With the development of advanced endoscopic techniques and improvements in adjuvant therapy, the management of primary paranasal sinus malignancies, a rare form of head and neck cancer, has evolved significantly over the past three decades. Treatment generally involves surgical resection and may include both radiation therapy and chemotherapy. In the past, patients with these malignancies have suffered from high mortality rates, particularly those who present at late stages or are symptomatic. In the early days of its utilization, endoscopic approaches for these tumors were limited and generally selected for early-stage lesions. However, recent investigations have shown comparable or improved outcomes for endoscopic surgery for sinonasal cancers, due primarily to advances in imaging, instrumentation, and technique.
Dr. David Gudis
Few studies have examined trends in outcomes of paranasal sinus and nasal cavity cancers over time in a national population. To that end, David A. Gudis, MD, Chief of the Division of Rhinology and Anterior Skull Base Surgery in the Department of Otolaryngology – Head and Neck Surgery at NewYork-Presbyterian/Columbia University Irving Medical Center, and colleagues recently led a multicenter study to examine whether disease-specific survival (DSS) has improved since the expansion of endonasal endoscopic surgery in the management of these malignancies occurring largely since 2000.
The investigators also assessed the effect of year of diagnosis on five-year conditional disease-specific survival (CDSS), noting, “Whereas the five-year DSS represents the likelihood of a patient surviving five years from the date of diagnosis, the CDSS represents the change in disease-specific survival prognosis as a function of time since the cancer diagnosis. CDSS represents a valuable metric for both patients and providers alike in the management and counseling of cancer patients and has not previously been explored for paranasal sinus and nasal cavity cancers.” To the researchers’ knowledge, this study is the first to examine CDSS for these malignancies.
In their research, the results of which appear in the January 2022 issue of the American Journal of Rhinology & Allergy, the team extracted patients diagnosed with sinus and nasal cavity cancer between 1973 to 2015 from the Surveillance, Epidemiology, End Results (SEER) registry. In an analysis of 10,535 patients:
- Diagnosis after the year 2000 was independently associated with improved DSS after controlling for age and stage
- After stratifying by stage, diagnosis after 2000 was associated with improved DSS for localized, regional, and distant malignancies
- CDSS improved with increasing survivorship for all stages of sinus and nasal cavity cancer
- Patients diagnosed after 2000 had improved CDSS compared to those diagnosed before 2000
- Association of year of diagnosis with CDSS diminished with increasing survivorship for localized cancers but was consistent for other stages
The study demonstrated that both DSS and CDSS for sinus and nasal cavity cancer have improved over time for patients who both did and did not undergo surgery, suggesting that changes in clinical outcomes are due to developments in both surgical therapy as well as adjuvant therapy. The authors added, “Further studies are necessary to characterize the effect of multimodal treatment on outcomes, as well as improve our understanding of the drivers of change in sinus and nasal cavity cancer outcomes.”