Aims

Sinonasal malignancies are rare; the most common histological subtype is squamous cell carcinoma (SCC). No randomised trial data exist to guide treatment decisions, with options including surgery, radiotherapy and chemotherapy. The role and sequence of a primary non-surgical approach in this disease remains uncertain. The aim of this study was to present treatment outcomes for a multicentre population of patients with locally advanced, stage IVa/b sinonasal SCC treated with radical-intent intensity-modulated radiotherapy, either definitively or postoperatively.

Materials and methods

Consecutively treated patients with locally advanced, stage IVa/b sinonasal SCC at four UK oncology centres between January 2012 and December 2017 were retrospectively identified. Descriptive statistics and survival analyses were carried out. Univariable Cox regression analysis was carried out to evaluate the relationship between patient, disease and treatment factors and survival outcomes.

Results

In total, 56 patients with sinonasal SCC were included (70% maxillary sinus, 21% nasal cavity, 9% ethmoid/frontal sinus). Forty-one patients (73%) were treated by surgery/adjuvant (chemo)radiotherapy and 15 (27%) by definitive (chemo)radiotherapy. The median duration of follow-up was 3.8 years (interquartile range 2.0–4.7 years). Estimates for 5-year overall survival and progression-free survival were 30.2% and 24.2%, respectively. Local, regional and distant treatment failures were seen in 33%, 33% and 16% of patients, respectively. Univariable analysis revealed inferior progression-free survival for patients treated with neck dissection (hazard ratio 2.6, 95% confidence interval 1.2–6.1, P = 0.022) but no other significant association between the studied factors and survival outcomes.

Conclusion

We show poor survival outcomes and high rates of locoregional treatment failure for patients with locally advanced stage IVa/b sinonasal SCC. There is a need to investigate improved treatments for this group of patients.

中文翻译：

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英国一项关于局部晚期鼻腔鳞状细胞癌辅助或明确调强放射治疗结果的多中心研究

宗旨

鼻腔恶性肿瘤很少见；最常见的组织学亚型是鳞状细胞癌 (SCC)。没有随机试验数据来指导治疗决策，可选择的治疗包括手术、放疗和化疗。主要非手术方法在该疾病中的作用和顺序仍不确定。本研究的目的是展示局部晚期 IVa/b 期鼻窦 SCC 患者的多中心人群的治疗结果，这些患者接受根治性调强放疗，无论是确定性的还是术后的。

材料和方法

回顾性确定了 2012 年 1 月至 2017 年 12 月期间在英国四个肿瘤中心连续治疗的局部晚期 IVa/b 期鼻窦 SCC 患者。进行了描述性统计和生存分析。进行单变量 Cox 回归分析以评估患者、疾病和治疗因素与生存结果之间的关系。

结果

总共包括 56 名鼻窦 SCC 患者（70% 上颌窦，21% 鼻腔，9% 筛窦/额窦）。41 名患者 (73%) 接受了手术/辅助（化学）放射治疗，15 名（27%）患者接受了根治性（化学）放射治疗。中位随访时间为 3.8 年（四分位距为 2.0-4.7 年）。5 年总生存期和无进展生存期的估计值分别为 30.2% 和 24.2%。分别有 33%、33% 和 16% 的患者出现局部、区域和远程治疗失败。单变量分析显示接受颈部夹层治疗的患者的无进展生存期较差（风险比 2.6，95% 置信区间 1.2-6.1，P = 0.022），但研究的因素与生存结果之间没有其他显着关联。

结论

我们显示局部晚期 IVa/b 期鼻窦 SCC 患者的生存结果不佳和局部治疗失败率高。有必要为这组患者研究改进的治疗方法。