Prognosis of Distant Metastatic Sites in Anterior Skull Base Malignancies

Abstract Objective This study aimed to provide information regarding the prognosis of patients presenting with metastatic anterior skull base malignancies based upon histology and site of distant metastasis (DM). Patients and Methods The National Cancer Database was queried for patients with anterior skull base malignant neoplasms with DM. Outcomes Prognosis was compared between site of DM and tumor histologies. A multivariable Cox proportional hazards model was used to identify prognostic factors for overall survival (OS). Results A total of 481 patients were identified. Lung was the most common site of DM (24.9%), followed by bone (22.2%), liver (5.6%), and brain (2.5%). Lung was the most common site for squamous cell carcinoma (SCCa) (28.3%), melanoma (37.7%), and adenoid cystic carcinoma (ACC; 31.4%). The median survival for patients presenting with metastatic disease regardless of tumor histology was 9.0 months (95% confidence interval [CI]: 8.2–10.3), and patients with metastasis to the liver had the best median survival at 15.5 months (95% CI: 10.5–25.6). The median survivals for the most common histologies, SCCa, melanoma, and ACC were 8.2 months (95% CI: 5.5–10.2), 10.5 months (95% CI: 8.7–14.1), and 15.0 months (95% CI: 11.1–61.1), respectively. Multivariable analysis demonstrated worse overall survival (OS) for older patients, higher Charlson-Deyo comorbidity scores, and tumors with higher grade and T stage. Compared with metastasis to bone, lung metastasis had better OS on multivariable analysis (hazard ratio [HR]: 0.70, 95% CI: 0.51–97). Adenoid cystic carcinoma had improved OS compared with SCCa (HR: 0.62, 95% CI: 0.39–99). Conclusion Tumor histology, metastatic sites, and several disease factors affected prognosis in anterior skull base malignancies with DM.

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Adenoid Cystic Carcinoma of the Nasopharynx with Skull Base Involvement: Retrospective National Cohort Analysis of Treatment Paradigms, Outcomes, and Provider Density

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718769 ◽

2020 ◽

Author(s):

Shekhar K. Gadkaree ◽

Anuraag S. Parikh ◽

Eric Barbarite ◽

Allen L. Feng ◽

Justin McCarty ◽

...

Keyword(s):

Socioeconomic Status ◽

Overall Survival ◽

Radiation Therapy ◽

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Cohort Analysis ◽

Posterior Pharyngeal Wall ◽

Pharyngeal Wall ◽

Adenoid Cystic ◽

National Cohort

Abstract Objectives This article examines a national cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for incidence, skull base invasion, overall survival, and treatment paradigms. Design, Setting, and Participants Retrospective national population-based study using Surveillance, Epidemiology, and End Results program data of patients with ACC of the nasopharynx (NACC) and skull base between 2004 and 2016. Main Outcomes and Measures Primary outcomes included 5-year overall survival and odds of radiation treatment. Statistical analysis was performed using STATA 15.0 (STATACorp). p-Values < 0.05 were considered statistically significant. Results Of the 2,385 cases of ACC, 70 cases were classified as NACC. Twenty-one percent (15) involved invasion of the skull base or posterior pharyngeal wall, and 42% (30) were either stage 3 or stage 4. The 5-year overall survival for patients with NACC without skull base invasion was 67% which dropped to 40% with invasion into the skull base. Radiation was used as the primary form of therapy for 62% of NACC and 73% of NACC invading into skull base. Odds of receiving radiation therapy and 5-year survival were not affected by socioeconomic status or density of providers. Conclusion NACC is rare in incidence and was most commonly treated with radiation therapy when advanced in stage. Prognosis was dependent on invasion through posterior pharyngeal wall and skull base. Provider density and socioeconomic status did not affect odds of radiation or overall survival for NACC.

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Adenoid Cystic Carcinoma of the Skull Base: Response to Radiation Therapy and Outcomes in a Retrospective Case Series

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1696706 ◽

2019 ◽

Vol 81 (05) ◽

pp. 505-510 ◽

Cited By ~ 1

Author(s):

Shekhar K. Gadkaree ◽

Anuraag S. Parikh ◽

Alejandro I. Rodarte ◽

Ashton Lehmann ◽

Stacey T. Gray ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Proton Beam ◽

Locoregional Control ◽

Single Center ◽

Beam Radiation ◽

Adenoid Cystic ◽

Pathologic Features

Abstract Objectives The main purpose of this article is to examine a single-center cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for pathologic features, skull base invasion, overall survival, and disease-free survival, with a focus on response to proton beam radiation therapy. Design, Setting, and Participants Single-center institutional cancer registry was used to retrospectively identify and analyze outcomes for 12 patients treated for ACC of the nasopharynx from 2000 to 2016. Main Outcomes and Measures Primary outcomes included 5-year overall survival and locoregional control. Statistical analysis was performed using STATA 12.0 (STATACorp, College Station, Texas, United States). Spearman's rank order correlation was used for ordinal, monotonic variables with p-values <0.05 considered statistically significant. Survival analysis was performed by Kaplan–Meier method; comparison between groups was performed using log-rank test. Results Twelve patients with ACC of the nasopharynx were included. All patients presented with advanced disease and were treated with primary radiation therapy, typically proton beam therapy. Only two underwent a surgical attempt at resection. A majority of cases had a cribriform growth pattern. The 5-year survival was 75% and rate of locoregional control rate at 5 years was 50%, comparable to other ACC cohort studies that included earlier stage tumors in various subsites that were surgically resected. Conclusions Although ACC is traditionally noted to be radioresistant, ACC of the nasopharynx was responsive to radiotherapy in our cohort, despite advanced stage and skull base invasion. Reasons for this improved survival are unclear and suggest the need for further pathologic and genetic characterization of nasopharyngeal ACC.

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Adenoid Cystic Carcinoma of the Anterior Skull Base

Skull Base ◽

10.1055/s-2009-1222297 ◽

2009 ◽

Vol 19 (01) ◽

Author(s):

Sabir Husin Athar Primuharsa Putra ◽

Ami Mazita ◽

Mohd Razif Mohamad Yusof ◽

Mohd Kenali ◽

Zurin Rahman

Keyword(s):

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Anterior Skull Base ◽

Adenoid Cystic

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The Infratemporal Fossa Approach for Adenoid Cystic Carcinoma of the Skull Base and Nasopharynx

Otolaryngologic Clinics of North America ◽

10.1016/s0030-6665(20)31046-x ◽

1991 ◽

Vol 24 (6) ◽

pp. 1445-1464 ◽

Cited By ~ 1

Author(s):

John C. Shotton ◽

Stephan Schmid ◽

Ugo Fisch

Keyword(s):

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Infratemporal Fossa ◽

Adenoid Cystic

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Skull Base Adenoid Cystic Carcinoma – Clinical Series and Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1370611 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

Rahul Mehta ◽

Samuel Spear ◽

Yu-Lan Mary Ying ◽

Moises Arriaga ◽

Daniel Nuss

Keyword(s):

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Adenoid Cystic ◽

Clinical Series

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Proton Beam Therapy for Unresectable Adenoid Cystic Carcinoma of the Skull Base

Skull Base ◽

10.1055/s-2008-1093198 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

Annie Chan ◽

Paul Busse ◽

Urmila Kamat ◽

Derrick Lin ◽

Norbert Liebsch

Keyword(s):

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Proton Beam ◽

Proton Beam Therapy ◽

Adenoid Cystic

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Adenoid cystic carcinoma of the skull base mimicking temporomandibular disorder

Oral and Maxillofacial Surgery ◽

10.1007/s10006-013-0414-5 ◽

2013 ◽

Vol 18 (1) ◽

pp. 115-118 ◽

Cited By ~ 3

Author(s):

Aynur Sari-Rieger ◽

Stefan Hassfeld ◽

Klaus Junker ◽

Jan Rustemeyer

Keyword(s):

Adenoid Cystic Carcinoma ◽

Skull Base ◽

Temporomandibular Disorder ◽

Adenoid Cystic

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Treatment outcomes of recurrent and metastatic adenoid cystic carcinoma: A retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18056 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18056-e18056

Author(s):

Julie Elaine McGrath ◽

Punita Grover ◽

Joanne Xiu ◽

Chadi Nabhan ◽

Jennifer Hsing Choe ◽

...

Keyword(s):

Overall Survival ◽

Adenoid Cystic Carcinoma ◽

Real World ◽

Kinase Inhibitors ◽

Checkpoint Inhibitors ◽

Predictive Biomarkers ◽

High Rate ◽

Entire Cohort ◽

Adenoid Cystic ◽

Significant Difference

e18056 Background: Adenoid cystic carcinoma (ACC) is a rare malignancy of glandular tissue with a high rate of local recurrence and metastatic disease. Despite being regarded as an indolent disease, the clinical course of recurrent and metastatic ACC (R/M ACC) is highly variable. Responses to chemotherapy (chemo) are uniformly poor. Several multi-targeted tyrosine-kinase inhibitors (mTKIs), EGFR inhibitors (EGFRi) and other targeted agents have been studied in single-arm early phase trials with response rates ranging from 0-16% and progression free survival ranging from 2.5-17 months. However, there have been no comparative clinical trials and it is not known if one treatment strategy is superior. We undertook this retrospective study to assess the real-world clinical outcomes in patients with adenoid cystic carcinoma using the Caris Life Sciences database. Methods: Real world overall survival (rwOS) for cases of ACC was obtained from insurance claims data and Kaplan-Meier estimates were calculated from the date of collection to the date of last contact. Cases were divided into subgroups based on treatment received – chemo (including platinum agents, taxanes, 5FU, topoisomerase inhibitors, anthracyclines), EGFRi (cetuximab, erlotinib, lapatinib), mTKIs (pazopanib, axitinib, sunitinib, cabozantinib, lenvatinib, sorafenib) and immune checkpoint inhibitors (ICIs) (atezolizumab, ipilimumab, pembrolizumab, nivolumab). Results: 368 patients (pts) were identified with ACC, 16 were locally recurrent and 216 tumors were taken from metastatic sites. 50 pts received chemo, 6 were treated with EGFRi and 15 with mTKIs. Pts who received combination EGFRi and chemo or mTKI and chemo were excluded. The median overall survival (mOS) all patients with metastatic ACC was 2.8 years (yrs). The mOS of pts with R/M ACC was 3 yrs for chemo, 2.9 yrs for EGFRi and 1.5 yrs for mTKIs. There was no significance in mOS between chemo vs mTKIs (HR 0.85, 95% CI 0.3 - 2, p = 0.72) and chemo vs EGFRi (HR = 0.88, 95% CI 0.3 - 2.5, p = 0.78). We further compared the outcomes of those treated with EGFRi (n = 8) with mTKIs (n = 19) in the entire cohort. For most pts, these agents were given as front line therapy. 25% (2/8) of patients had received treatment prior to EGFRi and 20% (4/9) prior to mTKIs (p = 1). There was no significant difference in mOS with HR 0.6 (95% CI 0.16 - 2.6), p = 0.6. We also compared the mOS of patients who received ICIs (n = 22) with those who did not (n = 346) but there was no significant difference (mOS 3.19 vs 3.17 yrs respectively, HR 0.87, 95% CI 0.47- 1.61, p = 0.65). Conclusions: There was no significant difference in the mOS between pts with R/M ACC who were treated with chemo, EGFRi or TKIs and in those who received ICIs compared to those who did not in our limited patient population. This highlights the need for predictive biomarkers for better patient selection with the goal of personalizing treatment strategies for this disease.

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