title: A comprehensive comparative analysis of treatment modalities for sinonasal malignancies.
abstract: BACKGROUND
  Sinonasal malignancies are a rare and heterogeneous group of tumors for which there is a paucity of robust data with which to guide management decisions. The authors used the National Cancer Data Base to better understand the presenting characteristics of these tumors and to compare outcomes by treatment modality.
  
  
  METHODS
  The National Cancer Data Base was queried for sinonasal malignancies diagnosed between 2004 and 2012. Overall survival was assessed using multivariate analyses and propensity score matching.
  
  
  RESULTS
  A total of 11,160 patients were identified for the initial analysis. The majority were male, aged 40 to 69 years, with tumors of the nasal cavity or maxillary sinus. Squamous cell histology was most common. The majority of patients presented with advanced tumor stage but without locoregional lymph node or distant metastases. Treatment modalities were compared for squamous cell carcinomas. In multivariate analysis, compared with surgery alone, patients who received adjuvant radiotherapy (hazard ratio [HR], 0.658 [P<.001]), adjuvant chemoradiotherapy (HR, 0.696 [P = .002]), or neoadjuvant therapy (HR, 0.656 [P = .007]) had improved overall survival. Patients who received radiotherapy alone (HR, 1.294 [P = .001]) or chemotherapy alone (HR, 1.834 [P<.001]) had worse outcomes. These findings were validated in propensity score matching. It is important to note that neoadjuvant chemoradiotherapy was associated with achieving a negative surgical margin (odds ratio, 2.641 [P = .045]).
  
  
  CONCLUSIONS
  Surgery is the mainstay of therapy for patients with sinonasal malignancies, but multimodality therapy is associated with improved overall survival. Cancer 2017;123:3040-49. © 2017 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Tyler P
authors.identifier: http://orcid.org/0000-0002-0211-5552
authors.initials: TP
authors.lastname: Robin
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Oren M
authors.initials: OM
authors.lastname: Gordon
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Andy
authors.initials: A
authors.lastname: Phan
authors.affiliation: Department of Biostatistics and Informatics, Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado.
authors.forename: Diana
authors.initials: D
authors.lastname: Abbott
authors.affiliation: Department of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: McDermott
authors.affiliation: Department of Otolaryngology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Goddard
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Raben
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Lanning
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000473:pathology / Q000628:therapy*; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000628:therapy*; D018277:Carcinoma, Mucoepidermoid / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D000072662:Margins of Excision; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009669:Nose Neoplasms / Q000473:pathology / Q000628:therapy*; D013517:Otorhinolaryngologic Surgical Procedures; D010255:Paranasal Sinus Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate; D055815:Young Adult
keywords: National Cancer Data Base (NCDB); chemoradiotherapy; head and neck cancer; radiotherapy; sinonasal malignancy