Page 51 - Portuguese Journal - SPORL - Vol 61. Nº2
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WHO . In our study, epithelial tumors were on a case-by-case basis, taking into account
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the most common histologic type (11 patients, several factors, such as histology, staging,
57.9%), whereas squamous cell carcinomas feasibility of complete surgical resection and
(SCC) were the most common histologic treatment risks and morbidity . Similarly
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subtypes (4 patients, 21.1%). The predominance to other reports, most patients underwent
of epithelial tumors and of squamous cell surgical treatment (16 patients, 84.2%), being
carcinomas is in line with the most published the surgical therapy followed by adjuvant
series in the literature 4, 7, 8, 16, 19 . radiotherapy the most common modality (10
We used the 8 edition of American Joint patients, 52.6%) 17,18 . Our results are in agreement
th
Committee on Cancer (AJCC) on epithelial with other series, which showed a better
tumors of the nose and paranasal sinuses and prognosis for surgical therapy compared to
mucosal melanoma to classify the staging of nonsurgical therapy (p < 0.001) 15,18 . Historically,
epithelial tumors and mucosal melanoma. the gold-standard surgical procedure for
The latter is very aggressive and carries a poor sinonasal malignant tumor has been the open
prognosis, which makes that all tumors are craniofacial approach. Over the past decade,
classified at least as a T3 and stage III . Patients there has been increasing evidence regarding
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with sinonasal malignancies usually present the effectiveness and safety of endoscopic
with advanced disease, because of its silent endonasal approaches.
pattern of growth. In the earlier stages of the Several studies demonstrated survival rates
disease, when there are signs and symptoms, comparable to those of open surgery in
they are usually nonspecific, similar to benign carefully selected patients, with reduced
sinus disease 2,4,6 . Therefore, it is necessary morbidity and increased quality of life 5,21,22 .
a high clinical suspicion to make an early Comparative studies between endoscopic and
diagnosis . In most series, epithelial tumors of external approaches are limited by multiple
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the sinonasal tract are diagnosed when they factors, including location, surgeon experience
are locally advanced, which means a T3 or T4 and TNM degree; considering these variables,
lesion 15, 16 . This is in accordance with our results, is still relevant to report that our study found
since 11 patients (78.6%) were diagnosed with no statistically significant difference in 5-year
a T3 or T4 lesion, while 3 patients (21.4%) were OS between open approach and endoscopic
diagnosed with a T1 lesion. All T1 lesions were approach (p = 0.724). According to Paolo
located in the nasal cavity. This probably Castelnuovo et al., endoscopic endonasal
occurred because as lesions in the nasal cavity approach allows resection of T1-T3 lesions, as
grow, they can produce symptoms such as well as selected T4a, being contraindicated
nasal obstruction earlier, comparatively to as exclusive approach in cases where there is
tumors that grow in paranasal sinuses. In infiltration of nasal bones and palate, extensive
several studies, T component of TNM staging involvement of the frontal sinus or the lacrimal
system was found to be a significant predictor pathway, extension into the infratemporal
of prognosis 4, 15 . Although we found a tendency fossa and involvement of orbital content .
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for worse prognosis in T3, T4a or T4b lesions In concordance with other series, the treatment
compared to T1 lesions, the difference was not failure was mainly due to local recurrence. Our
statistically significant (p = 0.092). We suspect study reports a 5-year OS of 53.5%, with results
that this happened because of the small from literature varying from 38-60% 4, 15, 16, 17, 18 .
number of patients with early-stage disease. The main limitations of this review are its
On the other hand, nodal stage (N component retrospective nature and the relatively small
of TNM) was also reported to be a significant sample size, which can be easily explained
factor of prognosis, which is in conformity with by the fact that sinonasal malignancies are
our results (p = 0.025) 15, 16 . rare entities. These facts, allied to the wide
Treatment of sinonasal malignancies is made histopathological diversity, the complex
Volume 61 . Nº2 . June 2023 193
