Sinonasal squamous cell carcinoma without clinical lymph node involvement : Which neck management is best?
OBJECTIVE
The purpose of this work was to report outcomes of patients with nonmetastatic sinonasal squamous cell carcinoma (SNSCC) and to discuss the impact of elective neck irradiation (ENI) and selective neck dissection (SND) in clinically negative lymph node (N0) patients.


METHODS
Data from 104 nonmetastatic SNSCC patients treated with curative intent were retrospectively analysed. Uni- and multivariate analyses were used to assess prognostic factors of overall survival (OS) and locoregional control (LRC).


RESULTS
Median follow-up was 4.5 years. Eighty-five percent of tumours were stage III-IV. Treatments included induction chemotherapy (52.9 %), surgery (72 %) and radiotherapy (RT; 87 %). The 5‑year OS, progression-free survival, and LRC rates were 48, 44 and 57 %, respectively. Absence of surgery predicted a decrease of OS (hazard ratio [HR] 2.6; 95 % confidence interval [CI] 1.4-4.7), and LRC (HR 3.5; 95 % CI 1.8-6.8). Regional relapse was observed in 13/104 (13 %) patients and most common sites were level II (n = 12; 70.6 %), level III (n = 5; 29.4 %) and level Ib (n = 4; 23.5 %). Management of the neck in N0 patients (n = 87) included 11 % SND alone, 32 % ENI alone, 20 % SND + ENI and 37 % no neck treatment. In this population, a better LRC was found according to the management of the neck in favour of SND (94 % vs. 47 %; p = 0.002) but not ENI.


CONCLUSIONS
SND may detect occult cervical positive nodes, allowing selective postoperative RT. ENI (ipsilateral level II, ±Ib and III or bilateral) needs to be proposed in selected patients, especially when SND has not been performed.
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Pauline
P
Castelnau-Marchand
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.|INSERM U1030, Molecular Radiotherapy, Gustave-Roussy, Université Paris-Saclay, F-94805, 94800, Villejuif, France.|Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France.
Antonin
A
Levy
Department of Head and Neck Oncology, Gustave-Roussy, Université Paris-Saclay, F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Antoine
A
Moya-Plana
Department of Head and Neck Oncology, Gustave-Roussy, Université Paris-Saclay, F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Haïtham
H
Mirghani
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
France
F
Nguyen
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Eleonor Rivin
ER
Del Campo
Department of Head and Neck Oncology, Gustave-Roussy, Université Paris-Saclay, F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
François
F
Janot
Department of Head and Neck Oncology, Gustave-Roussy, Université Paris-Saclay, F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Frédéric
F
Kolb
Department of Head and Neck Oncology, Gustave-Roussy, Université Paris-Saclay, F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
François-Régis
FR
Ferrand
Department of Head and Neck Oncology, Gustave-Roussy, Université Paris-Saclay, F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Stéphane
S
Temam
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Pierre
P
Blanchard
Department of Radiation Oncology, Gustave-Roussy, Université Paris-Saclay, , F-94805, 114 Rue Edouard Vaillant, 94800, Villejuif, France. yungan.tao@gustaveroussy.fr.
Yungan
Y
Tao
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000401:mortality* / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000401:mortality* / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D000071036:Sentinel Lymph Node / Q000473:pathology; D015996:Survival Rate; D055815:Young Adult
Chemotherapy; Intensity-modulated radiotherapy; Neck dissection; Radiotherapy; Treatment outcomes