Sinonasal undifferentiated carcinoma: Case series and literature review

Purpose: The purpose of this study was to understand the natural history and progression of sinonasal undifferentiated carcinoma (SNUC) to establish optimal management guidelines. Methods and Materials: We analyzed 8 consecutively treated patients diagnosed with SNUC between 1995 and 2002 at UCLA Medical Center. Staging was classified by the Kadish System with 7 patients presenting at stage C and 1 patient with stage B disease. Five patients received surgery. Four of these 5 patients received adjuvant radiotherapy, with 2 patients receiving it concurrently with chemotherapy (cisplatinum/5-fluorouracil). One patient received surgery alone as definitive management. Of the remaining 3 patients who did not receive surgical treatment, concurrent chemotherapy and radiation was used. Results: At last follow-up, 6 of the 8 patients were still alive (overall survival 75%) with mean survival time of 20.6 months. However, only 2 of the 6 were alive and free of disease (disease-free survival 25%) with a mean disease-free survival time of 12.3 months. Locoregional recurrence occurred in 5 of the 8 patients (63%). Time to recurrence ranged from 3 to 30 months. Distant metastasis presented in 4 of the 8 patients (50%), all with disease spread to bone. Two of the 4 patients with distant metastasis were found to have locoregional disease recurrence at the same time. Time to metastasis ranged from 2 to 30 months. Results also show that the 5 patients who received surgery are still alive with a mean survival time of 23 months at last follow-up. Meanwhile, 1 of the 3 patients who received no surgical therapy is alive, with a mean survival time of 16.7 months in this group. Conclusions: SNUC has proven to have a poor prognosis. Although limited by small numbers, this study along with reported series in the past appear to suggest longer survival results with aggressive multimodality therapy, especially with the incorporation of complete surgical resection.