title: Patterns of failure after combined-modality approaches incorporating radiotherapy for sinonasal undifferentiated carcinoma of the head and neck.
abstract: OBJECTIVE
  To report the clinical outcome of patients treated with combined-modality approaches for sinonasal undifferentiated carcinoma (SNUC) of the head and neck.
  
  
  METHODS
  The records of 21 patients with SNUC treated with curative intent at the University of California, San Francisco between 1990 and 2004 were analyzed. Patient age ranged from 33 to 71 years (median, 47 years). Primary tumor sites included the nasal cavity (11 patients), maxillary sinus (5 patients), and ethmoid sinus (5 patients). All patients had T3 (4 patients) or T4 (17 patients) tumors. Local-regional treatment included surgery followed by postoperative radiotherapy (PORT) with or without adjuvant chemotherapy for 17 patients; neoadjuvant chemoradiotherapy followed by surgery for 2 patients; and definitive chemoradiotherapy for 2 patients. Median follow-up among surviving patients was 58 months (range, 12-70 months).
  
  
  RESULTS
  The 2- and 5-year estimates of local control were 60% and 56%, respectively. There was no difference in local control according to initial treatment approach, but among the 19 patients who underwent surgery the 5-year local control rate was 74% for those with gross tumor resection, compared with 24% for those with subtotal tumor resection (p = 0.001). The 5-year rates of overall and distant metastasis-free survival were 43% and 64%, respectively. Late complications included cataracts (2 patients), lacrimal stenosis (1 patient), and sino-cutaneous fistula (1 patient).
  
  
  CONCLUSIONS
  The suboptimal outcomes suggest a need for more effective therapies. Gross total resection should be the goal of all treatments whenever possible.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA, USA. allenmchen@yahoo.com
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
authors.forename: Megan E
authors.initials: ME
authors.lastname: Daly
authors.forename: Ivan
authors.initials: I
authors.lastname: El-Sayed
authors.forename: Joaquin
authors.initials: J
authors.lastname: Garcia
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.forename: M Kara
authors.initials: MK
authors.lastname: Bucci
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D005005:Ethmoid Sinus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local; D009669:Nose Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome