Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach

Background: Timely postoperative radiation therapy (RT) within 50 days of surgery for head and neck cancers provides a survival advantage. Methods: Using the National Cancer Database, we performed a propensity score-matched analysis comparing patients undergoing open or endoscopic surgery for squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses from 2010 to 2015. Results: Among 168 pairs, patients undergoing endoscopic surgery had shorter time to surgery (24.2 vs 36.7 days, P <.001) and shorter postoperative time to RT (PTTR, 51.2 vs 58.4 days, P =.02). On multivariable linear regression, endoscopic surgery predicted shorter PTTR (β = −7.6, P =.01). Using the Kaplan-Meier method, patients in the longest PTTR quartile had decreased overall survival (OS; Q1 vs Q4, 3-year OS 76.5% vs 53.3%, P =.007), a durable finding when adjusted for covariates (Q1 vs Q4, HR 0.50, P =.008). Conclusions: Patients undergoing endoscopic surgery for sinonasal SCC experience shorter PTTR. Shorter PTTR is associated with extended OS.