What Is the Role of Induction Chemotherapy in the Treatment of Locally Advanced Sinonasal Squamous Cell Carcinoma?

TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summary below includes the Background and Best Practice sections of the original article. To view the complete Laryngoscope article free of charge, visit Laryngoscope.

BACKGROUND

Sinonasal neoplasms represent a distinct subset of head and neck malignancies exhibiting a wide spectrum of histopathologies and divergent biological behaviors. Squamous cell carcinoma (SCC) accounts for a majority of these tumors and is traditionally managed surgically. However, close proximity to critical structures, such as the skull base and orbit, can make surgical resection a challenge, especially in the context of locoregionally advanced disease. As a result, sinonasal SCC extending to the orbit has often necessitated radical excision with orbital exenteration to achieve clear surgical margins. Management of the skull base has evolved over time, with minimally invasive techniques providing comparable outcomes to traditional open craniofacial approaches. Over the years, the advent of endoscopic surgery and advancements in multimodal treatment strategies have increasingly enabled treatment protocols to favor organ-preserving management for advanced malignancies (Head Neck. 2019;41:2777–2788). Induction chemotherapy (IC), in particular, has shown promise, with reports suggesting its ability to improve morbidity and survival outcomes in select patients with locally advanced disease (Int Forum Allergy Rhinol. 2019;9:212–219). Herein, we review some of the most recent and highest levels of evidence that have investigated IC and its role in managing locoregionally advanced sinonasal SCC.

BEST PRACTICE

Locally advanced sinonasal SCC demonstrates a wide spectrum of disease, and susceptibility to IC remains largely observational, with no reliable pretreatment predictors. Patients may benefit from a trial of IC used in an attempt to downgrade tumor extension into nearby structures and facilitate organ preservation. The potential benefits of IC must be weighed against its associated adverse effects, however, especially in more vulnerable patient populations. Pathological response to IC may prognosticate long-term patient outcomes (“bioselection”), as an effective response to IC appears to portend a lower likelihood of recurrence and higher overall survival and disease-free survival. Therefore, a response-dependent treatment protocol (Figure 1), wherein subsequent definitive therapy is dictated by IC response, may be warranted until further investigations elucidate more optimal treatment strategies.