Can Definitive Radiation Therapy Substitute Surgical Resection in Locally Advanced T3 or T4 Sinonasal Squamous Cell Carcinoma?
Menée à partir de données 2008-2021 portant sur 155 patients atteints d'un carcinome épidermoïde sinonasal, cette étude évalue l'efficacité, du point de vue de la survie globale à 3 ans, de la survie sans progression locale et de la survie sans progression globale, d'une radiothérapie définitive par rapport à une résection chirurgicale
Purpose: This study aimed to compare oncologic outcomes between definitive radiation therapy (RT) and upfront surgical resection in sinonasal squamous cell carcinoma (SCC) patients. Methods and Materials: Between 2008 to 2021, 155 patients of T1-4b, N0-3 sinonasal SCC patients were analyzed. The 3-year overall survival (OS), local progression free survival (LPFS), and overall PFS were evaluated using Kaplan Meier method and compared using log-rank test. A pattern of regional neck lymph node (LN) failure and treatment related toxicity profiles were investigated. Results: The numbers of patients who underwent upfront RT (RT group) and surgical resection (Surgery group) were 63 and 92, respectively, where RT group included T3-4 disease patients significantly more frequently than Surgery group (90.5% vs. 39.1%, P<0.001). The rates of 3-year OS, LPFS, and PFS in RT and Surgery groups were 68.6% vs. 81.7% (P = .073), 62.3% vs. 73.8% (P = .187), and 47.4% vs. 66.1% (P = .005), respectively. However, the corresponding rates in T3-4 disease were 65.1% vs. 64.8% (P = .794), 57.4% vs. 56.8% (P = .351), and 43.2% vs. 46.5% (P = .638), demonstrating no statistically significant differences between two treatment modalities. Among 133 N0 patients, regional neck LN progression was observed in 17 patients, and the most common sites of regional neck LN failure was ipsilateral level Ib (9 patients) and II (7 patients). The 3-year neck node recurrence free rate in cT1-3N0 patients was 93.5 %, while that in cT4N0 patients was 81.1% (P = .025). Conclusions: Upfront RT may be considered in selected locally advanced sinonasal SCC patients where we have demonstrated similar oncologic outcomes to those of surgery. The prophylactic neck treatment in T4 disease requires further investigation to evaluate its efficacy.
International Journal of Radiation Oncology, Biology, Physics 2023