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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 651-652

Changing treatment paradigms in advanced sinonasal neuroendocrine cancers


1 Jaslok Hospital and Research Centre; Bombay Hospital and Research Centre, Mumbai; Department of Oncology, Vedant Hospital, Thane, Maharashtra, India
2 Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

Date of Submission01-Jul-2020
Date of Decision07-Jul-2020
Date of Acceptance09-Jul-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Rakesh Katna
Jaslok Hospital and Research Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_229_20

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How to cite this article:
Katna R, Kalyani N, Bhosale B. Changing treatment paradigms in advanced sinonasal neuroendocrine cancers. Cancer Res Stat Treat 2020;3:651-2

How to cite this URL:
Katna R, Kalyani N, Bhosale B. Changing treatment paradigms in advanced sinonasal neuroendocrine cancers. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 22];3:651-2. Available from: https://www.crstonline.com/text.asp?2020/3/3/651/295557



We would like to congratulate Patil et al. for their article titled, “Long-term outcomes of locally advanced and borderline resectable esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation treated with neoadjuvant chemotherapy.”[1] As sinonasal malignancies are rare entities, there is a paucity of data on their management. Sinonasal malignancies with neuroendocrine differentiation are difficult to characterize on histopathology and are generally classified as sinonasal undifferentiated carcinomas, sinonasal neuroendocrine carcinomas (SNECs), esthesioneuroblastomas (ENBs), and small cell carcinomas.[2]

In the past few decades, multimodality treatment with chemotherapy and radiotherapy, in addition to the traditional surgical methods, has been added to the management of these tumors.

There is a scarcity of prospective studies and randomized trials specially evaluating the role of neoadjuvant chemotherapy (NACT) in sinonasal carcinomas with neuroendocrine differentiation. The authors in their retrospective analysis of the robust follow-up data have advocated the role of NACT in improving the survival in their patient cohort.[1] However, we would like to put forward our comments and difference of opinion about the same.

The authors present a retrospective study with a small number of patients with rare tumors such as ENB and SNEC. The rarity of these tumors, difficulties in establishing a diagnosis, and heterogeneity in the treatment approaches are factors that contribute to the lack of consensus.[3],[4]

It is a known fact that the histology rules the roost in sinonasal malignancies, and the treatment is tailored according to the histology. In this study, the authors have reported two histologies, namely, ENB and SNEC, with an equal number of cases. However, the subcategory classification for SNEC is not provided, which could have a potential bearing on the prognosis. SNECs are usually high-grade tumors and locally advanced at the time of presentation; on the other hand, ENBs are mostly low-grade tumors but can present in the advanced stages. The histological differences between these two types of tumors set them apart in terms of the treatment response and survival outcomes.

The increase in the survival rates of patients with ENB is expected and is also shown in this dataset. The Hyams grading and Ki67 index are important tumor markers with prognostic implications in ENB; however, they were not evaluated in this study. The evaluation of these markers could have added value to these robust follow-up data.[5] The authors have acknowledged the limitation that, as ENB show a late recurrence, the follow-up period of 5 years was short. Therefore, a longer follow-up for patients with ENB patients would be desirable.

With their earlier published data on the same set of patients, the authors have shown a benefit in borderline resectable tumors/unresectable tumors post-NACT.[6] It would help to know the long-term survival outcomes of the patients who underwent surgical resection along with appropriate adjuvant treatment as compared to those who received chemoradiation/palliative radiation.

The benefit of NACT was maintained even at a longer follow-up and consolidates the evidence in favor of the usage of NACT in locally advanced sinonasal neuroendocrine malignancies. The incidence of late metabolic adverse events reported in this study was 80%, which could have been due to the high dose of cisplatin (380 mg/m2) in the NACT and concurrent settings. This high rate of adverse events can potentially mitigate the benefit conferred by NACT. What is more concerning here is the high incidence of the metabolic syndrome, which is also seen in the cisplatin-based chemotherapy protocol used in pediatric testicular germ cell tumors. However, the reported incidence is disproportionately high as compared to that of the testicular germ cell tumors.[7]

Furthermore, a stringent follow-up of all the patients for cardiovascular morbidity is essential, as are the retrieval of baseline data for the body mass index and the prevalence of obesity, hypertension, and diabetes. This study, with its very strong follow-up data, adds to the growing evidence for the benefit of NACT in patients with advanced sinonasal neuroendocrine malignancies, amidst some questions regarding the long-term safety of the regimen, which may play an important role in improving the survival outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
  [Full text]  
2.
Rosenthal DI, Barker JL Jr, El-Naggar AK, Glisson BS, Kies MS, Diaz EM Jr., et al. Sinonasal malignancies with neuroendocrine differentiation: Patterns of failure according to histologic phenotype. Cancer 2004;101:2567-73.  Back to cited text no. 2
    
3.
Limaye S, Shreenivas A. Who knows the nose? – The tale of esthesioneuroblastoma and sinonasal neuroendocrine carcinoma. Cancer Res Stat Treat 2020;3:293-5.  Back to cited text no. 3
  [Full text]  
4.
Hanna EY, Cardenas AD, DeMonte F, Roberts D, Kupferman M, Weber R, et al. Induction chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 2011;137:78-81.  Back to cited text no. 4
    
5.
Turri-Zanoni M, Maragliano R, Battaglia P, Giovannardi M, Antognoni P, Lombardi D, et al. The clinicopathological spectrum of olfactory neuroblastoma and sinonasal neuroendocrine neoplasms: Refinements in diagnostic criteria and impact of multimodal treatments on survival. Oral Oncol 2017;74:21-9.  Back to cited text no. 5
    
6.
Patil VM, Joshi A, Noronha V, Sharma V, Zanwar S, Dhumal S, et al. Neoadjuvant chemotherapy in locally advanced and borderline resectable nonsquamous sinonasal tumors (esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation). Int J Surg Oncol 2016;2016:6923730.  Back to cited text no. 6
    
7.
Haugnes HS, Aass N, Fosså SD, Dahl O, Klepp O, Wist EA, et al. Components of the metabolic syndrome in long-term survivors of testicular cancer. Ann Oncol 2007;18:241-8.  Back to cited text no. 7
    




 

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