Multidisciplinary treatment algorithm for the management of sinonasal cancers with orbital invasion: A retrospective study

Abstract

Background: Sinonasal cancers frequently involve the orbit with resulting controversies on whether to remove or preserve the orbital contents.

Methods: Retrospective review of patients with primary sinonasal cancer involving the orbit, treated according to a multidisciplinary protocol tailored to tumor histology and extent of orbital invasion in two tertiary care referral centers over a 20-year period.

Results: The oncological and functional outcomes of 163 patients were analyzed. The degree of orbital involvement significantly affected both overall (P < .0001) and disease-free (P < .0001) survival. Orbital apex invasion was an independent negative prognostic factor (5-year overall survival, 14.6% ± 7.5%), with dismal prognosis regardless of the treatment adopted. An appropriate use of induction chemotherapy and endoscopic-assisted surgery allowed for orbital preservation in 76.6% of cases; 96% of patients treated using an orbit-sparing approach maintained a functional eye after treatment.

Conclusion: The multimodal treatment algorithm herein proposed was able to maximize orbital preservation rates with acceptable oncological and functional outcomes.

Keywords: anterior skull base; endoscopic endonasal surgery; induction chemotherapy; orbital exenteration; sinonasal malignancy.