Neoadjuvant chemotherapy in locally advanced Sinonasal Teratocarcinosarcoma a rare malignancy - an audit from an academic Tertiary Care Centre in India

Background Sinonasal teratocarcinosarcomas (SNTCS) are rare sinonasal malignancies, the incidence of which is less-than 1% of all tumors. There is limited data available on SNTCS’s, often as case reports and small case series. The management of SNTCS is complicated because of its location, locally aggressive biology, difficulty in achieving complete resection, and limited data on chemotherapy in these malignancies. This audit was performed to understand the role of neoadjuvant chemotherapy (NACT) in SNTCS’s, its ability to downstage the disease, achieve complete resection, and impact on long-term survival outcomes. Methods This was a retrospective analysis of a prospectively maintained database approved by the Institutional Ethics Committee (IEC). The baseline characteristics, the extent of tumor, Kadish stage, NACT regimen, and adverse events were extracted from the Electronic Medical Records and the patient’s case file. Patients with baseline extensive/inoperable disease were referred for NACT from the multidisciplinary joint clinic followed by response assessment (RECIST v1.1). Patients underwent skull-base surgery if resectable post-completion of NACT, however, if deemed unresectable were treated with non-surgical modalities or palliative therapies. Results The data of 27 patients were evaluated from the year 2015 to 2022. The median age was 42 years (IQR:30-56) and 85.2% (n=23) were males. The ECOG-PS was 0-1 in 88.8% (n=24) patients. All 27 patients received NACT in view of extensive disease at presentation. 74.1% (n=20) patients received Cisplatin-Etoposide and 25.9% (n=7) received other chemotherapy regimens. The median number of chemotherapy cycles was 2(IQR:2-3). 96.3% patients (n=26) completed the planned NACT cycles. 70.4% (n=19) patients achieved a partial response in post-NACT imaging. 77.8% (n=18) underwent surgery, 18.5% (n=5) received CTRT, and 7.4% (n=2) received definitive-RT alone. The median PFS and OS of the cohort was 19months (95%CI:12.0-25.6) and 23months (95%CI:5.94-40.06) respectively. Conclusion NACT is safe, feasible, and effective with significant response rates, leading to effective downstaging, resectability and improved survival in patients with locally advanced SNTCS’s.