Primary Chemoradiotherapy Versus Primary Surgery for Non-Metastatic Sinonasal Rhabdomyosarcoma in Adolescents and Adults.
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OBJECTIVES: Sinonasal rhabdomyosarcoma (SNRMS) is a rare malignancy with a poor prognosis. This study aimed to determine the optimal treatment modality for SNRMS. MATERIALS AND METHODS: Fifty-five patients with SNRMS were treated at our institution between December 2012 and November 2022. Demographic characteristics, treatment information, and follow-up data were collected and analyzed. The log-rank tests were used to compare the differences between treatment groups, and overall survival (OS), progression-free survival (PFS), local failure-free survival (LFS), and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to determine the factors associated with OS and PFS. RESULTS: The 2-year OS, PFS, LFS, and DMFS rates were 55.6%, 46.5%, 51.9%, and 52.1%, respectively. Surgery was not associated with improved 2-year OS (52.0% vs. 58.1%, p = 0.51), PFS (44.4% vs. 48.4%, p = 0.45), LFS (48.4% vs. 54.8%, p = 0.27), or DMFS (48.0% vs. 54.8%, p = 0.63) rates. Multivariate Cox regression analysis showed that primary chemoradiotherapy and intensity-modulated radiotherapy (IMRT)/volumetric modulated arc radiotherapy (VMAT) independently predicted improved OS and PFS, and lack of response to induction chemotherapy (IC) independently was associated with poorer OS and PFS. Multivariate logistic regression analysis showed that IMRT/VMAT and primary chemoradiotherapy were the factors associated with a lower risk of local recurrence. CONCLUSIONS: Primary chemoradiotherapy may represent the optimal treatment. Primary chemoradiotherapy, response to IC, and radiation technique were the independent prognostic factors.