Download PDF
J Neurol Surg B Skull Base 2024; 85(01): 028-037
DOI: 10.1055/a-1980-8567
Original Article

Long-Term Outcomes of Endoscopic Resection versus Open Surgery for Locally Advanced Sinonasal Malignancies in Combination with Radiotherapy

Qian Liu    *
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Xiaodong Huang   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Xuesong Chen   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Jianghu Zhang   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Jingbo Wang   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Yuan Qu   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Kai Wang   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Runye Wu   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Ye Zhang   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Jianping Xiao   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Junlin Yi   #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
,
Jingwei Luo    #
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Our objective was to compare the long-term outcomes of endoscopic resection versus open surgery in combination with radiotherapy for locally advanced sinonasal malignancies (SNMs).

Methods Data for continuous patients with sinonasal squamous cell carcinoma and adenocarcinoma who received surgery (endoscopic or open surgery) combined with radiotherapy in our center between January 1999 and December 2016 were retrospectively reviewed. A 1:1 matching with propensity scores was performed. Overall survival (OS), progression-free survival (PFS), and local recurrence rate (LRR) were evaluated.

Results We identified 267 eligible patients, 90 of whom were included after matching: 45 patients in the endoscopy group and 45 in the open group. The median follow-up time was 87 months. In the endoscopic group, 84.4% of patients received intensity-modulated radiotherapy (IMRT), with a mean gross tumor volume (GTV) dose of 68.28 Gy; in the open surgery group, 64.4% of patients received IMRT, with a mean GTV dose of 64 Gy. The 5-year OS, PFS, and LRR were 69.9, 58.6, and 24.5% in the endoscopic group and 64.6, 54.4, and 31.8% in the open surgery group, respectively. Multivariable regression analysis revealed that the surgical approach was not associated with lower OS, PFS, or LRR. The overall postoperative complications were 13% in the endoscopic group, while 21.7% in the open group.

Conclusion For patients with locally advanced SNMs, minimally invasive endoscopic resection, in combination with a higher radiation dose and new radiation techniques such as IMRT, yields survival outcomes similar to those of open surgery in combination with radiotherapy.

Keywords

propensity score analysis - sinonasal malignancies - endoscopic surgery - radiotherapy - outcomes

Ethics Approval and Consent to Participate

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Institutional Review Board of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences, and Peking Union Medical College. Informed consent was obtained from all individual participants included in the study.


* Resident.


# Professor.


Supplementary Material



Publication History

Received: 05 August 2022

Accepted: 21 October 2022

Accepted Manuscript online:
16 November 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Cancer incidence in five continents. Volume IX. IARC Sci Publ 2008; (160) 1-837
    Google Scholar
  • 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70 (01) 7-30
    Google Scholar
  • 3 Youlden DR, Cramb SM, Peters S. et al. International comparisons of the incidence and mortality of sinonasal cancer. Cancer Epidemiol 2013; 37 (06) 770-779
    Google Scholar
  • 4 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
    Google Scholar
  • 5 Ketcham AS, Wilkins RH, Vanburen JM, Smith RR. A combined intracranial facial approach to the paranasal sinuses. Am J Surg 1963; 106: 698-703
    Google Scholar
  • 6 Tajudeen BA, Kennedy DW. Thirty years of endoscopic sinus surgery: what have we learned?. World J Otorhinolaryngol Head Neck Surg 2017; 3 (02) 115-121
    Google Scholar
  • 7 Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 2010; 267 (05) 649-663
    Google Scholar
  • 8 Castelnuovo P, Lepera D, Turri-Zanoni M. et al. Quality of life following endoscopic endonasal resection of anterior skull base cancers. J Neurosurg 2013; 119 (06) 1401-1409
    Google Scholar
  • 9 Nicolai P, Battaglia P, Bignami M. et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008; 22 (03) 308-316
    Google Scholar
  • 10 Suh JD, Ramakrishnan VR, Chi JJ, Palmer JN, Chiu AG. Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base. Ann Otol Rhinol Laryngol 2013; 122 (01) 54-59
    Google Scholar
  • 11 Nakamaru Y, Suzuki M, Kano S. et al. The role of endoscopic resection for selected patients with sinonasal squamous cell carcinoma. Auris Nasus Larynx 2020; 48 (01) 131-137
    Google Scholar
  • 12 Lund VJ, Stammberger H, Nicolai P. et al; European Rhinologic Society Advisory Board on Endoscopic Techniques in the Management of Nose, Paranasal Sinus and Skull Base Tumours. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22: 1-143
    Google Scholar
  • 13 Carlton DA, Beahm DD, Chiu AG. Sinonasal malignancies: endoscopic treatment outcomes. Laryngoscope Investig Otolaryngol 2019; 4 (02) 259-263
    Google Scholar
  • 14 Xiao R, Joshi RR, Husain Q. et al. Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: effect of surgical approach. Head Neck 2019; 41 (10) 3551-3563
    Google Scholar
  • 15 Duprez F, Madani I, Morbée L. et al. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys 2012; 83 (01) 252-259
    Google Scholar
  • 16 Marta GN, Silva V, de Andrade Carvalho H. et al. Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol 2014; 110 (01) 9-15
    Google Scholar
  • 17 Austin PC. Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples. Stat Med 2011; 30 (11) 1292-1301
    Google Scholar
  • 18 Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med 2014; 33 (07) 1242-1258
    Google Scholar
  • 19 Povolotskiy R, Farber NI, Bavier RD, Cerasiello SY, Eloy JA, Hsueh WD. Endoscopic versus open resection of non-squamous cell carcinoma sinonasal malignancies. Laryngoscope 2020; 130 (08) 1872-1876
    Google Scholar
  • 20 Hagemann J, Roesner J, Helling S. et al. Long-term outcome for open and endoscopically resected sinonasal tumors. Otolaryngol Head Neck Surg 2019; 160 (05) 862-869
    Google Scholar
  • 21 Kılıç S, Kılıç SS, Baredes S. et al. Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients. Int Forum Allergy Rhinol 2018; 8 (03) 421-434
    Google Scholar
  • 22 Farquhar D, Kim L, Worrall D. et al. Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes. Laryngoscope 2016; 126 (08) 1724-1729
    Google Scholar
  • 23 Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis. Int Forum Allergy Rhinol 2011; 1 (04) 255-261
    Google Scholar
  • 24 Rawal RB, Farzal Z, Federspiel JJ, Sreenath SB, Thorp BD, Zanation AM. Endoscopic resection of sinonasal malignancy—a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2016; 155 (03) 376-386
    Google Scholar
  • 25 Meccariello G, Deganello A, Choussy O. et al. Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: a pooled-analysis of 1826 patients. Head Neck 2016; 38 (Suppl. 01) E2267-E2274
    Google Scholar
  • 26 Grosjean R, Gallet P, Baumann C, Jankowski R. Transfacial versus endoscopic approach in the treatment of woodworker's nasal adenocarcinomas. Head Neck 2015; 37 (03) 347-356
    Google Scholar
  • 27 Kotelnikov VM, Coon JS IV, Haleem A. et al. Cell kinetics of head and neck cancers. Clin Cancer Res 1995; 1 (05) 527-537
    Google Scholar
  • 28 Umeda M, Nishimatsu N, Masago H. et al. Tumor-doubling time and onset of pulmonary metastasis from adenoid cystic carcinoma of the salivary gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88 (04) 473-478
    Google Scholar
  • 29 Abdelmeguid AS, Raza SM, Su SY. et al. Endoscopic resection of sinonasal malignancies. Head Neck 2020; 42 (04) 645-652
    Google Scholar
  • 30 Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 2012; 34 (06) 877-885
    Google Scholar
  • 31 Torabi SJ, Spock T, Cardoso B. et al. Margins in sinonasal squamous cell carcinoma: predictors, outcomes, and the endoscopic approach. Laryngoscope 2020; 130 (06) E388-E396
    Google Scholar
  • 32 Robin TP, Jones BL, Gordon OM. et al. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123 (16) 3040-3049
    Google Scholar
  • 33 Farris M, Lucas Jr JT, Soike M. et al. Impact of treatment paradigm and elective nodal coverage on resection status and failure patterns in paranasal sinus tumors. Int J Radiat Oncol Biol Phys 2015; 93 (03) E339-E340
    Google Scholar
  • 34 Wang Z, Qu Y, Wang K. et al. The value of preoperative radiotherapy in the treatment of locally advanced nasal cavity and paranasal sinus squamous cell carcinoma: a single institutional experience. Oral Oncol 2020; 101: 104512
    Google Scholar
  • 35 Yi J, Huang X, Xu Z. et al. Phase III randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Oncotarget 2017; 8 (27) 44842-44850
    Google Scholar
  • 36 Zhang ZM, Tang PZ, Gang XZ, Fa QY, Zh XG. Significance of different preoperative radiotherapy doses in combined therapy for hypopharyngeal squamous cell carcinoma. Chin J Radiat Oncol 2004; 13 (01) 1-3
    Google Scholar
  • 37 Zhang ZM, Tang PZ, Xu ZG, Li ZJ. [Squamous cell carcinoma of naso-ethmoid sinus: analysis of 146 cases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010; 45 (07) 555-559
    Google Scholar
  • 38 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
    Google Scholar
  • 39 Fan M, Kang JJ, Lee A. et al. Outcomes and toxicities of definitive radiotherapy and reirradiation using 3-dimensional conformal or intensity-modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies. Cancer 2020; 126 (09) 1905-1916
    Google Scholar
  • 40 Hoppe BS, Stegman LD, Zelefsky MJ. et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting–the MSKCC experience. Int J Radiat Oncol Biol Phys 2007; 67 (03) 691-702
    Google Scholar
  • 41 Eloy JA, Vivero RJ, Hoang K. et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope 2009; 119 (05) 834-840
    Google Scholar
  • 42 Fu TS, Monteiro E, Witterick I. et al. Costs and perioperative outcomes associated with open versus endoscopic resection of sinonasal malignancies with skull base involvement. J Neurol Surg B Skull Base 2017; 78 (05) 430-440
    Google Scholar