Cisplatin-based neoadjuvant chemotherapy and combined resection for ethmoid sinus adenocarcinoma reaching and/or invading the skull base
D. Brasnu, O. Laccourreye, V. Bassot, L. Laccourreye, P. Naudo and F. X. Roux
Department of Otorhinolaryngology-Head & Neck Surgery, Laennec Hospital, University Paris V, France.
OBJECTIVE: To review our experience with cisplatin-based neoadjuvant
chemotherapy before en bloc resection via a combined neurosurgical and
transfacial approach for ethmoid sinus adenocarcinoma reaching and/or
invading the skull base. DESIGN: Case series. SETTING: A tertiary care
center and university teaching hospital. PATIENTS: Twenty-two patients with
primary untreated ethmoid sinus adenocarcinoma reaching and/or invading the
skull base consecutively treated between 1984 and 1992 with cisplatin-based
neoadjuvant chemotherapy and combined neurosurgical and transfacial
approach. MAIN OUTCOME MEASURES: Statistical analysis of survival, local
control, nodal recurrence, distant metastasis, and metachronous second
primary tumor incidence based on the Kaplan-Meier actuarial method.
Univariate analysis was performed to analyze the relationships between
various factors, survival, and local recurrence. Clinical response,
histological response, toxic effects of chemotherapy, and postoperative
course were also reported. RESULTS: The Kaplan-Meier 3-year survival, local
control, nodal recurrence, and distant metastasis estimates were 68.1%,
65.7%, 5.3%, and 10%, respectively. Metachronous second primary tumor was
not encountered in our series. Survival was statistically more likely to be
reduced in patients with intrasphenoidal tumor extent (P = .04) and local
recurrence (P = .01). Local recurrence was statistically more likely in
patients with intrasphenoidal tumor extent (P = .002) and no response to
cisplatin-based neoadjuvant chemotherapy (P = .03). CONCLUSIONS: The
results achieved suggest that cisplatin-based neoadjuvant chemotherapy
before combined neurosurgical and transfacial approach should be further
investigated for the treatment of ethmoid sinus adenocarcinoma reaching
and/or invading the skull base.
