title: Therapy of sinonasal malignancies invading the orbit-orbital exenteration versus preservation of the orbit plus radiotherapy.
abstract: BACKGROUND
  Orbital invasion is a strong independent prognostic factor for sinonasal malignancies. While there is consent about preservation of the orbit for tumors limited to the orbital periosteum there is controversy about the optimal management of sinonasal malignancies transgressing this barrier. Therefore the aim of our study was to compare exenteration versus preservation of the orbit.
  
  
  METHODS
  52 patients with sinonasal malignancies invading the orbit beyond the orbital periosteum with involvement of the orbital soft tissues were included in the retrospective study. Prognostic factors were identified through univariate analysis.
  
  
  RESULTS
  Univariate analysis revealed a significant impact of N-classification (p = 0.017), and treatment strategy (p = 0.016). Exenteration of the orbit was associated with a significantly better 5-year overall survival rate (65.5%) than preservation of the orbit (14%).
  
  
  CONCLUSIONS
  For patients with invasion of the structures beyond the orbital periosteum, exenteration yields better survival results than preservation of the orbital structures in combination with radiotherapy. In cases where both eyes are affected from the tumor or if only one dysfunctional eye would be left over after therapy, we do not recommend orbital exenteration because life quality would be critically deteriorated.
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery (Head: Prof. Dr. Dr. J.E. Zöller), University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany. Electronic address: asafi@outlook.de.
authors.forename: Ali-Farid
authors.initials: AF
authors.lastname: Safi
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery (Head: Prof. Dr. Dr. J.E. Zöller), University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Behn
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery (Head: Prof. Dr. Dr. J.E. Zöller), University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rothamel
authors.affiliation: Department of Oto-Rhino-Laryngology and Head Neck Surgery, Jena University Hospital, 07743 Jena, Germany.
authors.forename: Orlando
authors.initials: O
authors.lastname: Guntinas-Lichius
authors.affiliation: Department of Oto-Rhino-Laryngology and Head Neck Surgery, University of Cologne, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Beutner
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery (Head: Prof. Dr. Dr. J.E. Zöller), University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Nickenig
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery (Head: Prof. Dr. Dr. J.E. Zöller), University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Zöller
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery (Head: Prof. Dr. Dr. J.E. Zöller), University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology Cologne, 50937 Cologne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kreppel
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000473:pathology* / Q000601:surgery; D017233:Orbit Evisceration; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Exenteration of the orbit; Multimodal treatment; Orbital invasion; Paranasal sinus carcinoma