The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract

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.