Sinus Surgery Combined with Antifungal Therapy is Effective in the Treatment of Invasive Aspergillus Sinusitis in Neutropenic Patients with Cancer

Invasive Aspergillus sinusitis (IAS) is associated with high mortality and poor response to antifungal therapy in patients with hematologic malignancies (HM). We identified 353 patients with invasive aspergillosis of whom 39 patients had IAS. Of the 39 patients, 13 underwent sinus surgery (SS) in addition to the antifungal therapy, and the remaining 26 control patients received antifungal therapy alone. Most patients with IAS had underlying leukemia (85%). Both groups had comparable clinical characteristics such as gender, age, underlying disease, neutropenia at the onset, persistent neutropenia, graft-vs-host-disease, and comparable antifungal therapy. Overall response was 7 (53.2%) in the SS group vs 5 (19.2%) in the control group (p = 0.06). Among the subgroup of patients with neutropenia at the onset of infection, the response rate in the SS group was significantly better than in the non-SS group (57% vs 11.8%, respectively; p = 0.028). In neutropenic patients with IAS and underlying HM, SS significantly improved the response to antifungal therapy. Additional studies are warranted.