Management of orbital invasion in sinonasal malignancies

Background: Indications for preservation of orbital contents in case of malignant sinonasal tumors invading the orbit remain controversial. Methods: A retrospective consecutive review was conducted of patients in a tertiary care center over a 15-year period. Results: Ninety-three patients were diagnosed with a malignant tumor invading the orbit. Eighty-three were treated with curative intent of which 58 underwent surgery. Mean follow-up was 45 months. Orbital preservation was feasible in 66% of cases, whereas orbital clearance was performed in cases of locally advanced disease (invasion of extraocular muscles, ocular globe, or orbital apex). Local control rate was 70% for patients treated with orbital clearance and 74% for those with orbital preservation, with no statistical difference. Five-year survival and 5-year relapse-free survival were similar in both groups. Conclusion: Using our strategy, the eye can be spared in more patients than what is currently proposed, without oncologic or survival disadvantages.