treatment of mucosal melanomas of the head and neck region. Arch Otolaryngol Head Neck Surg 2003; 129 (08) 864-868
13 Krengli M, Masini L, Kaanders JH. , et al. Radiotherapy in the treatment of mucosal melanoma of the upper aerodigestive tract: analysis of 74 cases. A rare cancer network study. Int J Radiat Oncol Biol Phys 2006; 65 (03) 751-759
14 Pfister DG, Ang KK, Brizel DM. , et al; National Comprehensive Cancer Network. Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2013; 11 (08) 917-923
15 Benlyazid A, Thariat J, Temam S. , et al. Postoperative radiotherapy in head and neck mucosal melanoma: a GETTEC study. Arch Otolaryngol Head Neck Surg 2010; 136 (12) 1219-1225
16 Thariat J, Poissonnet G, Marcy PY. , et al. Effect of surgical modality and hypofractionated split-course radiotherapy on local control and survival from sinonasal mucosal melanoma. Clin Oncol (R Coll Radiol) 2011; 23 (09) 579-586
17 Strojan P. Role of radiotherapy in melanoma management. Radiol Oncol 2010; 44 (01) 1-12
18 Trotti A, Peters LJ. Role of radiotherapy in the primary management of mucosal melanoma of the head and neck. Semin Surg Oncol 1993; 9 (03) 246-250
19 Schmidt-Ullrich RK, Johnson CR. Role of radiotherapy and hyperthermia in the management of malignant melanoma. Semin Surg Oncol 1996; 12 (06) 407-415
20 Sause WT, Cooper JS, Rush S. , et al. Fraction size in external beam radiation therapy in the treatment of melanoma. Int J Radiat Oncol Biol Phys 1991; 20 (03) 429-432
21 Chang AE, Karnell LH, Menck HR. ; The American College of Surgeons Commission on Cancer and the American Cancer Society. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. Cancer 1998; 83 (08) 1664-1678
22 Lian B, Si L, Cui C. , et al. Phase II randomized trial comparing high-dose IFN-α2b with temozolomide plus cisplatin as systemic adjuvant therapy for resected mucosal melanoma. Clin Cancer Res 2013; 19 (16) 4488-4498
23 Chapman PB, Hauschild A, Robert C. , et al; BRIM-3 Study Group. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 2011; 364 (26) 2507-2516
24 Larkin J, Chiarion-Sileni V, Gonzalez R. , et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med 2015; 373 (01) 23-34