Response to Induction Chemotherapy and Outcomes With Definitive Chemoradiotherapy or Surgery in Sinonasal Undifferentiated Carcinoma
In a single-center experience reported in the Journal of Clinical Oncology, Amit et al found that among patients with sinonasal undifferentiated carcinoma with a favorable response to induction chemotherapy, disease-specific survival was better in those receiving definitive concurrent chemoradiotherapy vs those receiving definitive surgery. In those without a favorable response to induction therpay, outcomes were better with surgery.
Study Details
The study involved 95 previously untreated patients with sinonasal undifferentiated carcinoma treated between 2001 and 2018 at The University of Texas MD Anderson Cancer Center. Patients were treated with curative intent and received induction therapy with a platinum-based doublet chemotherapy regimen prior to definitive locoregional therapy. Concurrent chemoradiotherapy began within 4 weeks after induction and consisted of two additional doses of platinum and etoposide chemotherapy concurrent with radiation therapy.
The primary endpoint was disease-specific survival.
Disease-Specific Survival
After induction chemotherapy, 63 patients received chemoradiotherapy and 32 underwent surgery followed by postoperative radiotherapy or chemoradiotherapy. In the total cohort, 5-year disease-specific survival was 59%. Among patients with partial or complete response to induction chemotherapy, 5-year disease-specific survival was 81% in patients receiving chemoradiotherapy vs 54% in those receiving definitive surgery and postoperative radiotherapy or chemoradiotherapy (P = .001). On multivariate analysis, adjusted hazard ratios favoring chemoradiotherapy were 4.19 (P < .001) for disease-specific survival and 3.43 (P < .001) for overall survival.
In patients without at least a partial response to induction chemotherapy, 5-year disease-specific survival was 0% in patients receiving concurrent chemoradiotherapy after induction vs 39% in patients receiving surgery plus postsurgery radiotherapy or chemoradiotherapy (P < .001). On multivariate analysis, adjusted hazard ratios favoring surgery were 5.68 (P < .001) for disease-specific survival and 4.20 (P < .001) for overall survival.
The investigators concluded, “In patients who achieve a favorable response to [induction chemotherapy], definitive [chemoradiotherapy] results in improved survival compared with those who undergo definitive surgery. In patients who do not achieve a favorable response to [induction chemotherapy], surgery when feasible seems to provide a better chance of disease control and improved survival.”
Moran Amit, MD, PhD, of Houston Methodist Research Institute, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported in part by a grant from the National Institutes of Health. The study authors’ full disclosures can be found at jco.ascopubs.org.
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