A Second Fight: Understanding Recurrences in Sinonasal Tumors

Abstract

Abstract:

Introduction: This study aimed to investigate recurrence patterns by histological diagnosis in sinonasal malignancies, focusing on patterns of failure, time to recurrence, recurrence frequency, and its location relative to the radiotherapy target area.

Materials and methods: Patients with sinonasal malignancies treated curatively (2010–2022) were included in this retrospective cohort study. Medical information was obtained from electronic health records. Disease-specific survival and recurrence-free survival at one, three, and five years were calculated for all patients. Patients who developed a local recurrence after receiving radiotherapy were assessed using rigid fusion to determine the center of mass and its position to the clinical target volume used in radiotherapy.

Results: A total of 71 patients were analyzed, most diagnosed with a squamous cell carcinoma (32.4%), mucosal melanoma (21.1%), or intestinal adenocarcinoma (12.7%). Treatment mainly involved surgery with postoperative radiotherapy (64.8%). Multiple recurrences occurred in 25.4% of patients. Recurrence occurred mostly locally (65.1%). In patients receiving radiotherapy, most recurrences occurred within the low and high dose clinical target volume. The median recurrence-free survival was 13.1 months; disease-specific survival was 77% at one year and 41% at five years, varying by histology.

Conclusion: This study provides insights into recurrence patterns in sinonasal malignancies, showing a median time to first recurrence of 13.1 months. Patients diagnosed with intestinal adenocarcinomas had a superior recurrence-free survival. Most recurrences were local, while distant recurrences affected the lungs, brain, bones, and liver. Among patients with local recurrence post-radiotherapy, 75% occurred within both high- and low-dose clinical target volume. Perineural invasion primarily affected the maxillary nerve.