Extent of surgery in the management of locally advanced sinonasal malignancies.
BACKGROUND
The relative importance of surgery within multimodality regimens commonly used to treat advanced sinonasal malignancies remains unknown.


METHODS
One hundred two patients with locally advanced sinonasal cancers treated with proton beam radiation therapy with or without surgery were retrospectively reviewed. Extent of surgery and outcome variables of local control, disease-free survival, and overall survival were evaluated. Patterns of failure were also assessed.


RESULTS
Extent of surgery correlated with disease-free survival and overall survival rates. Local control rate, however, was independent of the degree of surgical resection achieved. Overall, treatment failure most commonly resulted from distant metastases, which occurred in 30% of patients and also correlated with extent of surgical resection. Tumor type-specific outcomes reveal differences associated with the extent of surgery achieved.


CONCLUSIONS
High-dose radiotherapy with proton beam resulted in excellent local control rates in patients with locally advanced sinonasal cancer, irrespective of the extent of surgery. Complete resection, however, was predictive of improved disease-free survival and decreased rate of distant metastasis.
Resto
Vicente A
VA
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Chan
Annie W
AW
Deschler
Daniel G
DG
Lin
Derrick T
DT
D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D018304:Esthesioneuroblastoma, Olfactory / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009669:Nose Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D019292:Skull Base Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*