Induction chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses.
OBJECTIVE
To review the oncologic outcomes in patients with advanced (stage III-IV) squamous cell carcinoma of the paranasal sinuses treated with induction chemotherapy prior to definitive local therapy.


METHODS
The medical records of 46 consecutive patients with previously untreated, biopsy-proved squamous cell carcinoma of the paranasal sinuses who received induction chemotherapy during the course of their treatment were reviewed for demographics, tumor types and stages, treatment details, and oncologic outcomes.


RESULTS
Of the 46 patients (median age, 59 years), the tumor epicenter was in the maxillary sinus in 31 (67%), ethmoid sinus in 9 (20%), nasal cavity in 4 (9%), and sphenoid sinus in 2 (4%). All patients had T3 or T4 tumors, and 12 (26%) patients had clinical evidence of nodal metastasis, with an overall stage of III (20%) or IV (80%). Induction chemotherapy regimens consisted of a combination of a taxane and platinum in 80% of patients, by themselves (14 patients) or in combination with a third agent, such as ifosfamide (14 patients) or 5-fluorouracil (9 patients). The combination of a taxane and 5-fluorouracil was used in the remaining 9 patients. More than two-thirds (67%) of the patients achieved at least a partial response to induction chemotherapy, 24% had progressive disease, and 9% had stable disease. Subsequent treatment after induction chemotherapy consisted of surgery, usually followed by radiation or chemoradiation or by definitive radiation or chemoradiation with surgical salvage of any residual disease. Overall, surgical resection was performed in only 24 of 46 patients (52%) treated with induction chemotherapy. The 2-year survival for patients with at least a partial response or stable disease after induction chemotherapy was 77% in contrast to only 36% for patients with progressive disease.


CONCLUSIONS
Tumor response to induction chemotherapy in patients with advanced squamous cell carcinoma of the paranasal sinuses may be predictive of treatment outcome and prognosis. Favorable response to induction chemotherapy is associated with better survival and a reasonable chance of organ preservation.
Department of Head and Neck Surgery, Head and Neck Center, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA. eyhanna@mdanderson.org
Ehab Y
EY
Hanna
Alvaro Diaz
AD
Cardenas
Franco
F
DeMonte
Dianna
D
Roberts
Michael
M
Kupferman
Randal
R
Weber
David
D
Rosenthal
Merrill
M
Kies
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012074:Remission Induction; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome