Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Treatment
2.3. Endpoints and Statistical Analysis
3. Results
3.1. Patients’ Characteristics and Treatment Specifics
3.2. Clinical Outcomes and Patterns of Recurrences
3.3. Univariate and Multivariate Analyses
3.4. Adverse Events
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Bradley, P.J. Adenoid cystic carcinoma of the head and neck: A review. Curr. Opin. Otolaryngol. Head Neck Surg. 2004, 12, 127–132. [Google Scholar] [CrossRef]
- Spiro, R.H.; Huvos, A.G.; Strong, E.W. Adenoid cystic carcinoma of salivary origin. A clinicopathologic study of 242 cases. Am. J. Surg. 1974, 128, 512–520. [Google Scholar] [CrossRef]
- Dodd, R.L.; Slevin, N.J. Salivary gland adenoid cystic carcinoma: A review of chemotherapy and molecular therapies. Oral Oncol. 2006, 42, 759–769. [Google Scholar] [CrossRef]
- Coca-Pelaz, A.; Rodrigo, J.P.; Bradley, P.J.; Vander Poorten, V.; Triantafyllou, A.; Hunt, J.L.; Strojan, P.; Rinaldo, A.; Haigentz, M.; Takes, R.P.; et al. Adenoid cystic carcinoma of the head and neck—An update. Oral Oncol. 2015, 51, 652–661. [Google Scholar] [CrossRef]
- Turner, J.H.; Reh, D.D. Incidence and survival in patients with sinonasal cancer: A historical analysis of population-based data. Head. Neck 2012, 34, 877–885. [Google Scholar] [CrossRef]
- Robin, T.P.; Jones, B.L.; Gordon, O.M.; Phan, A.; Abbott, D.; McDermott, J.D.; Goddard, J.A.; Raben, D.; Lanning, R.M.; Karam, S.D. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017, 123, 3040–3049. [Google Scholar] [CrossRef] [PubMed]
- Miglianico, L.; Eschwege, F.; Marandas, P.; Wibault, P. Cervico-facial adenoid cystic carcinoma: Study of 102 cases. Influence of radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 1987, 13, 673–678. [Google Scholar] [CrossRef] [PubMed]
- Chen, A.M.; Bucci, M.K.; Weinberg, V.; Garcia, J.; Quivey, J.M.; Schechter, N.R.; Phillips, T.L.; Fu, K.K.; Eisele, D.W. Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: Prognostic features of recurrence. Int. J. Radiat. Oncol. Biol. Phys. 2006, 66, 152–159. [Google Scholar] [CrossRef] [PubMed]
- Abdelmeguid, A.S.; Teeramatwanich, W.; Roberts, D.B.; Amit, M.; Ferraroto, R.; Glisson, B.S.; Kupferman, M.E.; Su, S.Y.; Phan, J.; Garden, A.S.; et al. Neoadjuvant chemotherapy for locoregionally advanced squamous cell carcinoma of the paranasal sinuses. Cancer 2021, 127, 1788–1795. [Google Scholar] [CrossRef] [PubMed]
- Sahara, S.; Herzog, A.E.; Nör, J.E. Systemic therapies for salivary gland adenoid cystic carcinoma. Am. J. Cancer Res. 2021, 11, 4092–4110. [Google Scholar] [PubMed]
- Mendenhall, W.M.; Morris, C.G.; Amdur, R.J.; Werning, J.W.; Hinerman, R.W.; Villaret, D.B. Radiotherapy alone or combined with surgery for adenoid cystic carcinoma of the head and neck. Head Neck 2004, 26, 154–162. [Google Scholar] [CrossRef]
- Lupinetti, A.D.; Roberts, D.B.; Williams, M.D.; Kupferman, M.E.; Rosenthal, D.I.; Demonte, F.; El-Naggar, A.; Weber, R.S.; Hanna, E.Y. Sinonasal adenoid cystic carcinoma: The M. D. Anderson Cancer Center experience. Cancer 2007, 110, 2726–2731. [Google Scholar] [CrossRef]
- Kim, K.; Ahn, Y.C.; Oh, D.; Noh, J.M.; Jeong, H.S.; Chung, M.K.; Hong, S.D.; Baek, C.H. Can Definitive Radiation Therapy Substitute Surgical Resection in Locally Advanced T3 or T4 Sinonasal Squamous Cell Carcinoma? Int. J. Radiat. Oncol. Biol. Phys. 2023, 117, 893–902. [Google Scholar] [CrossRef] [PubMed]
- Fordice, J.; Kershaw, C.; El-Naggar, A.; Goepfert, H. Adenoid Cystic Carcinoma of the Head and Neck. Arch. Otolaryngol.–Head. Neck Surg. 1999, 125, 149–152. [Google Scholar] [CrossRef] [PubMed]
- Barrett, A.W.; Speight, P.M. Perineural invasion in adenoid cystic carcinoma of the salivary glands: A valid prognostic indicator? Oral Oncol. 2009, 45, 936–940. [Google Scholar] [CrossRef] [PubMed]
- Ramakrishna, R.; Raza, S.M.; Kupferman, M.; Hanna, E.; DeMonte, F. Adenoid cystic carcinoma of the skull base: Results with an aggressive multidisciplinary approach. J. Neurosurg. 2016, 124, 115–121. [Google Scholar] [CrossRef] [PubMed]
- Kosaki, K.; Ecker, S.; Habermehl, D.; Rieken, S.; Jakel, O.; Herfarth, K.; Debus, J.; Combs, S.E. Comparison of intensity modulated radiotherapy (IMRT) with intensity modulated particle therapy (IMPT) using fixed beams or an ion gantry for the treatment of patients with skull base meningiomas. Radiat. Oncol. 2012, 7, 44. [Google Scholar] [CrossRef] [PubMed]
- Florijn, M.A.; Sharfo, A.W.M.; Wiggenraad, R.G.J.; van Santvoort, J.P.C.; Petoukhova, A.L.; Hoogeman, M.S.; Mast, M.E.; Dirkx, M.L.P. Lower doses to hippocampi and other brain structures for skull-base meningiomas with intensity modulated proton therapy compared to photon therapy. Radiother. Oncol. 2020, 142, 147–153. [Google Scholar] [CrossRef]
- Gentile, M.S.; Yip, D.; Liebsch, N.J.; Adams, J.A.; Busse, P.M.; Chan, A.W. Definitive proton beam therapy for adenoid cystic carcinoma of the nasopharynx involving the base of skull. Oral Oncol. 2017, 65, 38–44. [Google Scholar] [CrossRef]
- Hu, W.; Hu, J.; Huang, Q.; Gao, J.; Yang, J.; Qiu, X.; Kong LLu, J.J. Particle Beam Radiation Therapy for Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinuses. Front. Oncol. 2020, 10, 572493. [Google Scholar] [CrossRef]
- Dautruche, A.; Bolle, S.; Feuvret, L.; Le Tourneau, C.; Jouffroy, T.; Goudjil, F.; Zefkili, S.; Nauraye, C.; Rodriguez, J.; Herman, P.; et al. Three-year results after radiotherapy for locally advanced sinonasal adenoid cystic carcinoma, using highly conformational radiotherapy techniques proton therapy and/or Tomotherapy. Cancer Radiother. 2018, 22, 411–416. [Google Scholar] [CrossRef] [PubMed]
- Boeckman, H.J.; Trego, K.S.; Turchi, J.J. Cisplatin sensitizes cancer cells to ionizing radiation via inhibition of nonhomologous end joining. Mol. Cancer Res. 2005, 3, 277–285. [Google Scholar] [CrossRef] [PubMed]
- Bhattasali, O.; Holliday, E.; Kies, M.S.; Hanna, E.Y.; Garden, A.S.; Rosenthal, D.I.; Morrison, W.H.; Gunn, G.B.; Fuller, C.D.; Zhu, X.R.; et al. Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: A series of 9 cases and a critical review of the literature. Head Neck 2016, 38 (Suppl. S1), E1472–E1480. [Google Scholar] [CrossRef] [PubMed]
- Ha, H.; Keam, B.; Ock, C.Y.; Kim, T.M.; Kim, J.H.; Chung, E.J.; Kwon, S.K.; Ahn, S.H.; Wu, H.G.; Sung, M.W.; et al. Role of concurrent chemoradiation on locally advanced unresectable adenoid cystic carcinoma. Korean J. Intern. Med. 2021, 36, 175–181. [Google Scholar] [CrossRef] [PubMed]
- Swain, M.; Ghosh-Laskar, S.; Budrukkar, A.; Patil, R.; Murthy, V.; Gupta, T.; Mummudi, N.; Prabhash, K.; Joshi, A.; Patil, V.M.; et al. Concurrent chemoradiotherapy for locally advanced unresectable adenoid cystic carcinoma of head and neck: Experience from a single institute. Eur. Arch. Otorhinolaryngol. 2021, 278, 4423–4431. [Google Scholar] [CrossRef] [PubMed]
- Fang, Y.; Peng, Z.; Wang, Y.; Gao, K.; Liu, Y.; Fan, R.; Zhang, H.; Xie, Z.; Jiang, W. Current opinions on diagnosis and treatment of adenoid cystic carcinoma. Oral Oncol. 2022, 130, 105945. [Google Scholar] [CrossRef] [PubMed]
- Jang, S.; Patel, P.N.; Kimple, R.J.; McCulloch, T.M. Clinical Outcomes and Prognostic Factors of Adenoid Cystic Carcinoma of the Head and Neck. Anticancer Res. 2017, 37, 3045–3052. [Google Scholar]
- Noh, J.M.; Lee, E.; Ahn, Y.C.; Oh, D.; Kim, Y.D.; Woo, K.I.; Ko, Y.H.; Kim, S. Clinical significance of post-surgical residual tumor burden and radiation therapy in treating patients with lacrimal adenoid cystic carcinoma. Oncotarget 2016, 7, 60639–60646. [Google Scholar] [CrossRef]
- Ishida, E.; Ogawa, T.; Rokugo, M.; Ishikawa, T.; Wakamori, S.; Ohkoshi, A.; Usubuchi, H.; Higashi, K.; Ishii, R.; Nakanome, A.; et al. Management of adenoid cystic carcinoma of the head and neck: A single-institute study with over 25-year follow-up. Head Face Med. 2020, 16, 14. [Google Scholar] [CrossRef]
- Ohta, K.; Matsuda, S.; Okada, A.; Sasaki, M.; Imamura, Y.; Yoshimura, H. Adenoid cystic carcinoma of the sublingual gland developing lung metastasis 20 years after primary treatment: A case report and literature review. Medicine 2021, 100, e28098. [Google Scholar] [CrossRef]
Characteristics | S+PORT Group (N = 31) | D(C)RT Group (N = 30) | p-Value |
---|---|---|---|
Age at diagnosis (years, median) | 48 (range: 28–67) | 54 (range: 20–82) | 0.168 |
Sex | 1.000 | ||
Male | 15 (48.4%) | 15 (50.0%) | |
Female | 16 (51.6%) | 15 (50.0%) | |
Time of treatment initiation | 0.554 | ||
1995–1999 | 1 (3.2%) | 3 (10.0%) | |
2000–2004 | 3 (9.7%) | 2 (6.7%) | |
2005–2009 | 5 (16.1%) | 2 (6.7%) | |
2010–2014 | 5 (16.1%) | 7 (23.3%) | |
2015–2019 | 11 (35.5%) | 13 (43.3%) | |
2020–2021 | 6 (19.4%) | 3 (10.0%) | |
Primary site | 0.074 | ||
Nasal cavity | 14 (45.2%) | 10 (33.3%) | |
Maxillary sinus | 17 (54.8%) | 14 (46.7%) | |
Ethmoid sinus | 0 (0.0%) | 2 (6.7%) | |
Sphenoid sinus | 0 (0.0%) | 4 (13.3%) | |
T stage (AJCC 8th) | <0.001 | ||
T1 | 3 (9.7%) | 0 (0.0%) | |
T2 | 11 (35.5%) | 2 (6.7%) | |
T3 | 9 (29.0%) | 4 (13.3%) | |
T4a | 8 (25.8%) | 6 (20.0%) | |
T4b | 0 (0.0%) | 18 (60.0%) | |
Neurologic symptom as chief complaints | 1 (3.2%) | 13 (43.3%) | 0.001 |
PET/CT staging | 26 (83.9%) | 25 (83.3%) | 1.000 |
Longest diameter on radiologic exams (cm, median) | 3.7 (range: 2.0–5.5) * | 4.2 (range: 1.6–6.4) * | 0.033 |
Longest diameter on pathologic exam (cm, median) | 4.0 (range; 2.0–8.0) † | - | - |
Solid portion | 0.741 ‡ | ||
Yes | 4 (12.9%) | 3 (10.0%) | |
No | 21 (67.7%) | 8 (26.7%) | |
Unknown | 6 (19.4%) | 19 (63.3%) | |
Radiological evidence of nerve involvement § | 10 (32.3%) | 24 (80.0%) | <0.001 |
Perineural invasion in pathologic exam | - | ||
Yes | 13 (41.9%) | - | |
No | 8 (25.8%) | - | |
Unknown | 10 (32.3%) | - | |
Margin status | - | ||
Positive (R1) | 20 (64.5%) | - | |
Close (<0.5 cm) | 11 (35.5%) | - | |
Neck dissection | 8 (25.8%) | - | - |
Concurrent chemotherapy | 0 (0.0%) | 7 (23.3%) | 0.014 |
Radiation therapy modality | 0.489 | ||
3D-CRT | 7 (22.6%) | 6 (20.0%) | |
IMRT | 12 (38.7%) | 16 (53.3%) | |
Proton therapy (alone or combined with IMRT) | 12 (38.7%) | 8 (26.7%) | |
Radiation dose, EQD2 (Gy, median) ¶ | 60.4 (range: 50.0–70.0) | 67.7 (range: 57.3–71.6) | <0.001 |
Radiation therapy duration (days, median) | 41 (range: 34–47) | 41 (range: 29–53) | 0.580 |
Patterns of Recurrence | T1 | T2 | T3 | T4a | T4b | |||
---|---|---|---|---|---|---|---|---|
S+PORT Group (N = 3) | S+PORT Group (N = 11) | D(C)RT Group (N = 2) | S+PORT Group (N = 9) | D(C)RT Group (N = 4) | S+PORT Group (N = 8) | D(C)RT Group (N = 6) | D(C)RT Group (N = 18) | |
Any progression | 0 (0.0%) | 8 (72.7%) | 2 (100.0%) | 7 (77.8%) | 1 (25.0%) | 5 (62.5%) | 6 (100.0%) | 15 (83.3%) |
Local progression | 0 (0.0%) | 4 (36.4%) | 2 (100.0%) | 6 (66.7%) | 0 (0.0%) | 3 (37.5%) | 4 (66.7%) | 13 (72.2%) |
Regional recurrence | 0 (0.0%) | 1 (9.1%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1 (12.5%) | 1 (16.7%) | 2 (11.1%) |
Distant metastasis | 0 (0.0%) | 5 (45.5%) | 2 (100.0%) | 5 (55.6%) | 1 (25.0%) | 5 (62.5%) | 5 (83.3%) | 10 (55.6%) |
5-Year Rate of LFFS (95% CI) | 5-Year Rate of DMFS (95% CI) | 5-Year Rate of PFS (95% CI) | 5-Year Rate of OS (95% CI) | |||||
---|---|---|---|---|---|---|---|---|
S+PORT | D(C)RT | S+PORT | D(C)RT | S+PORT | D(C)RT | S+PORT | D(C)RT | |
All patients | 61.8% | 37.8% | 64.8% | 38.1% | 52.6% | 19.3% | 93.2% | 73.4% |
(44.6%–85.6%) | (23.5%–60.8%) | (48.2%–87.1%) | (23.4%–62.3%) | (35.9%–77.2%) | (8.9%–41.8%) | (84.5%–100%) | (58.0%–92.8%) | |
p = 0.003 | p = 0.036 | p = 0.010 | p = 0.001 | |||||
T3–4 subgroup | 43.4% | 36.8% | 49.5% | 32.9% | 34.9% | 16.7% | 94.1% | 71.1% |
(22.7%–83.2%) | (22.2%–60.9%) | (28.2%–86.8%) | (18.5%–58.7%) | (16.4%–74.4%) | (6.9%–40.3%) | (83.6%–100%) | (54.7%–92.2%) | |
p = 0.107 | p = 0.426 | p = 0.158 | p = 0.011 |
Characteristics (Comparison vs. Reference) | Local Failure-Free Survival | Distant Metastasis-Free Survival | Progression-Free Survival | Overall Survival | ||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | |||||||||||||||||
HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | |
Age at diagnosis (per a year) | 1.027 | 0.998–1.056 | 0.070 | 1.022 | 0.993–1.052 | 0.137 | 1.021 | 0.992–1.051 | 0.150 | - | - | - | 1.021 | 0.996–1.047 | 0.106 | - | - | - | 1.041 | 0.999–1.084 | 0.057 | 1.038 | 0.995–1.083 | 0.084 |
Sex (female vs. male) | 0.992 | 0.513–1.918 | 0.980 | - | - | - | 1.086 | 0.564–2.094 | 0.804 | - | - | - | 1.511 | 0.820–2.782 | 0.186 | - | - | - | 0.779 | 0.328–1.853 | 0.573 | - | - | - |
Primary site (maxillary sinus vs. others) | 0.664 | 0.341–1.295 | 0.229 | - | - | - | 1.688 | 0.859–3.318 | 0.129 | - | - | - | 0.939 | 0.513–1.719 | 0.838 | - | - | - | 0.987 | 0.417–2.336 | 0.976 | - | - | - |
T4b disease (yes vs. no) | 3.586 | 1.751–7.347 | <0.001 | 2.024 | 0.596–6.870 | 0.258 | 1.988 | 0.968–4.081 | 0.061 | 0.871 | 0.334–2.270 | 0.777 | 2.250 | 1.189–4.255 | 0.013 | 0.567 | 0.217–1.487 | 0.249 | 7.702 | 2.609–22.74 | <0.001 | 4.829 | 0.598–33.44 | 0.111 |
Neurologic symptom as chief complaints (yes vs. no) | 2.189 | 1.053–4.548 | 0.036 | 0.807 | 0.306–2.127 | 0.664 | 1.424 | 0.678–2.992 | 0.350 | - | - | - | 1.454 | 0.743–2.844 | 0.274 | - | - | - | 2.684 | 1.086–6.635 | 0.033 | 0.605 | 0.148–2.464 | 0.483 |
PET/CT staging (yes vs. no) | 1.064 | 0.472–2.401 | 0.881 | - | - | - | 1.331 | 0.585–3.028 | 0.495 | - | - | - | 2.399 | 0.913–6.301 | 0.076 | 1.715 | 0.620–4.745 | 0.299 | 0.780 | 0.300–2.030 | 0.611 | - | - | - |
Longest diameter on radiologic exam (per 1 cm) * | 1.265 | 0.933–1.717 | 0.130 | - | - | - | 1.153 | 0.879–1.512 | 0.305 | - | - | - | 1.192 | 0.923–1.539 | 0.178 | - | - | - | 1.588 | 1.081–2.333 | 0.018 | 1.281 | 0.897–1.867 | 0.197 |
Radiological evidence of nerve involvement (yes vs. no) | 2.634 | 1.255–5.526 | 0.010 | 1.601 | 0.641–4.001 | 0.314 | 2.652 | 1.275–5.517 | 0.009 | 2.369 | 1.032–5.437 | 0.042 | 3.741 | 1.838–7.615 | <0.001 | 3.478 | 1.501–8.063 | 0.004 | 2.612 | 1.016–6.717 | 0.046 | 0.822 | 0.202–3.351 | 0.785 |
Radiation therapy modality | ||||||||||||||||||||||||
IMRT vs. 3D-CRT | 1.108 | 0.484–2.538 | 0.808 | - | - | - | 1.121 | 0.523–2.403 | 0.769 | - | - | - | 1.602 | 0.747–3.435 | 0.226 | - | - | - | 0.696 | 0.273–1.776 | 0.449 | - | - | - |
Proton therapy (alone or combined with IMRT) vs. 3D-CRT | 1.331 | 0.494–3.585 | 0.572 | - | - | - | 1.228 | 0.440–3.425 | 0.695 | - | - | - | 1.402 | 0.550–3.576 | 0.480 | - | - | - | 0.616 | 0.116–3.287 | 0.571 | - | - | - |
Treatment group (D(C)RT vs. S+PORT group) | 2.878 | 1.416–5.846 | 0.003 | 1.717 | 0.644–4.579 | 0.280 | 2.077 | 1.042–4.139 | 0.038 | 1.672 | 0.696–4.013 | 0.250 | 2.172 | 1.189–3.967 | 0.012 | 2.143 | 0.929–4.939 | 0.074 | 5.093 | 1.872–13.86 | 0.001 | 3.390 | 0.845–13.59 | 0.085 |
Patient Number | Treatment Group | Sex | Age | Primary Site | T Stage | CTCAE Terminology | Months from Treatment Initiation | Course |
---|---|---|---|---|---|---|---|---|
#1 | S+PORT | F | 51 | Maxillary sinus | T4a | Sinusitis | 26 | Surgical debridement was required. |
#2 | S+PORT | F | 66 | Maxillary sinus | T2 | Facial pain | 34 | Severe facial pain due to a titanium plate inserted during the previous radical surgery. Partial removal of the plate was indicated. |
Skin ulceration | 54 | Partial removal of the titanium plate and a skin graft was required. | ||||||
#3 | S+PORT | M | 44 | Maxillary sinus | T3 | Osteonecrosis | 35 | Surgical debridement on the irradiated side of the maxilla was required. |
#4 | S+PORT | M | 43 | Nasal cavity | T2 | Dermatitis radiation | 1 | Moist desquamation of the radiation field. |
Sinus disorder | 6 | Obstruction required surgical synechiolysis. | ||||||
#5 | S+PORT | F | 48 | Maxillary sinus | T2 | Skin infection | 3 | Cellulitis of the treated site required hospitalization and intravenous antibiotics. |
#6 | S+PORT | F | 59 | Maxillary sinus | T3 | Skin infection | 4 | Cellulitis of the treated site required hospitalization and intravenous antibiotics. |
#7 | D(C)RT | F | 38 | Sphenoid sinus | T4b | Extraocular muscle paresis | 25 | Diplopia during lateral gaze. |
Facial muscle weakness | 28 | Near complete facial palsy. | ||||||
#8 | D(C)RT | M | 52 | Maxillary sinus | T4b | Sinusitis | 11 | Surgical drainage was required. |
Hearing impaired | 57 | Hearing aid was indicated. | ||||||
Central nervous system necrosis | 42 | Progressive necrosis of the temporal lobe persisted after steroid administration. Bevacizumab was indicated. | ||||||
Extraocular muscle paresis | 79 | Diplopia during lateral gaze. | ||||||
Oral cavity fistula | 83 | Surgical closure was indicated. | ||||||
#9 | D(C)RT | F | 60 | Maxillary sinus | T3 | Sinusitis | 32 | Surgery was recommended, but the patient refused. |
#10 | D(C)RT | F | 64 | Nasal cavity | T4a | Optic nerve disorder | 37 | Decreased visual acuity on the irradiated side. |
#11 | D(C)RT | F | 69 | Maxillary sinus | T4a | Sinusitis | 3 | Surgical debridement was required. |
#12 | D(C)RT | M | 71 | Maxillary sinus | T4b | Optic nerve disorder | 23 | Decreased visual acuity on the irradiated side. |
#13 | D(C)RT | F | 64 | Nasal cavity | T4b | Vestibular disorder | 40 | Severe dizziness necessitated an emergency department visit. |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lee, T.H.; Kim, K.; Oh, D.; Yang, K.; Jeong, H.-S.; Chung, M.K.; Ahn, Y.C. Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities. Cancers 2024, 16, 1235. https://doi.org/10.3390/cancers16061235
Lee TH, Kim K, Oh D, Yang K, Jeong H-S, Chung MK, Ahn YC. Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities. Cancers. 2024; 16(6):1235. https://doi.org/10.3390/cancers16061235
Chicago/Turabian StyleLee, Tae Hoon, Kangpyo Kim, Dongryul Oh, Kyungmi Yang, Han-Sin Jeong, Man Ki Chung, and Yong Chan Ahn. 2024. "Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities" Cancers 16, no. 6: 1235. https://doi.org/10.3390/cancers16061235
APA StyleLee, T. H., Kim, K., Oh, D., Yang, K., Jeong, H. -S., Chung, M. K., & Ahn, Y. C. (2024). Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities. Cancers, 16(6), 1235. https://doi.org/10.3390/cancers16061235