A Meta-Analysis on the Impact of Induction Chemotherapy on Survival Outcomes for Sinonasal Squamous Cell Carcinoma

Background and Objectives: Malignant neoplasms of the nasal cavity and paranasal sinuses are an aggressive form of tumour that tends to be diagnosed at a locoregionally advanced stage. Among its various histological subtypes, squamous cell carcinomas (SCC) are the most common form of sinonasal cancer, with approximately 50%–60% of sinonasal malignancies being SCC. This review aims to investigate the impact of induction chemotherapy on survival outcomes for patients undergoing cancer care for sinonasal squamous cell carcinomas (SNSCC).Methods: Two reviewers independently assessed 2,118 studies pooled from four bibliographic databases, namely MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science and hand-searched grey literature. This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. As this was a time-to-event analysis, hazard ratios (HRs) and standard errors were derived from individual studies and pooled together for analysis. If these values were not available directly, statistical methods were used to indirectly extract the required data via Kaplan-Meier curves or via the p-value and the numbers of events.Results: Results suggest a notable improvement in overall survival (HR=0.56, 95% confidence interval [CI]=[0.36, 0.86], p<0.009) and a promising improvement in disease-free survival (HR=0.82, 95% CI=[0.62, 1.08], p=0.16) for patients who underwent induction chemotherapy in addition to definitive treatment for SNSCC.Conclusion: Our findings add to existing literature by providing a precise pooled estimate of the beneficial effects, revealing that induction chemotherapy is not just a viable add-on to traditional treatment regimens but also improves survival outcomes when compared to definitive local therapy as a standalone treatment. Clinicians should consider incorporating induction chemotherapy as a treatment option for locoregionally advanced SNSCC.