Defining response-adapted surgery after neoadjuvant systemic therapy in sinonasal squamous cell carcinoma

Area of Science:

• Head and Neck Oncology
• Surgical Oncology
• Cancer Research

Background:

• Neoadjuvant systemic therapy and response-adapted surgery show promise for head and neck cancer.
• Standardized documentation is crucial for evaluating this approach in sinonasal tumors.
• A classification system for sinonasal tumor surgery is currently lacking.

Purpose of the Study:

• To develop a framework for documenting surgical extent and morbidity in sinonasal squamous cell carcinoma (SCC) following neoadjuvant therapy.
• To address the need for a system that accounts for the complex anatomy of sinonasal tumors.
• To facilitate the evaluation of response-adapted surgery in this patient population.

Main Methods:

• Literature review identified a gap in response-adapted surgery research for sinonasal malignancies.
• Development of a novel classification system based on surgical anatomy.
• Creation of a surgical morbidity score through a multidisciplinary expert consensus process.

Main Results:

• A novel classification system was developed to document sinonasal SCC resection before and after neoadjuvant treatment.
• The framework categorizes surgical adaptations by structures resected, exposure, reconstruction, and lymph node management.
• The classification system was endorsed by an institutional tumor board, establishing it as a standardized documentation tool.

Conclusions:

• The proposed system is the first response-adapted surgery classification for locoregionally advanced sinonasal SCC treated with neoadjuvant therapy.
• Standardized terminology improves multidisciplinary communication and enables cross-study comparisons.
• This framework supports consistent development of clinical trial endpoints balancing oncologic control and functional preservation.