Induction chemotherapy for locally advanced sinonasal carcinoma: A systematic review and meta-analysis.

Abstract

e18160 Background: Induction chemotherapy (IC) has emerged as a promising approach in the management of locally advanced sinonasal carcinoma. Recent studies have demonstrated that IC can lead to significant tumor reduction, facilitating subsequent definitive treatments such as chemoradiotherapy (CRT) or surgery, and improving overall outcomes. Methods: A systematic search was conducted on PubMed, Cochrane, and Clinicaltrials.gov following PRISMA guidelines and 25 studies reporting outcomes of induction chemotherapy in locally advanced sinonasal carcinoma were included after screening of 6352 studies. Inter-study variance was assessed using the Der Simonian-Laird Estimator, and pooled analysis was conducted with 95% confidence intervals using the ‘meta’ package in R (version 4.16-2) Results: A total of 1864 patients from twenty-five studies (1994-2024) were included for analysis. The median age was 56.2 (14-89) years and majority were male (72%, n=1239/1732). 64% (n=16) of studies were retrospective. 47% (n=879) had squamous cell sinonasal carcinoma while 36% (n=672) had undifferentiated sinonasal carcinoma with majority (91%, n=1703) having stage III-IV sinonasal carcinoma. Platinum-based, taxanes, and fluoropyrimidines were the most commonly used induction chemotherapy agents followed later by additional chemoradiation and/or surgery. Median follow-up time was 32.6 (7-109.1) months. The pooled rates of complete response (CR) and partial response (PR) were 7.8% (95% CI 0.06-0.10, I2=93%, p<0.01, n=1127) and 49.3% (95% CI 0.46-0.52, I2=92%, p<0.01, n=1127), respectively. The pooled overall survival (OS) at 3, 5, and 10-years was 57.4% (95% CI 0.53-0.62, I2=91%, p<0.01, n=459), 49.6% (95% CI 0.47-0.52, I2=70%, p<0.01, n=1302), and 38.5% (95% CI 0.35-0.42, I2=0%, p=0.84, n=821), respectively. The pooled progression free survival (PFS) at 2, 3, and 5-years was 52.7% (95% CI 0.45-0.60, I2=70%, p=0.04, n=179), 50% (95% CI 0.43-0.57, I2=83%, p<0.01, n=226), and 49.4% (95% CI 0.46-0.53, I2=84%, p<0.01, n=638), respectively. The pooled rate of mortality was 16.9% (95% CI 0.14-0.20, I2=95%, p<0.01, n=722) and the most common grade III-IV adverse events were leukopenia (39%, n=51/132), neutropenia (38%, n=129/340), and thrombocytopenia (17%, n=33/191). Conclusions: IC demonstrated significant response rates and promising long-term survival outcomes in locally advanced sinonasal carcinoma, along with tolerable toxicity profile. The evidence supports the use of induction chemotherapy to improve disease control, survival rates, and organ preservation in patients with this challenging malignancy. Further research and prospective trials are warranted to optimize IC regimens and establish standardized treatment protocols.