Analysis of long-term results of conservative and surgical treatment in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses

Abstract

Introduction. Surgical intervention with subsequent chemoradiation therapy is one of the treatment standards in squamous cell carcinoma of the nasal cavity and paranasal sinuses. However, the question of the optimal therapy for this pathology remains open.Aim. To compare treatment results in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses after conservative and surgical treatment.Materials and methods. The study included 86 patients with squamous cell carcinoma of the nasal cavity and paranasal sinuses, stages III–Iva, who between 2000 and 2020 received treatment at the N.N. Blokhin National medical Research Oncology Center. Surgical treatment with subsequent radiation or chemoradiation therapy was performed in 31 patients, conservative treatment (radiation or chemoradiation therapy) was performed in 55 patients.Results. Five-year overall survival in the conservative treatment group was 46.2 %, in the surgical treatment group – 59.7 % (р = 0.081); 5-year progression-free survival was 17 and 50.5 %, respectively (p = 0.002). In patients with Т3N0 tumor who received surgical treatment, 5-year progression-free survival was significantly higher than in patients who received conservative treatment (p <0,05). Comparison of overall survival and progression-free survival of patients who achieved objective response (complete response + partial response) after conservative treatment (n =36) and after surgical treatment (n = 31) did not show statistically significant differences (р = 0.469 and р = 0.183, respectively). The overall 5-year survival rate in the salvage surgery treatment group (24/55) was 63.1 % compared with 59.7 % in the surgical treatment group (n = 31), there were also no significant differences (p = 0.95). In patients with T3 tumor who received conservative treatment in this study, higher risk of progression was observed compared to patients who underwent surgical treatment.Conclusion. Surgical intervention remains an important treatment method for patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, especially in cases of smaller tumor extent. Conservative therapy seems promising but large-scale prospective controlled randomized clinical trials are necessary to confirm its effectiveness and safety in various patient groups.