A Comparison of Neoadjuvant versus Adjuvant Radiotherapy in the Management of Sinonasal Malignancy: A Single Quaternary Skull Base Unit Experience
Bibliographic record
Abstract
Introduction: Current surgical tenet maintains that the management of sinonasal malignancy requires primary surgical resection followed by adjuvant radiotherapy. However, mapping of radiotherapy fields can be challenging post operatively, given the post operative changes apparent on cross sectional imaging. Furthermore, radiation induced toxicity is directly related to both the dose and field of radiation therapy administered and has the potential to impart significant visual toxicity particularly in sinonasal malignancy. This study aims to compare neoadjuvant and adjuvant radiotherapy approaches, evaluating both progression-free and overall survival. Methods: This is a retrospective review of prospectively gathered data. It included all patients over the age of 18 years, with a diagnosis of squamous cell carcinoma, adenocarcinoma or olfactory neuroblastoma who had undergone surgical resection between January 2001 and December 2018 at a single quaternary skull base referral center. A total of 58 patients were included in the study. 28 patients underwent surgical resection followed by adjuvant radiotherapy (AR) and 30 patients underwent neo-adjuvant radiotherapy (NAR) followed by surgical resection. Results: Preliminary analysis indicated no statistically significant differences between the NAR and AR groups in terms of overall survival (OS) (90.84 vs. 102.99 months) ( p = 0.4692) and progression-free survival (PFS) (89.62 vs. 81.38 months) ( p = 0.6412). No significant discrepancies in pathology ( p = 0.6579), or demographics [age ( p = 0.4164), Gender ( p = 0.6053)] were observed between groups. Positive margin rates were lower in the neoadjuvant group with a trend towards statistical significance noted; specifically, there were 2 cases in individuals with olfactory neuroblastoma, compared to 8 cases in the adjuvant group, who had a variety of pathologies ( p = 0.0630). The pathology-specific data demonstrated the following: For the 12 patients with olfactory neuroblastoma in the neoadjuvant group, the median PFS and OS stood at 115.98 months for both as opposed to 80.03 and 86.72 months in the 8 patients from the adjuvant group. In the squamous cell carcinoma category, 9 patients from the neoadjuvant group had median PFS and OS of 67.57 and 93.73 months, contrasted with 10 patients in the adjuvant group who had 74.6 and 85.83 months. Additionally, 9 patients in the neoadjuvant group diagnosed with adenocarcinoma recorded median PFS and OS of 57.23 and 60.3 months, compared to 82.25 and 92.7 months in the 10 patients from the adjuvant group. Conclusion: Our data suggest that neoadjuvant radiotherapy is not inferior to adjuvant radiotherapy in terms of PFS and OS in sinonasal malignancy treatment. Given the potentially higher visual toxicity of adjuvant radiotherapy and the encouraging lower rate of positive margins observed in the neoadjuvant approach, it presents a potentially preferable alternative in many cases, warranting further research. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".