International Forum of Allergy & Rhinology最新文献

Introduction

Sinonasal sarcomas are exceedingly rare entities, constituting less than 7% of head and neck sarcomas. Their complex histology needs specialized treatment, which is often based on multimodal approaches including surgery, radiation therapy, and/or chemotherapy. This manuscript aims to gather expert opinions to establish common management principles for sinonasal sarcomas.

Methods

This international consensus followed a modified Delphi method in seven steps, including statements definition by the core group, expert panel recruitment, and a two-round survey. Sixty-two statements on sinonasal sarcoma management were developed. Experts from multiple continents participated, and results were anonymized and analyzed between March and May 2025.

Results

A total of 44 invited experts were recruited, 43.2% otorhinolaryngologists/head and neck surgeons, 31.8% medical oncologists, and 25% radiation oncologists. Participants varied in age and experience, representing Europe (70.5%), North America (18.2%), South America (6.8%), and Asia (4.5%). Among all histologies, biphenotypic sarcoma, chondrosarcoma, leiomyosarcoma, and myofibrosarcoma are principally treated with an upfront surgical management, differently from Ewing sarcoma and rhabdomyosarcoma in which chemotherapy, eventually associated with radiotherapy, is often chosen. In the remaining histologies (angiosarcoma, liposarcoma, malignant peripheral nerve sheath tumor [MPNST], osteosarcoma, and synovial sarcoma), a precise multimodal treatment is less standardized and needs to be discussed on a case-by-case basis.

Conclusion

Sinonasal sarcomas require a histology-driven approach to determine upfront treatment, whether surgical, medical, or multimodal. Despite this structured strategy, prognosis remains highly variable across subtypes. Multidisciplinary evaluation and individualized management in referral centers are crucial to address the biological diversity and anatomical complexity of these rare malignancies.

Background

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease that is associated with polymicrobial infections, often involving S. aureus and P. aeruginosa. It is unclear whether the polymicrobial context plays a role in exacerbating epithelial damage, inflammation, and resistance to therapy.

Methods

S. aureus and P. aeruginosa (n = 3 each) biofilms were established in a Transwell system, followed by the extraction of P. aeruginosa conditioned media and application to an air–liquid interface (ALI) model of human nasal epithelial cells (HNECs). Transepithelial electrical resistance (TEER) and FITC dextran paracellular permeability tests evaluated the epithelial integrity. Colony-forming unit (CFU) counting, protease activity assay, and pyocyanin and pyoverdine quantification were used to test the proliferation and production of virulence factors of the bacteria.

Results

Cocultures of P. aeruginosa and S. aureus isolated from the same patient reduced HNEC TEER values, had an earlier onset of HNEC barrier disruption, and increased paracellular permeability compared to monocultures of P. aeruginosa. P. aeruginosa proliferation was enhanced, and protease activity increased significantly. The production of pyoverdine increased significantly in the same patient cocultures, while the pyocyanin levels remained unchanged.

Conclusions

These results indicate a role of within-host evolution in shaping P. aeruginosa-mediated virulence in the context of polymicrobial biofilms. This supports the need to develop strategies directed at disrupting interspecies synergies that culminate in the formation of polymicrobial biofilms associated with CRS for the purpose of improving disease management and therapeutic efficacy.

Background

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease characterized by persistent sinonasal inflammation. There is increasing interest in endotype-based classification, which categorizes CRS based on underlying inflammatory pathways. We applied factor analysis to facilitate continuous endotype assignment to CRS patients and assess cross-sectional and longitudinal CRS outcomes.

Methods

We prospectively enrolled 203 patients (52 controls, 88 CRSsNP, and 63 CRSwNP) undergoing endoscopic nasal or sinus surgery (ESS). Middle meatal mucus biomarkers were analyzed pre-ESS (V0) and 6–12 months post-ESS (V1). Factor analysis was performed to identify latent factors. Factor scores were generated, and statistical analyses were conducted to assess correlations with radiographic (Lund–Mackay [LM]) and patient-reported (SNOT-22, CRS-PRO) outcomes measured at V0, V1, and V2 (1.5–5 years post-ESS).

Results

Four factors were identified: Type 1 (T1), Type 2 (T2), Type 3 (T3), and macrophage-associated (M). CRSwNP patients had higher T2 and M factor scores than CRSsNP and controls. T2, T3, and M factor scores demonstrated stronger or equivalent associations with radiographic and patient-reported outcomes compared to individual biomarkers. Following ESS, median T2 and M factor scores significantly declined, while T1 and T3 remained stable. V0 T1 and T2 were weakly associated with long-term (V2) radiographic and symptom scores. V1 factor scores were more consistently predictive of long-term (V2) outcomes, with T2, T3, and M demonstrating modest correlations with radiographic severity and CRS-PRO.

Conclusions

Factor analysis identifies distinct, quantifiable patterns of inflammation in CRS, offering improved associations with cross-sectional and longitudinal outcomes compared to individual biomarkers.

Key Points

Background

Various interventions have been proposed to enhance surgical field quality during endoscopic sinus surgery (ESS). This study evaluates whether preoperative oral clonidine enhances surgical field quality during ESS.

Methods

PubMed, Scopus, Web of Science, Embase, and CENTRAL databases were searched. Eligible randomized controlled trials (RCTs) were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcome was surgical field quality. Secondary outcomes included intraoperative blood loss (IBL), operative duration, mean arterial pressure (MAP), heart rate (HR), surgeon satisfaction score, and postoperative complications (i.e., nausea and vomiting, bradycardia, and hypotension). Outcomes were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Trial sequential analysis (TSA) was also performed.

Results

Eight RCTs involving 597 patients were included. Preoperative oral clonidine significantly enhanced surgical field quality (MD = −0.65, 95% CI: −0.92, −0.37) and reduced IBL (MD = −44.67 mL, 95% CI: −62.03, −27.32), operative duration (MD = −11.64 min, 95% CI: −22.25, −1.04), MAP (MD = −10.36 mmHg, 95% CI: −18.03, −2.69), and HR (MD = −10.16 bpm, 95% CI: −17.62, −2.70). It was also associated with a significantly higher surgeon satisfaction score (p = 0.01) and comparable rates of postoperative complications (p > 0.05). TSA confirmed conclusive evidence for all outcomes except operative duration.

Conclusion

Preoperative oral clonidine shows potential in enhancing surgical field quality, reducing IBL, MAP, and HR, and enhancing surgeon satisfaction during ESS, without increasing postoperative complications. Its potential to reduce operative duration requires cautious interpretation.