Locally advanced sinonasal adenoid cystic carcinomas: endoscopic endonasal surgery-centered comprehensive treatment provides benefits.

Background: Sinonasal adenoid cystic carcinomas (SNACCs) are aggressive tumors that show massive expansion and are challenging to treat when locally advanced.

Aims: To report our experiences with endoscopic endonasal surgery (EES) - centered comprehensive treatment and discuss the associated outcomes of these patients.

Material and methods: A retrospective review of primary locally advanced SNACCs patients was conducted in a single center. EES combined with postoperative radiotherapy (PORT) was used as a comprehensive surgery-centered approach to treat these patients.

Results: The study included 44 patients with Stage III/IV tumors. The median follow-up duration was 43 months (4-161 months). Forty-two patients underwent PORT. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 61.2% and 46%, respectively. Local recurrence occurred in 7 patients, and 19 patients had distant metastasis. No significant relationship was found between OS and postoperative local recurrence. The OS of patients with Stage IV or exhibiting distant postoperative metastases was shorter than that of other patients.

Conclusions and significance: Locally advanced SNACCs are not a contraindication for EES. EES-centered comprehensive treatment can ensure satisfactory survival rates and reasonable local control. Function-preserving surgery using EES and PORT may represent an alternative strategy when vital structures are involved.