Riassunto analitico
INTRODUCTION: Sino nasal tumors constitutes a minority among either head and neck neoplasms or systemic neoplastic diseases representing 3% of head and neck tumors and 0.2%-0.8% of systemic malignancies.
When advanced in stage, these tumours can extend to the adjacent anatomical structures, such as the skull base, the anterior frontal fossa and, above all, the orbit. In literature, in particular orbit is reported to be an important predictor of poor prognosis.
For most nasal cavity or sinus tumors, surgery, followed by post operative radiotherapy to improve the results, is the cornerstone of treatment; although the orbit is involved, surgical treatment allowing radical excision and eye preservation are also possible.
Sino nasal cancer treatment, as well as head & neck cancer in general, has provided better survival and prognosis but patients quality of life is still a challenging issue; thus, researchers have given greater attention to the assessment of quality of life of these patients.
OBJECTIVE: the aim of this study is evaluating the overall survival in patients with sino nasal and craniofacial tumors with orbital involvement, treated in Head & Neck Department of the University Hospital of Modena from 2001 to 2021. We want also to analize the impact of specific factors on the survival and recurrence risk. Post treatment quality of life has been also considered using a validated questionnaire.
MATHERIALS AND METHOD: the considered period runs from 1st January 2001 to 31st May 2021; during this period we selected 62 patients with diagnosis of sino nasal or craniofacial tumors (24 benign, 38 malignant), treated at the Head and Neck Department of the Univeristy Hospital of Modena.
The survival has been analized according to Kaplan-Meier method; recurrence rates have been calculated using Nelson-Aalen estimator. The results are considered valid if p<0.05. Patients’ quality of life has been assessed through the University of Washington Quality of Life Questionnaire, version 4.
RESULTS: we have observed a 5-years overall survival of 56.5% for malignant sino-nasal tumours. Because of the small number of cases forming the sample and the great variety in histology, which have played as limiting and confounding factors, factors such as histology, orbital involvement and surgery have no statistical relevance in influencing the survival (p>0.05), although we have found values consistent with those reported in many other studies. Though, surgery seems to influence the recurrence risk, in particular endoscopic surgery provides a lower risk rather than open transfacial approach (p=0.03), although this datum must be further analized, considering that transfacial approach is required when the tumour is very advanced.
Concerning evaluation of quality of life, patients experience a deep fall in well being, with social and emotional domains (mood, anxiety and appearance) getting the lowest score. However, most patients report pain as their main discomfort when interviewed.
CONCLUSIONS: the rarety of sino-nasal tumours makes difficult to create large cohorts to perform a proper survival study, above all if only one center is involved. Our results are consistent with those reported in literature but have the limitation of small number, which cause lack of statistical relevance. Therefore we recommend to create larger regional or even national database to obtain more case series.
Concerning quality of life, a balance between oncological safety and quality of life preservation is difficult to achieve; early diagnosis may be of use to plan a less invasive and demolitive surgery and reduce post-operative disfiguring outcomes.
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