Chemotherapy Before Surgery: Improving Organ Preservation in Nose and Sinus Cancer

Highlights:

Chemotherapy before surgery increases organ preservation from 15% to 50%
The trial provides a new treatment approach for rare nose and sinus cancers
Future research may include chemotherapy modifications or immunotherapy

A recent clinical trial led by the ECOG-ACRIN Cancer Research Group has delivered promising results for patients with advanced squamous cell carcinoma of the nose and sinus. The trial aimed to test whether administering chemotherapy before surgery could improve outcomes for patients, particularly those at risk of losing vital structures like the eye or the base of the skull. The findings, presented at the ESMO Congress 2024 in Barcelona, Spain, show that this approach can dramatically increase the chances of preserving these critical structures ().

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‘Did You Know?
Patients treated with chemotherapy before surgery have a 50% chance of organ preservation. #medindia #cancerresearch #chemotherapy’

Bold Move for Organ Preservation

Nose and sinus cancer is a rare disease, affecting approximately 2,000 people annually in the United States, mostly those aged 55 and older. Because the cancer often develops near vital structures such as the eyes and the base of the skull, surgical treatment can have debilitating effects. In many cases, patients face the prospect of losing their eyes or parts of their skull bones.

Prior small studies had suggested that chemotherapy before surgery could help shrink tumors, reducing the need for aggressive surgery. However, the absence of large, multi-center trials made it difficult to validate this approach. The EA3163 trial, sponsored by the National Cancer Institute, aimed to fill this gap by providing reliable, objective data to compare chemotherapy before surgery (neoadjuvant chemotherapy) with surgery alone.

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Chemotherapy Boosts Chances of Structure Preservation

The randomized prospective EA3163 trial was the first of its kind to evaluate the effectiveness of chemotherapy before surgery in shrinking tumors and preserving vital structures in patients with nasal and paranasal sinus squamous cell carcinoma. The trial's results were striking: patients who received chemotherapy before surgery had a 50% chance of preserving both their eye and the base of their skull bone, compared to only a 15% chance in patients who underwent surgery alone.

These findings mark a significant improvement in organ preservation, providing hope for patients who would otherwise face life-altering surgeries.

Patients in the experimental group received three cycles of chemotherapy (docetaxel and cisplatin, or carboplatin if necessary) before surgery, followed by radiation therapy. In contrast, those in the control group underwent surgery followed by radiation alone. The chemotherapy regimen followed the National Comprehensive Cancer Network’s clinical practice guidelines.

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Improving Quality of Life and Survival

While the EA3163 trial focused primarily on structural preservation, improving the 5-year survival rate remains a critical goal. Current survival rates for nasal and sinus cancer are less than 50%, and the researchers hope that reducing the need for aggressive surgery will not only improve patients' quality of life but also enhance their long-term survival prospects.

The study participants continue to be monitored for overall survival at the 2-year mark, with future research aimed at further improving patient outcomes through advancements in chemotherapy and treatment strategies.

The results of the EA3163 trial represent a significant advance in the treatment of nasal and paranasal sinus squamous cell carcinoma. Chemotherapy before surgery offers patients a better chance of preserving their vital structures and reducing the long-term physical toll of treatment. Though the trial faced challenges due to the rarity of the disease, its findings pave the way for more research and improvements in cancer care.

Reference:

Chemotherapy before surgery helps patients with nose and sinus cancer avoid debilitating eye and bone removal - (https://ecog-acrin.org/chemotherapy-before-surgery-helps-patients-with-nose-and-sinus-cancer-avoid-debilitating-eye-and-bone-removal/)

Source-Medindia

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