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Isolated leptomeningeal progression from sinonasal carcinomas: Implications for staging workup and treatment
Author(s) -
Dagan Roi,
Bryant Curtis M.,
Mendenhall William M.,
Amdur Robert J.,
Morris Christopher G.,
Lanza Donald C.,
Dziegielewski Peter T.,
Justice Jeb M.,
Lobo Brian C.,
Silver Natalie L.,
Fernandes Rui,
Bunnell Anthony,
Guthrie Troy,
Gopalan Priya K.,
Rahman Maryam,
Tavanaiepour Daryoush
Publication year - 2019
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25741
Subject(s) - medicine , radiation therapy , hazard ratio , histology , chemotherapy , radiology , proportional hazards model , oncology , confidence interval
Purpose To evaluate the rate and risk factors of isolated leptomeningeal progression in sinonasal carcinomas. Methods We retrospectively reviewed imaging and clinical records to determine progression patterns, and estimated rates using the Kaplan‐Meier method. We evaluated risk factors using proportional hazard regression. Results We analyzed 120 patients who received adjuvant or primary radiotherapy for sinonasal carcinomas. Most patients had T4 disease (68%) and underwent surgery (84%) and chemotherapy (72%). Twenty‐seven (23%) patients developed distant metastases (DM), including 20 (17%) with isolated DMs. Leptomeningeal progression was the most common site of isolated DMs (n = 9; 45%) with an average disease‐free interval of 1.2 years (0.1‐4.3 years). High‐grade histology ( P = 0.0003), intracranial invasion ( P < 0.0001), and neuroendocrine histology ( P = 0.06) were associated with increased risk. Conclusions Isolated leptomeningeal progression is a common pattern of DM in advanced sinonasal carcinomas. We recommend adding cerebrospinal fluid cytology and contrast‐enhanced spine MRI to routine staging evaluations for high‐risk patients.