Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma

Background: There is emerging evidence to suggest the role of induction chemotherapy (IC) in definitive management of locoregionally advanced sinonasal squamous cell carcinoma (SNSCC). We evaluated the influence of IC on survival and predictors of its use in SNSCC patients. Methods: The 2004-2017 National Cancer Database was queried for patients with locoregionally advanced SNSCC (T4/M0). Treatments were stratified into 7 groups: definitive chemoradiation (CRT), IC with definitive CRT (IC+CRT), IC+CRT with salvage surgery (IC+CRT+Sx), definitive surgery (Sx), IC with definitive surgery (IC+Sx), definitive surgery with adjuvant radiation or CRT (Sx+ATx), or IC+Sx+ATx. Cox proportional-hazards regression assessed overall survival (OS) and logistic regression identified predictors of IC. Results: Of 3162 patients, 1088 (34.4%) were female with a mean age of 63.4 ± 13.4 years. The 2- and 5-year OS rates were 58.6% and 42.0%, respectively. Compared to CRT, Sx+ATx (HR: 0.663; p<0.001), IC+Sx (HR: 0.606; p=0.005), or IC+Sx+ATx (HR: 0.468; p=0.001) exhibited reduced mortality. Among patients who were treated with definitive surgery, those receiving IC had additional OS benefit (all p<0.05). Older age (OR: 0.607; p<0.001), female sex (OR: 0.759; p=0.028), black race (OR: 1.650; p<0.001, T4b stage (OR: 1.674; p<0.001), and higher N stage (OR: 1.395; p<0.001) were predictors of IC. Conclusions: IC prior to definitive surgery with or without adjuvant therapy exhibited the highest OS for locoregionally advanced SNSCC. Age, sex, race, and T/N staging were predictors of IC. Multimodal treatment regimens involving surgery as the primary modality may, therefore, provide the greatest therapeutic response.