Special considerations in sinonasal tumors with orbitalinvolvement: our experience at Hospital Universitario SanIgnacio. Bogotá, Colombia
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Abstract
Introduction: malignant sinonasal tumors (MSTs) represent an aggressive disease entity associated with poor prognosis and high mortality. The extent of orbital involvement and histological subtype significantly influence oncologic outcomes. However, controversy persists regarding the indication for orbital exenteration versus orbital preservation. Objective: to describe the clinical and histopathological characteristics and oncologic outcomes, including overall survival, in patients with malignant sinonasal tumors with orbital invasion treated with either orbital preservation or orbital exenteration surgery at a high-complexity referral center in Bogotá, Colombia. Methods: a retrospective observational descriptive case series was conducted. Patients with histopathologically confirmed malignant sinonasal tumors with orbital involvement who underwent surgical treatment between January 2017 and December 2023 were included. Clinical and demographic variables, the degree of orbital invasion according to the Iannetti classification based on magnetic resonance imaging, histological subtype, type of surgical management, and adjuvant therapy were analyzed. Surgical decisions were made through a multidisciplinary head and neck tumor board. Overall survival was estimated using the Kaplan–Meier method. Results: thirteen patients were included; 54% presented with grade III orbital invasion. Seven distinct histopathological subtypes were identified. During follow-up, seven patients died due to tumor progression, six within the first postoperative year. The estimated overall survival was 30.7%, with a marked decline during the first 12 months, particularly among patients undergoing orbital exenteration with orbital apex involvement. Conclusion: malignant sinonasal tumors with orbital invasion are associated with low overall survival, especially in advanced stages. Therapeutic decision-making should be individualized through a multidisciplinary approach.
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