Eye-sparing treatment for sinonasal tumors invading the orbit in the era of personalized therapy

Few studies investigated the eye-sparing treatment in patients with sinonasal carcinomas (SNCs) from the perspective of modern precision radiation, and the eye-sparing treatment in patients with grade III orbital invasion was rarely discussed. This retrospective study included patients with primary SNCs who accepted eye-sparing treatment from October 2000 to June 2022 at a single institution. Patients' clinical information and follow-up data (including visual data) were obtained. All patients underwent radio(chemo)therapy alone or with surgery. The primary outcomes were overall survival (OS) and progression-free survival (PFS) rates. Secondary outcomes included regional-failure-free survival (RFS) and distant metastasis-free survival (DMFS) rates. 42.7% of SNC patients (430/1006) had orbital invasion. Orbital invasion significantly decreased the 5-year OS (77.9% vs. 61.1%, p < .001), PFS (70.5% vs. 51.3%, p < .001), RFS (77.8% vs. 60.8%, p < .001), and DMFS (76.8% vs. 59.3%, p < .001), which worsened as the invasion grade increased. Stratified analysis by treatment indicated that surgery significantly improved the OS (p < .001) and PFS (p = .0031) in patients with grade I/II orbital invasion. In contrast, surgery conferred no benefits to OS (p = .14) and PFS (p = .16) in patients with grade III orbital invasion. Blindness occurred in 6.7% of patients with orbital involvement and 1.9% of patients without orbital involvement. There was no difference in the blindness ratio among different treatment modes (χ² = 2.35, p = .31). Orbital invasion predicted poor survival outcomes, which worsened as the invasion grade increased. Surgery combined with radio(chemo)therapy was preferred in patients with grade I/II orbital invasion; however, surgery may have a limited effect on the survival of patients with grade III orbital invasion.