title: Nodal metastasis and elective nodal level treatment in sinonasal small-cell and sinonasal undifferentiated carcinoma: a surveillance, epidemiology and end results analysis.
abstract: OBJECTIVE
  Risk of nodal involvement in patients with sinonasal small-cell carcinoma and sinonasal undifferentiated carcinoma (SNUC) has not been well defined because of their rarity. We describe a population-based assessment of specific nodal level involvement in this group of rare neuroectodermal tumours.
  
  
  METHODS
  The Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2011 identified patients with SNUC and sinonasal small-cell carcinoma. Overall neck involvement and individual nodal level involvement at presentation were assessed, and comparison was made with a contemporaneous cohort of patients with a borderline clinically significant risk of nodal involvement and recurrence.
  
  
  RESULTS
  Of 141 patients, 31 (22%) had gross nodal involvement at presentation (range 14-33% by site and histology). Non-nasal, non-ethmoid site with SNUC histology has the highest rates of initial nodal involvement, whereas higher stage and size do not predict for higher nodal involvement rates. Bilateral Levels 2-3 for all sinonasal small cell; Levels 2-3 for nasal or ethmoid SNUC; and bilateral Levels 1-3 in non-nasal/non-ethmoid SNUC have the highest rates of involvement compared with a clinical reference standard.
  
  
  CONCLUSIONS
  We found high rates of initial nodal involvement in all SNUC and sinonasal small-cell carcinoma. We found higher initial involvement of Levels 2 and 3 and in certain cases to the Level 1 nodal levels, hypothesizing benefit for elective treatment to those levels.
  
  
  CONCLUSIONS
  With small single-institution series reporting conflicting nodal involvement rates, our data support high rates of nodal presentation at diagnosis, hypothesizing benefit for elective nodal treatment in this cohort.
authors.affiliation: 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Ahn
authors.affiliation: 2 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.affiliation: 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Alonso-Basanta
authors.affiliation: 3 Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
authors.affiliation: 3 Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.affiliation: 3 Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.affiliation: 3 Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Rassekh
authors.affiliation: 3 Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ara
authors.initials: A
authors.lastname: Chalian
authors.affiliation: 4 Department of Medical Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Cohen
authors.affiliation: 1 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lin
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D008875:Middle Aged; D011159:Population Surveillance; D018426:SEER Program; D014481:United States / Q000453:epidemiology