Kt. Pitman et al., The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract, HEAD NECK, 21(5), 1999, pp. 402-407
Citations number
18
Categorie Soggetti
Otolaryngology
Journal title
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
Background. Adenoid cystic carcinoma (ACC) of the sinonasal tract is an agg
ressive malignancy associated with a poor 5-year survival rate. The role of
skull base surgery for the treatment of patients presenting with sinonasal
ACC and its impact upon their survival has not previously been evaluated.
Methods. A retrospective review of 35 patients with ACC of the sinonasal tr
act who were treated with surgery and radiation therapy at the University o
f Pittsburgh Medical Center was performed to evaluate patient outcome.
Results. Local recurrence of tumor following surgery and radiation therapy
was observed in 36% of the patients originally treated at the University of
Pittsburgh Medical Center. Fourteen percent of these patients developed a
regional tumor recurrence, and 21% developed distant metastases. We did not
identify any tumor-related factors that predicted patient outcome. Local r
ecurrences were treated with salvage surgical excision, and, despite aggres
sive management, only 1 of 17 patients with local recurrence was considered
cured (NED) at 24 months (follow-up after salvage surgery). Overall, disea
se-free survival was 46.4%, at a median follow-up of 40 months.
Conclusions. ACC of the sinonasal tract is an aggressive malignancy. Skull
base surgery has facilitated the gross total excision of advanced lesions t
hat were deemed inoperable in the past, but has not resulted in an overall
improvement in disease-free survival. Local recurrence portends a very poor
prognosis, despite aggressive salvage regimens. Alternative therapies for
local recurrences warrant further investigation. Prospective, randomized st
udies are necessary to evaluate the outcome of patients treated with aggres
sive multimodal treatment regimens, including chemotherapeutic regimens. (C
) 1999 John Wiley & Sons, Inc.