164 Pre-operative Radiotherapy for Sinonasal Squamous Cell Carcinoma: outcomes and patient selection
Notice bibliographique
Résumé
Resectable sinonasal squamous cell carcinoma (SNSCC) is often managed by surgery +/- post-operative radiation (postop-RT), guided by surgical pathology. In our institution, pre-operative radiation (preop-RT) +/- chemotherapy has been used in select cases after multidisciplinary input from radiation, surgical, and medical oncology teams. Preop-RT has the advantages of lower dose and smaller/better defined volumes in non-surgically perturbed tissues, which can be especially important for treatment approximating optic structures. The aim of this study is to evaluate preop-RT, compared to standard postop-RT, in patients with SNSCC, focusing on oncologic outcomes and patient selection. All newly diagnosed SNSCC treated with preop-RT or postop-RT from 2005 to 2021 were included. Clinical characteristics and outcomes were compared between preop-RT vs postop-RT cohorts. Outcome endpoints included overall survival (OS), disease-free survival (DFS), locoregional control (LRC) and distant control (DC). OS and DFS were estimated with Kaplan-Meier method while LRC and DC were calculated with competing risk methods. A total of 72 patients were eligible: 25 received preop-RT and 47 postop-RT. The preop-RT cohort comprised more origin from the ethmoid sinus (44% vs 0%, p<0.001), and more T3-T4 diseases (versus T1-2) at presentation (96% vs 68%, p<0.01). HPV testing was not performed in the majority of cases; among those tested, two out of 8 (25%) SNSCC tested p16-positive in the preop-RT cohort and 13 out of 18 (72%) in the postop-RT cohort. The remaining baseline characteristics were similar between the preop-RT vs postop-RT cohorts. The documented clinical reasons for pre-operative radiation included minimizing dose to preserve orbital structures and avoidance of orbital exenteration (n=12, 48%), improving resection margin clearance (n=7, 28%), and reducing extent and morbidity of the surgical approach (n=4, 16%). All patients in preop-RT cohort received 50 Gy in 25 fractions (50 Gy/25f) to the primary site, with 7 patients receiving a boost to 60 Gy (6 patients with simultaneous integrated boost, 1 patient with sequential 10 Gy/5f boost). The reasons for boost were treatment of gross/equivocal nodal disease to spare a neck dissection (n=4, 57%), or high-risk surgical regions with a high likelihood of a R1 resection based on a pre-emptive discussion with the surgical team (n=3, 43%). Three patients received concurrent cisplatin chemotherapy. Patients in the postop-RT cohort received 60 Gy/30f (n=11), 66 Gy/33f (n=20), 70 Gy/33-35f (n=11), and other (n=5). Fourteen (56%) preop-RT patients had complete pathological responses. The median follow-up was 5.5 and 5.2 years for the preop-RT and postop-RT cohort, respectively. Oncologic outcomes at 5-years were similar between preop-RT and postop-RT cohorts: OS 76% vs 69% (p=0.799), DFS 66% vs 62% (p=0.892), LRC 78% vs 69% (p=0.313), and DC 92% vs 88% (p=0.919), respectively (Table 1). With multidisciplinary decision-making for SNSCC, preop-RT is correlated with pathologic complete response, and lower doses to critical normal tissues. Oncologic outcomes are comparable between the two groups despite more T3-T4 disease in the preop-RT cohort. In the setting of collaborative multidisciplinary care in a high-volume centre, pre-op RT in the management of locally advanced resectable sinonasal SCC is a reasonable, and possibly preferred, option in select patients to minimize dose to optic structures and improve margin clearance.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».