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Cavernous sinus involvement is NOT a risk factor for the
treatment outcome of sinonasal adenoid cystic carcinoma
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基隆及林口長庚醫院
耳鼻喉頭頸腫瘤外科
李 宜 展, 張 凱 評
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2. Background Methods Results Conclusions
Sinonasal adenoid cystic carcinoma (ACC) is rare
Cavernous sinus invasion and management have rarely been investigated
Impact of cavernous sinus invasion and other parameters on survival

3. Background Methods Results Conclusions
retrospective case series study at a tertiary referral center. 47 patients with primary sinonasal ACC between 1984 and 2015

4. Background Methods Results Conclusionsv
Patient demographics
Advanced Ds in 68.1%

5. Background Methods Results Conclusionsv
Patient demographics
Tumor primary sites :
Maxillary sinus (n = 30)
Ethmoid sinus (n = 8)
Nasal cavity (n = 9)
Cavernous sinus invasion ( n=8; 17.0%)
7 from maxillary , 1 from ethmoidal ACC

6. Background Methods Results Conclusions
Treatment modality
30 pts received initial surgical tx (T1= 6, T2= 1, T3=7, T4a=11, T4b= 5)
3 surgery alone,
12 postop radiotherapy
15 postop chemoradiation
17 patients received initial non-surgical tx (T1=1, T4a=8, T4b=8)
5 radiotherapy alone
12 chemoradiation

7. Background Methods Results Conclusions
Tumor recurrence
14 Pts had recurrence (29.8%)
Tx to recurrence : median 53.6m (15.7 to 257.7 months )
11 had stage III or IV disease (78.6%)
12 local recurrence (25.5%)
3 regional recurrence (6.4%)

8. Background Methods Results Conclusions
Staging
Surgery
Skull base
Infratemporal fossa
Cavernous sinus OS
DFS

9. Infratempotal fossa invasion
Background
Methods
Results
Conclusions OS
univariate
multivariate
Clinical stage
Surgery
Skull base invasion
Infratempotal fossa invasion

10. Infratempotal fossa invasion
Background
Methods
Results
Conclusions
DFS
univariate
multivariate
Clinical stage
Surgery
Surgery
Skull base invasion
Infratempotal fossa invasion

11. Background Methods Results Conclusions
Factors influencing survival
Cavernous sinus invasion was not a negative factor (OS/DFS)
No significant difference of local recurrence rate & distant metastasis rate between Pt with or without cavernous sinus invasion
(Fisher’s exact test ,P = 0.658, P = 1.000, respectively)

12. Background Methods Results Conclusions
Adjuvant RT vs CRT
Primary RT vs CRT

13. Background Methods Results Conclusions
Maxillary ACC has a high rate of cavernous sinus invasion, and preop planning is important
Primary surgery provides better locoregional control and survival
Cavernous sinus invasion did not significantly impact survival
 should not be regarded as a contraindication for curative surgery
The role of cisplatin-based chemotherapy remains unclear

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Cavernous sinus involvement is NOT a risk factor for the
treatment outcome of sinonasal adenoid cystic carcinoma
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基隆長庚醫院
耳鼻喉頭頸腫瘤外科
李宜展醫師
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Cavernous sinus involvement is NOT a risk factor for the
treatment outcome of sinonasal adenoid cystic carcinoma
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Albert Y.C. Lee, MD
Chang Gung Memorial Hospital
Taipei & Keelung branch, Taiwan
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16. Background Methods Results Conclusions
Maxillary ACC has a high rate of cavernous sinus invasion, and preop planning is important
Primary surgery provides better locoregional control and survival
Cavernous sinus invasion did not significantly impact survival;
 it should not be regarded as a contraindication for curative surgery
The role of cisplatin-based chemotherapy remains unclear

17. Background Methods Results Conclusions
Factors influencing survival
Median DFS time 77.1 months
DFS at 3, 5, and 10 years: 76.6%, 61.7%, and 23.4%
Median OS time 57.1 months
OS at 3, 5, and 10 years: 66.0%, 44.7%, and 14.9%

18. Based on these findings, we suggest that the primary treatment modality for sinonasal ACC with cavernous sinus invasion, similar to other sinonasal ACC tumors, should be surgery. Cavernous sinus invasion should not be considered a contraindication for surgery even if its involvement is not within the surgical field.

19. Background Methods Results Conclusions
Thi

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21. Patient Demographics and Tumor Stage
Parameters N
(%)
All patients 47
100
Sex
Male/ Female
27/20
57.4/42.6
Age (yr)
Median (Range)
52.4 (16.3–81.2)
Follow-up (mo)
56.0 (3.7–326.5)
T stage T1 6
12.8 T2 1
2.1 T3 8
17.0
T4a 19
40.4
T4b 13
27.7
N stage N0 46
97.9
N1-3
M stage M0 M1

22. Background Methods Results Conclusions
Stage I II III, N=15
OP +/- CRT or RT, N=30
Skull base invasion(+), N=36
ITF invasion(+),
N=29
Cavernous sinus invasion,(+), N=39
Stage IV, N=32
ITF invasion(-), N=18
Cavernous sinus invasion,(+), N=8
CRT or RT, N=17
Skull base invasion,(-), N=11
P=0.026
P=0.009
P=0.006
P=0.029
P=0.183
Skull base
invasion(+), N=36
ITF invasion(+),
N=29
Stage I II III, N=15
OP +/- CRT or RT, N=30
Cavernous sinus
invasion,(+), N=39
Stage IV, N=32
CRT or RT, N=17
ITF invasion(-), N=18
Skull base
invasion(+), N=36
Cavernous sinus
invasion,(+), N=8
P=0.014
P<0.001
Skull base invasion(-), N=11
P=0.020
P=0.034
P=0.230

23. ALLPPT.com _ Free PowerPoint Templates, Diagrams and Charts
Cavernous sinus involvement is NOT a risk factor for the
treatment outcome of sinonasal adenoid cystic carcinoma
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INSERT THE TITLE
OF YOUR PRESENTATION HERE
Albert Y.C. Lee, MD
Chang Gung Memorial Hospital
Taipei & Keelung branch, Taiwan
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