|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 650-651
Does induction chemotherapy advance the multimodal treatment of locally advanced esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation?
Merrill S Kies
MD Anderson Physicians Network, Houston, Texas, USA
|Date of Submission||07-Jul-2020|
|Date of Decision||10-Jul-2020|
|Date of Acceptance||12-Jul-2020|
|Date of Web Publication||19-Sep-2020|
Merrill S Kies
MD Anderson Physicians Network, Houston, Texas
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kies MS. Does induction chemotherapy advance the multimodal treatment of locally advanced esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation?. Cancer Res Stat Treat 2020;3:650-1
|How to cite this URL:|
Kies MS. Does induction chemotherapy advance the multimodal treatment of locally advanced esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation?. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 22];3:650-1. Available from: https://www.crstonline.com/text.asp?2020/3/3/650/295492
Patil et al. describe a complex sequential treatment approach in 25 consecutive patients, 12 with esthesioneuroblastoma (ESNB) and 13 with sinonasal neuroendocrine carcinoma (SNEC). These patients with locally advanced, but variable staging and limited molecular background data were observed over a median of 5.15 years to assess their progression-free survival (PFS), overall survival (OS), and clinical status. The patients received neoadjuvant chemotherapy (NACT) consisting of cisplatin/carboplatin and etoposide for two cycles and then based on the response received definitive local therapy comprising either surgical resection with adjuvant chemoradiation, definitive chemoradiation, or palliative radiation. The authors observed a PFS of 63.5% and 34.6% for patients with ESNB and SNEC, respectively. The OS was 91.7% and 46.2%, respectively. Both these sets of figures have wide confidence intervals, given the small numbers of patients. A multivariate analysis showed that the tumor response to NACT was associated with an improved PFS (P = 0.033), and the potential OS benefit was related to the fact that NACT preceded surgery and radiation. Moreover, orbital preservation was observed in some patients relating to the initial tumor response. Notably, 80% of the patients appeared to have meaningful chronic drug-related toxicities.
This report is valuable, given the threatening nature, relative rarity, and diversity of sinonasal malignancies. Continued focus on sequential multimodal treatment strategies has clear potential benefits., However, we must be cautious as we consider data from retrospective studies with small patient cohorts and attempt to relate the findings to previous observations. Times change. Patients' access to sophisticated multidisciplinary care has generally improved; radiation and surgical strategies have become more sophisticated, and imaging has become more discerning.
As we relate the overall treatment outcomes to the implementation of NACT, we must also consider that the correlation of tumor response to PFS may relate, in part, to patient selection rather than overt benefit. It has been observed for long that the sensitivity of head and neck squamous cancers to cytotoxic chemotherapy is predictive of their responsiveness to radiation.
A prospective randomized study of NACT may not be feasible, given the low incidence and heterogeneity of sinonasal cancers. Therefore, a prospective Phase II study design with an innovative approach and comparison with prior outcomes is necessary. However, this will require meticulous efforts to identify prior patient groups with matching histology, stage, molecular underpinnings, and locoregional treatment. The treatment objectives will continue to focus on the PFS, OS, favorable changes in definitive local therapy, and long-term treatment toxicities. Moreover, the prospects for the potential identification of increasingly active systemic treatments, targeting strategies based on molecular tumor assays, and immunotherapy can be anticipated.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Patil VM, Noronha V, Joshi A, Talreja V, Dhumal S, Menon N, et al
. Long-term outcomes of locally advanced and borderline resectable esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation treated with neoadjuvant chemotherapy. Cancer Res Stat Treat 2020;3:201-6. [Full text]
Amit M, Abdelmeguid AS, Watcherporn T, Takahashi H, Tam S, Bell D, et al
. Induction chemotherapy response as a guide for treatment optimization in sinonasal undifferentiated carcinoma. J Clin Oncol 2019;37:504-12.
Limaye S, Shreenivas A. Who knows the nose? – The tale of esthesioneuroblastoma and sinonasal neuroendocrine carcinoma. Cancer Res Stat Treat 2020;3:293-5. [Full text]
Ensley JF, Jacobs JR, Weaver A, Kinzie J, Crissman J, Kish JA, et al
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