Trimodality management of sinonasal undifferentiated carcinoma and review of the literature

Waleed Fouad Mourad, David Hauerstock, Rania A. Shourbaji, Kenneth S. Hu, Bruce Culliney, Zujun Li, Adam Jacobson, Theresa Tran, Spiros Manolidis, Stimson Schantz, Mark Urken, Mark Persky, Louis B. Harrison

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

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 70Gy of radiation, respectively. In all patients receiving concurrent chemoradiation, cisplatin was used, at a dose of 100mg/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.

Original languageEnglish (US)
Pages (from-to)584-588
Number of pages5
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume36
Issue number6
DOIs
StatePublished - Dec 1 2013

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Mucositis
docetaxel
Cisplatin
Survival
Xerostomia
Optic Nerve Diseases
Cranial Nerves
Chemoradiotherapy
Peripheral Nervous System Diseases
Dermatitis
Deglutition Disorders
Sinonasal undifferentiated carcinoma
Fluorouracil
Disease-Free Survival
Fatigue
Cause of Death
Neoplasms
Retrospective Studies
Radiation
Neoplasm Metastasis

Keywords

  • Chemotherapy
  • Radiation therapy
  • SNUC
  • Sinonasal cancer
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Trimodality management of sinonasal undifferentiated carcinoma and review of the literature. / Mourad, Waleed Fouad; Hauerstock, David; Shourbaji, Rania A.; Hu, Kenneth S.; Culliney, Bruce; Li, Zujun; Jacobson, Adam; Tran, Theresa; Manolidis, Spiros; Schantz, Stimson; Urken, Mark; Persky, Mark; Harrison, Louis B.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 36, No. 6, 01.12.2013, p. 584-588.

Research output: Contribution to journalReview article

Mourad, WF, Hauerstock, D, Shourbaji, RA, Hu, KS, Culliney, B, Li, Z, Jacobson, A, Tran, T, Manolidis, S, Schantz, S, Urken, M, Persky, M & Harrison, LB 2013, 'Trimodality management of sinonasal undifferentiated carcinoma and review of the literature', American Journal of Clinical Oncology: Cancer Clinical Trials, vol. 36, no. 6, pp. 584-588. https://doi.org/10.1097/COC.0b013e31825eb3a5
Mourad, Waleed Fouad ; Hauerstock, David ; Shourbaji, Rania A. ; Hu, Kenneth S. ; Culliney, Bruce ; Li, Zujun ; Jacobson, Adam ; Tran, Theresa ; Manolidis, Spiros ; Schantz, Stimson ; Urken, Mark ; Persky, Mark ; Harrison, Louis B. / Trimodality management of sinonasal undifferentiated carcinoma and review of the literature. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2013 ; Vol. 36, No. 6. pp. 584-588.
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abstract = "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 70Gy of radiation, respectively. In all patients receiving concurrent chemoradiation, cisplatin was used, at a dose of 100mg/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.",
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T1 - Trimodality management of sinonasal undifferentiated carcinoma and review of the literature

AU - Mourad, Waleed Fouad

AU - Hauerstock, David

AU - Shourbaji, Rania A.

AU - Hu, Kenneth S.

AU - Culliney, Bruce

AU - Li, Zujun

AU - Jacobson, Adam

AU - Tran, Theresa

AU - Manolidis, Spiros

AU - Schantz, Stimson

AU - Urken, Mark

AU - Persky, Mark

AU - Harrison, Louis B.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - 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 70Gy of radiation, respectively. In all patients receiving concurrent chemoradiation, cisplatin was used, at a dose of 100mg/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.

AB - 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 70Gy of radiation, respectively. In all patients receiving concurrent chemoradiation, cisplatin was used, at a dose of 100mg/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.

KW - Chemotherapy

KW - Radiation therapy

KW - SNUC

KW - Sinonasal cancer

KW - Surgery

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