Session Item

Malignant tumors of the nose and the paranasal sinuses (sinonasal malignancies, SNM) are often diagnosed in their advanced stages. Local recurrence remains the main reason treatment fails and is diagnosed in about 50% of patients with SNM. Due to this, the question arises as to how effective the salvage procedure offered to these patients actually is. 

A review of retrospective clinical data of 146 consecutive patients with either nasal cavity or paranasal sinuses tumors treated radically between 2000 and 2016 in the National Cancer Research Institute, Gliwice branch, was performed. Squamous cell carcinoma was found in 79 (54%) cases. Maxilla was the primary tumor localization in 85 (58%) cases. In most cases, the tumor was locally advanced 100 (67.5%). Surgery was the primary treatment approach in 117 (80%) patients and followed induction CHT in 8 (6%) patients. The ratio and effects of salvage were analyzed. Probabilities of overall survival (OS), local control (LC), nodal control (NC), and locoregional control (LRC) were estimated from the end of RT using the Kaplan-Meier method and were compared by the log-rank test. Univariate analysis was used to evaluate the impact of clinical and treatment parameters on primary and salvage treatment outcomes.  

The 5-year and 10-year OS amounted to 62% and 45%. In 60 (41%) patients, treatment failure was observed. Locoregional failure was significantly higher for patients with primary symptoms lasting shorter than 5 months (p=0.04). A significantly higher ratio of locoregional failure was also found for patients without surgery (p=0.04). For patients eligible for salvage, median time to failure  was 10 months and for those who were not eligible – 2 months (p=0.005). The 5- and 10- year OS rates for patients with the median time to failure <= 7 months and >7 months were 25%, 17% and 63%, 44%, respectively (p=0.002). Salvage was performed in 36 (60%) patients. The 5- and 10- year OS rates for patients with disease failure who underwent salvage and who did not have such treatment, were 60%, 44% and 11%, 11% (p=0.0008), respectively. For patients with successful salvage, the 5- and 10- year OS was significantly higher compared to those with failed salvage: 90% v 25% and 72% v 0% respectively (p=0.0003) and did not differ significantly when compared to the OS of primarily cured patients (p=0,3). Surgery was the most frequent type of salvage both as a single approach (53%) and as a component of combined treatment (84%). 

Patients after radical treatment due to SNM should remain under oncological surveillance since salvage therapy is possible in more than 50% of those with failure and can improve their overall survival. Surgery is the most effective salvage option. Moreover, effective salvage can compensate for the failure and give the same ultimate OS as in primarily cured patients.