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Trimodality Management of Sinonasal Undifferentiated Carcinoma and Review of the Literature

Mourad, Waleed F. MD, MSc, PhD*,†; Hauerstock, David MD*; Shourbaji, Rania A. MPH*; Hu, Kenneth S. MD*,†; Culliney, Bruce MD; Li, Zujun MD; Jacobson, Adam MD§; Tran, Theresa MD§; Manolidis, Spiros MD§; Schantz, Stimson MD§; Urken, Mark MD§; Persky, Mark MD§; Harrison, Louis B. MD*,†

American Journal of Clinical Oncology: December 2013 - Volume 36 - Issue 6 - p 584–588
doi: 10.1097/COC.0b013e31825eb3a5
Original Articles: Head & Neck

Objective: Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive malignancy with optimal management remains unclear. We performed a review of the impact of trimodality approach on SNUC outcome.

Methods: This is a single-institution retrospective study of 18 patients, who were managed between 1997 and 2009. The median age at presentation was 52 years (28 to 82). Nine patients (50%) were female. Three patients had stage II disease and underwent surgery alone, 12 had stages III and IVa and underwent surgery combined with chemoradiation, and 3 had stage IVb and underwent definitive chemoradiation. Patients who underwent preoperative, postoperative, and definitive chemoradiation received 60, 66, and 70 Gy of radiation, respectively. In all patients receiving concurrent chemoradiation, cisplatin was used, at a dose of 100 mg/m2 every 3 weeks for 3 cycles. Neoadjuvant chemotherapy included docetaxel, cisplatin, and 5-fluorouracil (TPF) every 3 weeks for 2 to 3 cycles.

Results: After a median follow-up of 26 months (16 to 120), a total of 8 patients (44%) have experienced the following: 1 persistent disease (5.5%), 4 local failure (22%), and 3 distant metastases (DM, 16.5%). Five of the 8 patients had preexisting cranial nerve deficits or gross cranial invasion. The 2-, 3-, and 4-year local control (LC), disease-free survival (DFS), and overall survival (OS) were 78%, 72%, and 56%; 75%, 65%, and 52%; and 75%, 50%, and 48%, respectively. Trimodality approach provided 83% LC and 92% DM-free survival, whereas other modalities provided 50% LC and 33% DM-free survival. The causes of death for the entire cohort were DM and local invasion. Acute chemoradiotherapy toxicity was 100% grades 1 and 2 dermatitis, mucositis, and fatigue, 55% developed grades 1 and 2 dysphagia, and 6% had grade 3 mucositis. Long-term toxicity was 28% grade 1 xerostomia, 11% retinopathy and optic neuropathy, and 6% orbital exenteration and grade 3 peripheral neuropathy.

Conclusions: SNUC is an aggressive neoplasm that frequently presents at an advanced stage. Our data show that trimodality approach in the form of surgery combined with chemoradiation seems to offer better LC and lower DM compared with other modalities.

*Department of Radiation Oncology

Department of Medical Oncology

§Department of Otolaryngology, Beth Israel Medical Center, New York

Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center, Bronx, NY

The authors declare no conflicts of interest.

Reprints: Waleed Fouad Mourad, MD, MSc, PhD, Department of Radiation Oncology, Beth Israel Medical Center, Albert Einstein College of Medicine,Yeshiva University, 10 Union Square E. Suite 4G, New York, NY 10003. E-mail: waleed246@gmail.com.

© 2013 by Lippincott Williams & Wilkins, Inc