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J Neurol Surg B Skull Base 2025; 86(05): 538-546
DOI: 10.1055/s-0044-1791573
Original Article

International, Multi-Institutional Evaluation of Practice Patterns and Outcomes for Recurrent and Metastatic Sinonasal Undifferentiated Carcinoma

Anirudh Saraswathula
1   Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
1   Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Mohammed N. Ullah 
1   Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
1   Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Jacklyn Liu
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Yoko Takahashi
3   Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Arushi Mahajan
4   Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
,
Simonetta Battocchio
5   Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
,
Paolo Bossi
6   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
7   Head and Neck Cancer Medical Oncology Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Paolo Castelnuovo
8   Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
,
Carla Facco
9   Unit of Pathology, ASST Sette Laghi, University of Insubria, Varese, Italy
,
Marco Ferrari 
10   Section of Otorhinolaryngology – Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
,
Dawn Carnell
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Martin D. Forster
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Alessandro Franchi
11   Department of Translational Research, University of Pisa, Pisa, Italy
,
Amrita Jay
12   Department of Histopathology, University College London Hospitals NHS Trust, London, United Kingdom
,
Davide Lombardi
13   Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
,
Valerie J. Lund
14   Royal National Ear, Nose, Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, United Kingdom
,
Davide Mattavelli
13   Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
,
Piero Nicolai
10   Section of Otorhinolaryngology – Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
,
Vittorio Rampinelli
13   Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
,
Fausto Sessa
9   Unit of Pathology, ASST Sette Laghi, University of Insubria, Varese, Italy
,
Shirley Y. Su
3   Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Mario Turri-Zanoni
8   Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
,
Laura Ardighieri
5   Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
,
Erin McKean
4   Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
,
Matt Lechner
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
15   Division of Surgery and Interventional Science, University College London, and National Hospital Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Ehab Hanna
3   Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Nyall R. London Jr.
1   Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
16   Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
2   UCL Cancer Institute, University College London and Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
› Author Affiliations
Funding This research was supported (in part) by the Intramural Research Program of the NIH, Center for Cancer Research, National Cancer Institute and the National Institute on Deafness and Other Communication Disorders training grant 2T32DC000027.
› Further Information
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Abstract

Objectives

The aims of this study were to analyze the clinical characteristics of patients with recurrent and metastatic sinonasal undifferentiated carcinoma (SNUC) and evaluate the current treatment strategies to help guide future management.

Design

This is a retrospective cohort study.

Setting

The study was conducted at six international tertiary treatment centers.

Participants

Patients with documented diagnoses of recurrent or metastatic SNUC since 1983 were included in the study.

Main Outcome Measures

Patient demographics and clinical characteristics were collected. Primary outcome measures included disease-specific survival (DSS), overall survival (OS), and time to recurrence (TTR) following initial treatment. Further univariable and multivariable analyses were performed to assess for prognostic factors.

Results

A total of 97 patients with a mean (standard deviation [SD]) age of 52.4 (15.6) were identified, 15 of whom presented with metastatic SNUC and 90 of whom developed recurrence. Management in both populations was widely variable. For patients with metastatic disease, the 1-year DSS probability was 33.3% (95% confidence interval [CI], 10.8–100%). For patients with recurrent SNUC, the 1- and 5-year DSS probabilities were 45.7% (95% CI, 31.9–65.6%) and 8.6% (95% CI, 2.9–25.3%), respectively. The median (interquartile range [IQR]) TTR was 8 months (3–18.5 months). Multivariable analyses revealed a significant association between orbital involvement on initial presentation and TTR (hazard ratio [HR] = 3.28; 95% CI, 1.45–7.42; p = 0.004).

Conclusions

To our knowledge, this is the first study addressing metastatic and recurrent SNUC based on a large patient cohort. Orbital extension of the primary SNUC may predict a higher probability of recurrence following treatment, suggesting the possible utility of a more aggressive treatment in this subgroup of patients. A heterogenous patient population and wide variability in management emphasize the challenges in standardizing care; however, dismal survival rates demonstrate the necessity for further evaluation of current approaches to improve evidence-based recommendations.

Keywords

sinonasal undifferentiated carcinoma - metastatic - recurrence - chemoradiation - orbital extension

Previous Presentation

This study was presented at the North American Skull Base Society Annual meeting on February 18, 2024, in Atlanta, Georgia.


* These authors contributed equally to this work.


† These authors contributed equally to this work and are co-corresponding authors.


Supplementary Material



Publication History

Received: 16 June 2024

Accepted: 03 September 2024

Article published online:
03 October 2024

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