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Head and Neck Surgery

Effectiveness of Nasolacrimal SCC Treatments and Promising Role of Chemo Induction

Wednesday, October 4, 2023
10:09 AM - 10:15 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • MA

    Mohammad Bilal Alsavaf, MD

    Research Fellow
    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
    Columbus, OH, United States

    • Co-Author(s)

  • MA

    Mohammad Bilal Alsavaf, MD

    Research Fellow
    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
    Columbus, OH, United States

  • MA

    Moataz Desouky Abouammo, MBBS MS

    Department of Otolaryngology - Head and Neck Surgery, Tanta University, Tanta, Egypt, USA

  • GB

    Govind S. Bhuskute, MBBS, DNB ENT

    Senior Resident ( Hospital services) Neurotology
    Sanjay Gandhi Post Graduate Institute of Medical Sciences
    LUCKNOW, Uttar Pradesh, India

  • BK

    Brandon Koch, PhD

    Division of Biostatistics, College of Public Health at The Ohio State University, Columbus, Ohio, USA, USA

  • MI

    Majd Issa, MD

    Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA, USA

  • MB

    Marcelo Bonomi, MD

    Professor of Medicine
    Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
    Columbus, OH, USA

    • Senior Author(s)

  • RC

    Ricardo L. Carrau, MD MBA FACS

    Professor
    Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, 43210, USA
    columbus, Ohio, USA

Disclosure(s):
Mohammad Bilal Alsavaf, MD: No relevant relationships to disclose.
Introduction: Nasolacrimal malignancies are rare, with squamous cell carcinoma (NLSCC) constituting a significant proportion of reported cases. This study aims to systematically evaluate the efficacy of various treatment strategies and present two illustrative cases to demonstrate the potential utility of chemo-induction therapy for NLSCC.

Methods: This study was conducted including all publications identified by relevant keywords in PubMed Database as well as using the references of identified papers. 72 studies were included. Two cases from our clinic were analyzed to illustrate the utility of induction chemotherapy.

Results: The selected publications comprised 302 patients, treated with 11 distinct strategies. The three most common therapies were surgery alone or in combination with radiotherapy (RT) or chemoradiotherapy (CRT). Rates of recurrence and regional or distant metastasis were 40.6%, 32.6%, and 16.7%, respectively. No significant differences in R/M were observed for any of the various histopathological subtypes. Need for an orbital exenteration was statistically significantly between the treatment groups, 55.0% for those requiring just surgery, 16.7% for surgery + RT, and 10% for surgery + CRT group. The overall rates of recurrence, metastasis, and survival were 21.9%, 15.1%, and 79.9%, respectively. 11 out of 31 patients (35.5%) in the surgery-only, 13 out of 42 patients (31.0%) in the surgery + radiation, and 1 out of 12 patients (8.3%) in the surgery + CRT group experienced R/M. Probability of being disease-free over time was nearly significant (p = 0.06) between treatment groups.

The two cases from our clinic were successfully treated with TPF induction followed by definitive RT. The large initial lesion in the second case demanded surgery before RT.

Conclusions: This study is the first Systematic Reviews for comparison of available treatment strategies for NLSCC. The findings suggest that the use of RT or CRT in conjunction with surgery reduces the need for eye exenteration and rate of R/M . Induction therapy emerges as a promising tool for decreasing the need for orbital exenteration.