title: Trimodality management of sinonasal undifferentiated carcinoma and review of the literature.
abstract: OBJECTIVE
  Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive malignancy with optimal management remains unclear. We performed a review of the impact of trimodality approach on SNUC outcome.
  
  
  METHODS
  This is a single-institution retrospective study of 18 patients, who were managed between 1997 and 2009. The median age at presentation was 52 years (28 to 82). Nine patients (50%) were female. Three patients had stage II disease and underwent surgery alone, 12 had stages III and IVa and underwent surgery combined with chemoradiation, and 3 had stage IVb and underwent definitive chemoradiation. Patients who underwent preoperative, postoperative, and definitive chemoradiation received 60, 66, and 70 Gy of radiation, respectively. In all patients receiving concurrent chemoradiation, cisplatin was used, at a dose of 100 mg/m every 3 weeks for 3 cycles. Neoadjuvant chemotherapy included docetaxel, cisplatin, and 5-fluorouracil (TPF) every 3 weeks for 2 to 3 cycles.
  
  
  RESULTS
  After a median follow-up of 26 months (16 to 120), a total of 8 patients (44%) have experienced the following: 1 persistent disease (5.5%), 4 local failure (22%), and 3 distant metastases (DM, 16.5%). Five of the 8 patients had preexisting cranial nerve deficits or gross cranial invasion. The 2-, 3-, and 4-year local control (LC), disease-free survival (DFS), and overall survival (OS) were 78%, 72%, and 56%; 75%, 65%, and 52%; and 75%, 50%, and 48%, respectively. Trimodality approach provided 83% LC and 92% DM-free survival, whereas other modalities provided 50% LC and 33% DM-free survival. The causes of death for the entire cohort were DM and local invasion. Acute chemoradiotherapy toxicity was 100% grades 1 and 2 dermatitis, mucositis, and fatigue, 55% developed grades 1 and 2 dysphagia, and 6% had grade 3 mucositis. Long-term toxicity was 28% grade 1 xerostomia, 11% retinopathy and optic neuropathy, and 6% orbital exenteration and grade 3 peripheral neuropathy.
  
  
  CONCLUSIONS
  SNUC is an aggressive neoplasm that frequently presents at an advanced stage. Our data show that trimodality approach in the form of surgery combined with chemoradiation seems to offer better LC and lower DM compared with other modalities.
authors.affiliation: *Department of Radiation Oncology ‡Department of Medical Oncology §Department of Otolaryngology, Beth Israel Medical Center, New York †Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center, Bronx, NY.
authors.forename: Waleed F
authors.initials: WF
authors.lastname: Mourad
authors.forename: David
authors.initials: D
authors.lastname: Hauerstock
authors.forename: Rania A
authors.initials: RA
authors.lastname: Shourbaji
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Hu
authors.forename: Bruce
authors.initials: B
authors.lastname: Culliney
authors.forename: Zujun
authors.initials: Z
authors.lastname: Li
authors.forename: Adam
authors.initials: A
authors.lastname: Jacobson
authors.forename: Theresa
authors.initials: T
authors.lastname: Tran
authors.forename: Spiros
authors.initials: S
authors.lastname: Manolidis
authors.forename: Stimson
authors.initials: S
authors.lastname: Schantz
authors.forename: Mark
authors.initials: M
authors.lastname: Urken
authors.forename: Mark
authors.initials: M
authors.lastname: Persky
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods*; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil