Open surgery versus primary radiotherapy in T4b sinonasal carcinoma

Open surgery versus primary radiotherapy in T4b sinonasal carcinoma. Objectives: We evaluated the outcome after primary open surgery with adjuvant intensity modulated radiotherapy (IMRT) compared with primary IMRT in patients diagnosed with T4b sinonasal carcinoma. Methodology: Between 1998 and 2016, 20 patients with T4b sinonasal adenocarcinoma were treated with primary IMRT (n=10) with a high dose to achieve maximal locoregional control or adjuvant IMRT following open surgery (n=10). Results: With a median follow-up of 13.2 months, overall survival rates at 1 and 3 years were 55.0% and 15.2%, respectively; disease-specific survival rates were 47.8% and 23.9%, respectively; and disease-free survival rates were 45.0% and 22.5%, respectively. No significant differences were found between primary surgery and primary IMRT. Conclusions: Based on our limited, though homogeneous, patient cohort of cT4b sinonasal adenocarcinomas, we did not detect differences in outcome between primary surgery followed by adjuvant IMRT vs. primary IMRT. Thus, we have chosen to avoid open surgery, due to the bad prognosis and its invasiveness, by performing organ-sparing IMRT as the primary treatment for these patients.