Purpose

We report the use of Intra-arterial chemotherapy (IAC) to achieve local control of SMARCB-1-deficient sinonasal carcinoma involving the orbit in two patients.

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Methods

Retrospective review of medical records.

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Results

The first patient is a 49-year-old female status post right Maxillectomy and orbital exenteration for a T4aN0M0 recurrent poorly differentiated SMARCB-1-deficient sinonasal carcinoma. She presented with a rapidly progressive invasion of the left orbit and started systemic immunotherapy. She was treated with a total of eight IAC treatments, concurrent with local palliative radiation therapy and systemic therapy, maintaining good vision for 12 months despite disease progression. The second patient is a 25-year-old male with a cT4bN0M1 SMARCB-1-deficient sinonasal carcinoma extending into bilateral orbits and anterior cranial fossa with metastases to the iliac bone. He presented after a first dose of systemic chemotherapy with progressive disease, preserved visual acuity bilaterally, and with mild right compressive optic neuropathy. He received 3 cycles of IAC with concurrent chemoradiation therapy and SBRT to oligometastatic bone lesions, achieving a significant partial response to treatment, with near-complete tumor resolution on imaging. Due to biopsy-confirmed persistent disease in the right nasal cavity, he was switched to an alternative systemic therapy.

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Conclusion

In both cases, a combination of IAC with systemic and radiation therapy led to a significant local response and vision preservation. These findings suggest that IAC is a promising adjunctive treatment modality for SMARCB-1–deficient sinonasal carcinoma involving the orbit.

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Additional Authors

First name	Last name	Base Hospital / Institution
Neal	Akhave	The University of Texas MD Anderson Cancer Center
Khaled	Sanber	The University of Texas MD Anderson Cancer Center
Nagham	Al-Zubidi	The University of Texas MD Anderson Cancer Center
Shirley	Su	The University of Texas MD Anderson Cancer Center
Stephen	Chen	The University of Texas MD Anderson Cancer Center

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