Minimally invasive endoscopic resection of sinonasal undifferentiated carcinoma

• Published in: American journal of otolaryngology 2011-11, Vol.32 (6), p.464-469
• Main Authors: Revenaugh, Peter C., MD, Seth, Rahul, MD, Pavlovich, Justin B., MD, Knott, P. Daniel, MD, Batra, Pete S., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Biopsy, Needle; Carcinoma - mortality; Carcinoma - pathology; Carcinoma - surgery; Carcinoma - therapy; Chemoradiotherapy - methods; Chemotherapy; Cohort Studies; Confidence Intervals; Disease-Free Survival; Endoscopy - methods; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Male; Maxillary Sinus Neoplasms - mortality; Maxillary Sinus Neoplasms - pathology; Maxillary Sinus Neoplasms - surgery; Maxillary Sinus Neoplasms - therapy; Medical sciences; Medical treatment; Middle Aged; Minimally Invasive Surgical Procedures - methods; Mortality; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Otolaryngology; Otorhinolaryngology. Stomatology; Paranasal Sinus Neoplasms - mortality; Paranasal Sinus Neoplasms - pathology; Paranasal Sinus Neoplasms - surgery; Paranasal Sinus Neoplasms - therapy; Prognosis; Radiation therapy; Retrospective Studies; Sinuses; Surgery; Survival Analysis; Young Adult
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2010.09.006

Abstract Purpose The purpose of the study was to review a single-institution experience with endoscopic resection of sinonasal undifferentiated carcinoma (SNUC). Materials and Methods Thirteen patients underwent treatment of SNUC between January 2002 and July 2009. Retrospective data were collected including demographics, tumor characteristics, surgical strategy, adjuvant therapies, local and regional recurrence, distant metastasis, overall survival, and disease-free survival. Results The mean age was 51.8 years. The most common tumor stage at presentation was T4 (92%). Seven patients (53%) were treated with minimally invasive endoscopic resection (MIER) with negative intraoperative margins. Endoscopic anterior skull base resection was performed in 5 patients, and endoscopic-assisted bifrontal craniotomy was performed in 1 patient to clear the superior tumor margin. Six patients received pre- or postoperative chemoradiation. One patient underwent palliative chemoradiation, and one patient underwent open craniofacial resection. In the MIER group, simultaneous local and regional recurrence was observed in 1 patient (14%) after 30 months. Distant metastases were observed in 2 other patients (28%) without local or regional recurrence. All 3 patients with recurrences died of their disease. The remaining 4 patients were clinically, endoscopically, and radiographically free of disease, resulting in overall and disease-free survival rates of 57% with mean follow-up of 32.3 months. Conclusions These preliminary data suggest a potential role for MIER in the comprehensive management algorithm of SNUC in appropriately selected patients. Patient outcomes including local and regional recurrence, distant metastases, and overall and disease-free survival were comparable to a treatment strategy using traditional craniofacial resection. Level of evidence 2b.