In the Journals Plus

Chemoradiotherapy may confer survival benefit in sinonasal undifferentiated carcinoma

Editor’s Note: On March 15, we corrected the headline of this article to accurately reflect the patient population in the study. The study included patients with sinonasal undifferentiated carcinoma. The Editors regret this error.

Patients with sinonasal undifferentiated carcinoma who responded well to induction chemotherapy had better survival outcomes with definitive concurrent chemoradiotherapy than definitive surgery, according to a study published in Journal of Clinical Oncology.

However, surgery appeared to offer a better chance of disease control and improved survival for those who do not respond favorably to induction chemotherapy.

“Most published studies report the outcomes of patients treated surgically, with or without postoperative radiotherapy; some case series delineate the outcomes of patients treated with preoperative radiotherapy followed by surgery, induction chemotherapy followed by definitive radiotherapy with concurrent chemotherapy, or definitive radiotherapy with concurrent chemotherapy and reserving surgery to salvage therapy,” Moran Amit, MD, PhD, acting assistant professor of otolaryngology at Institute for Academic Medicine at Houston Methodist Hospital, and colleagues wrote. “Most of these studies suffer from a small number of patients and inconsistent treatment strategies. Although there is agreement that multimodal therapy is needed, the optimal sequence and combination of treatment modalities is not known.”

The analysis by Amit and colleagues included 95 treatment-naive patients diagnosed with sinonasal undifferentiated carcinoma and treated at The University of Texas MD Anderson Cancer Center between 2001 and 2018.
(median cycles, 3; range, 1-5) prior to definitive locoregional therapy.

After induction chemotherapy, 63 patients (median age, 53 years; 71% men) received concurrent chemoradiotherapy and 32 patients (median age, 55 years; 67% men) underwent surgery — including craniofacial resection (n = 18), endoscopic endonasal resection (n = 11) and endoscopically assisted craniofacial resection (n = 3) — followed by radiotherapy.

Most patients who underwent surgery also received concurrent chemoradiotherapy (n = 28).

Disease-specific survival served as the study’s primary endpoint. OS, DFS, disease recurrence and organ preservation served as secondary endpoints.

Results showed 5-year disease-specific survival probability of 59% (95% CI, 53-66) for the entire cohort and 5-year OS probability of 56% (95% CI, 51-61).

Among those who responded to induction chemotherapy, 5-year disease-specific survival probabilities were 81% (95% CI, 69-88) after definitive concurrent chemoradiotherapy and 54% (95% CI, 44-61) after definitive surgery and postoperative therapy (log-rank P = .001).

Among those who did not respond to induction chemotherapy, 5-year disease-specific survival probabilities were 0% (95% CI, 0-4) for patients subsequently treated with concurrent chemoradiotherapy and 39% (95% CI, 30-46) for patients treated with surgery plus therapy (adjusted HR = 5.89; 95% CI, 2.89-9.36).

“Our findings must be further validated in a prospective study that will likely need multi-institutional participation because of the rarity of this disease,” the researchers wrote. “There is also a critical need to identify molecular markers of response to treatment to further guide the selection of therapy and perhaps provide targets for novel therapies for treatment of sinonasal undifferentiated carcinoma.” – by Jennifer Byrne

Disclosures: Amit reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Editor’s Note: On March 15, we corrected the headline of this article to accurately reflect the patient population in the study. The study included patients with sinonasal undifferentiated carcinoma. The Editors regret this error.

Patients with sinonasal undifferentiated carcinoma who responded well to induction chemotherapy had better survival outcomes with definitive concurrent chemoradiotherapy than definitive surgery, according to a study published in Journal of Clinical Oncology.

However, surgery appeared to offer a better chance of disease control and improved survival for those who do not respond favorably to induction chemotherapy.

“Most published studies report the outcomes of patients treated surgically, with or without postoperative radiotherapy; some case series delineate the outcomes of patients treated with preoperative radiotherapy followed by surgery, induction chemotherapy followed by definitive radiotherapy with concurrent chemotherapy, or definitive radiotherapy with concurrent chemotherapy and reserving surgery to salvage therapy,” Moran Amit, MD, PhD, acting assistant professor of otolaryngology at Institute for Academic Medicine at Houston Methodist Hospital, and colleagues wrote. “Most of these studies suffer from a small number of patients and inconsistent treatment strategies. Although there is agreement that multimodal therapy is needed, the optimal sequence and combination of treatment modalities is not known.”

The analysis by Amit and colleagues included 95 treatment-naive patients diagnosed with sinonasal undifferentiated carcinoma and treated at The University of Texas MD Anderson Cancer Center between 2001 and 2018.
(median cycles, 3; range, 1-5) prior to definitive locoregional therapy.

After induction chemotherapy, 63 patients (median age, 53 years; 71% men) received concurrent chemoradiotherapy and 32 patients (median age, 55 years; 67% men) underwent surgery — including craniofacial resection (n = 18), endoscopic endonasal resection (n = 11) and endoscopically assisted craniofacial resection (n = 3) — followed by radiotherapy.

Most patients who underwent surgery also received concurrent chemoradiotherapy (n = 28).

Disease-specific survival served as the study’s primary endpoint. OS, DFS, disease recurrence and organ preservation served as secondary endpoints.

Results showed 5-year disease-specific survival probability of 59% (95% CI, 53-66) for the entire cohort and 5-year OS probability of 56% (95% CI, 51-61).

Among those who responded to induction chemotherapy, 5-year disease-specific survival probabilities were 81% (95% CI, 69-88) after definitive concurrent chemoradiotherapy and 54% (95% CI, 44-61) after definitive surgery and postoperative therapy (log-rank P = .001).

Among those who did not respond to induction chemotherapy, 5-year disease-specific survival probabilities were 0% (95% CI, 0-4) for patients subsequently treated with concurrent chemoradiotherapy and 39% (95% CI, 30-46) for patients treated with surgery plus therapy (adjusted HR = 5.89; 95% CI, 2.89-9.36).

“Our findings must be further validated in a prospective study that will likely need multi-institutional participation because of the rarity of this disease,” the researchers wrote. “There is also a critical need to identify molecular markers of response to treatment to further guide the selection of therapy and perhaps provide targets for novel therapies for treatment of sinonasal undifferentiated carcinoma.” – by Jennifer Byrne

Disclosures: Amit reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.