Clin Exp Otorhinolaryngol.  2024 Aug;17(3):253-262. 10.21053/ceo.2024.00157.

The Search for an Ideal Definitive Treatment of Sinonasal Squamous Cell Carcinoma With Orbit Invasion

• Han SC
• Seong J
• Cho SW
• Kim HJ
• Kim JW
• Kim DY
• Rhee CS
• Won TB

• KMID: 2558842
• DOI: http://doi.org/10.21053/ceo.2024.00157

Abstract

Objectives
. Sinonasal squamous cell carcinoma (SqCC) often invades the orbit. The treatment approach for sinonasal cancer that has spread to the orbit varies across medical centers and depends on the extent of the invasion. The decision to preserve the orbit in the treatment strategy is made on a case-by-case basis and results in varying outcomes. Currently, a multimodal treatment regimen, which may include surgery, chemotherapy, radiotherapy (RT), or concurrent chemoradiotherapy (CCRT), is commonly adopted for managing sinonasal cancers. This study aims to assess the prognosis of sinonasal SqCC with orbital invasion from various perspectives.
Methods
. We conducted a retrospective review of patients with primary sinonasal SqCC invading the orbit who were treated at Seoul National University Hospital and Seoul National University Bundang Hospital between 2009 and 2018. The extent of the tumor, orbital invasion, treatment strategies, recurrence rates, and survival rates were analyzed.
Results
. Overall survival and disease-free survival (DFS) rates showed no significant differences based on the grade of orbital invasion. When tumor resection with orbit preservation was employed as the definitive treatment, DFS was significantly extended compared to cases where surgery was not the definitive treatment (RT or CCRT). Additionally, there was no significant difference in DFS between patients who underwent orbit exenteration and those who underwent tumor resection with orbit preservation as the definitive treatment.
Conclusion
. Tumor resection with orbit preservation as the definitive treatment appears to be the preferred approach, prolonging DFS and increasing the likelihood of longer-term survival in cases of SqCC with orbital invasion.

Keyword

Nasal Cancers; Survival Analysis; Disease-Free Survival; Mortality

Figure

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  Fig. 1. Examples of four grades of orbital invasion. (A) Orbital invasion grade 1. There is erosion of the right inferior orbital bony wall (yellow arrows). (B) Orbital invasion grade 2. There is invasion of the periorbital layer and focal invasion of the extraconic periorbital fat (yellow arrows). (C) Orbital invasion grade 3. There is invasion of the orbital contents in the anterior two-thirds of the orbit, including the extra-ocular muscles and ocular bulb (yellow arrows). (D) Orbital invasion grade 4. There is involvement of the orbital apex (yellow arrows).

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  Fig. 2. Treatment algorithm for advanced sinonasal malignancies. If neoadjuvant chemotherapy (CTx) is not administered, the initial treatment options include surgery, concurrent chemo-radiotherapy (CCRT), or radiotherapy (RT), and CTx surgery may be followed by postoperative RT or CCRT, depending on individual patient factors. When neoadjuvant CTx is considered appropriate, it is the first step in treatment. If the tumor is inoperable or the patient declines surgery, CCRT or RT is then administered. In cases of stable disease (SD), progressive disease (PD), or partial response (PR) with downstaging, surgical intervention is considered, which may or may not be followed by postoperative CCRT or RT. This figure classifies and illustrates a total of 68 patients with squamous cell carcinoma according to this treatment algorithm. OE, orbit exenteration.

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  Fig. 3. Kaplan-Meier curves for overall survival and disease-free survival in 68 patients diagnosed with sinonasal squamous cell carcinoma (SqCC) with orbital invasion. The Kaplan-Meier curve of overall survival (A) and disease-free survival (B) in 68 patients diagnosed with sinonasal SqCC with orbital invasion.

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  Fig. 4. Kaplan-Meier curves for overall survival and disease-free survival in squamous cell carcinoma (SqCC) patients according to the orbital invasion grade. The Kaplan-Meier curve for overall survival (A) and disease-free survival (B) in 68 patients with SqCC according to the orbital invasion grade. Gr, grade.

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  Fig. 5. Kaplan-Meier curves for overall survival and disease-free survival in squamous cell carcinoma (SqCC) patients according to the definitive treatment. The Kaplan-Meier curve for overall survival (A) and disease-free survival (B) in 68 patients with SqCC according to the definitive treatment. OE, patients who received treatments including orbit exenteration as definitive treatment; OP, surgery, patients who received surgical treatments without orbit exenteration as definitive treatment; OP, other Tx, patients who received non-surgical treatments such as chemotherapy or concurrent chemoradiotherapy as definitive treatment.

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