Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities.

Simple Summary: Adenoid cystic carcinoma (ACC) is known to have distinctive clinical features. It tends to metastasize to the lungs and spread through the nerves. As the nasal cavity and paranasal sinuses are close to cranial nerves, ACC arising in such areas presents explicit challenges for treatment. This study reported the treatment patterns and outcomes of sixty-one patients with sinonasal ACC who were treated at a single institution. Patients with more extensive disease underwent radiation therapy as the mainstay of treatment, and these showed worse treatment outcomes when compared to those who were able to undergo surgery and postoperative radiation therapy. The difference in treatment outcomes may be attributed to worse clinical features, such as extensive disease and involvement of cranial nerves, rather than treatment modality. As patients with ACC tend to survive for many years, the balance between risk and benefit needs to be thoroughly considered before determining the initial treatment. This study aimed to present the treatment patterns and outcomes for adenoid cystic carcinoma (ACC) arising in the nasal cavity and paranasal sinus. Sixty-one sinonasal ACC patients were retrospectively reviewed: 31 (50.8%) underwent surgery followed by postoperative radiation therapy (S+PORT), and 30 (49.2%) received definitive radiation therapy (D(C)RT). T4 disease was significantly more frequent in the D(C)RT group (25.8% vs. 80.0%, p < 0.001), where all T4b disease patients underwent D(C)RT. The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival were 61.8% versus 37.8% (p = 0.003), 64.8% versus 38.1% (p = 0.036), 52.6% versus 19.3% (p = 0.010), and 93.2% versus 73.4% (p = 0.001) in the S+PORT and D(C)RT groups, respectively. The absolute differences in 5-year rates of LFFS, DMFS, and PFS between the two groups were smaller in the T3–4 subgroup. The univariate analysis showed that T4b disease, neurologic symptoms, longest diameter of tumor, radiological evidence of nerve involvement, and undergoing D(C)RT were associated with worse clinical outcomes, but the significance disappeared in the multivariate analysis, except for in the case of radiological evidence of nerve involvement. In conclusion, most patients with extensive disease underwent upfront D(C)RT and generally exhibited inferior clinical outcomes when compared to those with less extensive disease and who underwent S+PORT. [ABSTRACT FROM AUTHOR]