Introduction: Delays in initiation of adjuvant therapy are associated with poorer outcomes in patients
who have undergone oncological resection for head and neck malignancy. There are many
potential factors that can contribute to these delays, but unique to cancers that
involve the base of skull is the potential to create communications that produce a
leak in cerebral spinal fluid (CSF). This study aims to evaluate variables that may
produce delays in postoperative adjuvant radiotherapy for patients undergoing sinonasal
malignancy surgery.
Method: After approval from our institutional review board, a single-institution retrospective
review of all patients undergoing endoscopic or open surgery for sinonasal malignancies
from January 2007 to December 2017 were identified. Clinically relevant data, including
basic demographics, tumor characteristics, procedure details, postoperative course
and interested dates were tabulated. The covariates of surgical approach, tumor T
stage (T1/2 vs. T3/4), reconstruction type, presence of an intraoperative CSF leak,
and geographic location of radiation therapy were analyzed to see if they significantly
impacted time to initiation of radiation therapy.
Results: Of the 361 patients found on initial screening, 36 were identified to have a surgically
resected primary sinonasal malignancy followed by radiation or chemoradiation therapy.
Of these, 2 were excluded for incomplete data. The average number of days from surgery
to initiation of radiation therapy was 50 (range: 21–86). No difference was found
comparing endoscopic to open surgery (p = 0.80, CI: −12.6 to 9.9), tumor stage (p = 0.66, CI: −14.6 to 22.18), reconstruction method (p = 0.86), presence of an intraoperative CSF leak (p = 0.18, CI: −19.2 to 3.8), occurrence of an immediate postoperative complication
(p = 0.36, CI: −19.7 to 7.3), or geographic location of radiation therapy (p = 0.10, CI: −26.8 to 2.6).
Conclusion: This study suggests that adequate surgical resection, including base of skull resection
with the potential of encountering a CSF leak, achieved by the appropriate approach
and robust reconstruction for all tumor stages does not delay initiation of radiation
therapy in sinonasal malignancies.
