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Information from PDQ -- for Health Professionals
Paranasal sinus and nasal cavity cancer
208/02892
** GENERAL INFORMATION **
The majority of tumors of the paranasal sinuses present with advanced disease,
and cure rates are generally poor (50% or less). Nodal involvement is
infrequent. Metastases from both nasal cavity and paranasal sinus may occur,
but most patients die of direct extension into vital areas of the skull or of
rapidly recurring local disease. Squamous cell carcinoma is the most frequent
type of malignant tumor in the nose and paranasal sinuses (70%-80%).
Papillomas are distinct entities that may undergo malignant degeneration. The
cancers grow within the bony confines of the sinuses and often are asymptomatic
until they erode and invade adjacent structures.[1-3]
The importance of pretreatment evaluation and staging, as well as the need for
multidisciplinary planning of treatment, must be stressed. Generally, the
first opportunity to treat patients with head and neck cancers is the most
effective, although occasionally salvage surgery or salvage radiation therapy,
as appropriate, may be successful. Since most failures of treatment occur
within 2 years, the follow-up of patients must be frequent and meticulous
during this period. In addition, because nearly one third of these patients
develop second primary cancers in the aerodigestive tract, a lifetime of
follow-up is essential. Although distant metastases are found in 20% to 40% of
patients who do not respond to treatment, loco-regional recurrence is the rule
and accounts for the majority of cancer deaths.
Cancers of the maxillary sinus are the most common of the paranasal sinus
cancers. Tumors of the ethmoid sinuses, nasal vestibule, and nasal cavity are
less common, and tumors of the sphenoid and frontal sinuses are rare.
The major lymphatic drainage route of the maxillary antrum is through the
lateral and inferior collecting trunks to the first station submandibular,
parotid, and jugulodigastric nodes and through the superoposterior trunk to
retropharyngeal and jugular nodes.
Some data indicate that various industrial exposures may be related to cancer
of the paranasal sinus and nasal cavity. The risk of a second primary head and
neck tumor is considerably increased.[4]
References:
1. Schantz SP, Harrison LB, Forastiere AA: Tumors of the nasal cavity and
paranasal sinuses, nasalpharynx, oral cavity, and oropharynx. In:
DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and
Practice of Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 5th
ed., 1997, pp 741-801.
2. Laramore GE, Ed.: Radiation Therapy of Head and Neck Cancer. Berlin:
Springer-Verlag, 1989.
3. Thawley SE, Panje WR, Batsakis JG, et al.: Comprehensive Management of
Head and Neck Tumors. New York: W.B. Saunders Company, 1986.
4. Johns ME, Kaplan MJ: Advances in the management of paranasal sinus
tumors. In: Wolf GT, Ed.: Head and Neck Oncology. Boston: Martinus
Nijhoff Publishers, 1984, pp 27-52.
** CELLULAR CLASSIFICATION **
The most common cell type for paranasal sinus and nasal cavity cancers is
squamous cell carcinoma. Minor salivary gland tumors comprise 10% to 15% of
these neoplasms. Malignant melanoma presents in less than 1% of neoplasms in
this region. Some 5% of cases are malignant lymphomas.[1,2]
Esthesioneuroepithelioma, sometimes confused with undifferentiated carcinoma or
undifferentiated lymphoma, arises from the olfactory nerves.
Chondrosarcoma, osteosarcoma, Ewing's sarcoma, and most soft tissue sarcomas
have been reported for this region.
Inverting papilloma is considered a low-grade benign tumor with a tendency to
recur and, in a small percentage of cases, to transform into a malignant tumor.
Midline granuloma, a progressively destructive condition, involves this region
as well.
References:
1. Schantz SP, Harrison LB, Forastiere AA: Tumors of the nasal cavity and
paranasal sinuses, nasalpharynx, oral cavity, and oropharynx. In:
DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and
Practice of Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 5th
ed., 1997, pp 741-801.
2. Goldenberg D, Golz A, Fradis M, et al.: Malignant tumors of the nose and
paranasal sinuses: a retrospective review of 291 cases. Ear, Nose &
Throat Journal 80(4): 272-277, 2001.
** STAGE INFORMATION **
The staging systems are clinical estimates of the extent of disease. The
assessment of the tumor is based on inspection, palpation, and direct endoscopy
when necessary. The tumor must be confirmed histologically, and any other
pathological data obtained on biopsy may be included. The appropriate nodal
drainage areas are examined by careful palpation. Computed tomographic and/or
magnetic resonance imaging studies are generally required to adequately
evaluate tumor extent prior to attempted surgical resection or definitive
radiation therapy. If a patient relapses, complete restaging must be done in
order to select the appropriate additional therapy.[1,2]
Staging of nasal cavity and paranasal sinus carcinomas is not as well
established as for other head and neck tumors. Only the maxillary sinus and
ethmoid sinus have a staging system agreed on by the American Joint Committee
on Cancer (AJCC). For cancer of the maxillary sinus and the ethmoid sinus, the
AJCC has designated staging by TNM classification.[3]
-- TNM definitions --
Maxillary sinus
Primary tumor (T):
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor limited to the antral mucosa with no erosion or destruction of
bone
T2: Tumor causing bone erosion or destruction, except for the posterior
antral wall, including extension into the hard palate and/or the
middle of the nasal meatus
T3: Tumor invades any of the following: bone of the posterior wall of
maxillary sinus, subcutaneous tissues, skin of cheek, floor or medial
wall of orbit, infratemportal fossa, pterygoid plates, ethmoid sinuses
T4: Tumor invades orbital contents beyond the floor or medial wall including
any of the following: the orbital apex, cribriform plate, base of
skull, nasopharynx, sphenoid, frontal sinuses
Ethmoid sinus
Primary tumor (T):
T1: Tumor confined to the ethmoid with or without bone erosion
T2: Tumor extends into the nasal cavity
T3: Tumor extends to the anterior orbit, and/or maxillary sinus
T4: Tumor with intracranial extension, orbital extension including apex,
involving sphenoid, and/or frontal sinus and/or skin of external nose
Regional lymph nodes (N)
NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest
dimension
N2: Metastasis in a single ipsilateral lymph node, more than 3 cm but not
more than 6 cm in greatest dimension, or in multiple ipsilateral lymph
nodes, none more than 6 cm in greatest dimension, or in bilateral or
contralateral lymph nodes, none more than 6 cm in greatest dimension
N2a: Metastasis in a single ipsilateral lymph node more than 3 cm but
not more than 6 cm in greatest dimension
N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6
cm in greatest dimension
N2c: Metastasis in bilateral or contralateral lymph nodes, none more
than 6 cm in greatest dimension
N3: Metastasis in a lymph node more than 6 cm in greatest dimension
In clinical evaluation, the actual size of the nodal mass should be measured,
and allowance should be made for intervening soft tissues. Most masses over 3
centimeters in diameter are not single nodes but confluent nodes or tumors in
soft tissues of the neck. There are 3 stages of clinically positive nodes: N1,
N2, and N3. The use of subgroups a, b, and c is not required but recommended.
Midline nodes are considered homolateral nodes.
Distant metastasis (M)
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis
-- AJCC stage groupings --
-- Stage 0 --
Tis, N0, M0
-- Stage I --
T1, N0, M0
-- Stage II --
T2, N0, M0
-- Stage III --
T3, N0, M0
T1, N1, M0
T2, N1, M0
T3, N1, M0
-- Stage IVA --
T4, N0, M0
T4, N1, M0
-- Stage IVB --
Any T, N2, M0
Any T, N3, M0
-- Stage IVC --
Any T, Any N, M1
References:
1. Schantz SP, Harrison LB, Forastiere AA: Tumors of the nasal cavity and
paranasal sinuses, nasalpharynx, oral cavity, and oropharynx. In:
DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and
Practice of Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 5th
ed., 1997, pp 741-801.
2. Laramore GE, Ed.: Radiation Therapy of Head and Neck Cancer. Berlin:
Springer-Verlag, 1989.
3. Maxillary sinus. In: American Joint Committee on Cancer: AJCC Cancer
Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed.,
1997, pp 47-52.
** TREATMENT OPTION OVERVIEW **
Except for T1 mucosal carcinomas, the accepted method of treatment is a
combination of radiation therapy and surgery. The incidence of lymph node
metastases is generally low (approximately 20% of all cases). Thus, routine
radical neck dissection or elective neck irradiation is recommended only for
patients presenting with positive nodes. For patients with operable tumors,
radical surgery is generally performed first to remove the bulk of the tumor
and to establish drainage of the affected sinus(es). This is followed by
postoperative radiation therapy. Some institutions continue to give a full
dose of radiation therapy preoperatively for all stage II and III tumors and
operate 4 to 6 weeks later.[1-3] A review of published clinical results of
radical radiation therapy for head and neck cancer suggests a significant loss
of local control when the administration of radiation therapy was prolonged;
therefore, lengthening of standard treatment schedules should be avoided
whenever possible.[4]
Surgical exploration may be required to determine operability. Destruction of
the base of skull (anterior cranial fossa), cavernous sinus, or the pterygoid
process; infiltration of the mucous membranes of the nasopharynx; or
nonresectable lymph node metastases are relative contraindications to surgery.
Surgical approaches include fenestration with removal of the bulk tumor, which
is usually followed by radiation therapy or block resection of the upper jaw.
A combined craniofacial approach, including resection of the floor of the
anterior cranial fossa is used with success in selected patients. Removal of
the eye is performed if the orbit is extensively invaded by cancer. Clinically
positive nodes, if resectable, may be treated with radical neck dissection.
Radiation therapy must be carried to high doses for any significant probability
of permanent control. The treatment volume must include all of the maxillary
antrum and involved hemiparanasal sinus and contiguous areas. The orbit and
its contents are excluded except under unusual circumstances. Lymph nodes of
the neck, when palpable, should be treated in conjunction with treatment of
advanced carcinomas of the antrum. This may be unnecessary for early tumors.
Accumulating evidence has demonstrated a high incidence (>30%-40%) of
hypothyroidism in patients who have received external-beam irradiation to the
entire thyroid gland or to the pituitary gland. Thyroid function testing of
patients should be considered prior to therapy and as part of post-treatment
follow-up.[5,6]
For patients with recurrent disease, chemotherapy trials should be considered.
Chemotherapy for recurrent squamous cell cancer of the head and neck has been
shown to be efficacious as palliation and may improve quality of life and
length of survival. Various drug combinations including cisplatin,
fluorouracil, bleomycin, and methotrexate are effective.[7]
Treatment of tumors of the paranasal sinuses and of the nasal cavity should be
planned on an individual basis because of the complexity involved.
The designations in PDQ that treatments are "standard" or "under clinical
evaluation" are not to be used as a basis for reimbursement determinations.
References:
1. Schantz SP, Harrison LB, Forastiere AA: Tumors of the nasal cavity and
paranasal sinuses, nasalpharynx, oral cavity, and oropharynx. In:
DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and
Practice of Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 5th
ed., 1997, pp 741-801.
2. Laramore GE, Ed.: Radiation Therapy of Head and Neck Cancer. Berlin:
Springer-Verlag, 1989.
3. Thawley SE, Panje WR, Batsakis JG, et al.: Comprehensive Management of
Head and Neck Tumors. New York: W.B. Saunders Company, 1986.
4. Fowler JF, Lindstrom MJ: Loss of local control with prolongation in
radiotherapy. International Journal of Radiation Oncology, Biology,
Physics 23(2): 457-467, 1992.
5. Turner SL, Tiver KW, Boyages SC: Thyroid dysfunction following
radiotherapy for head and neck cancer. International Journal of
Radiation Oncology, Biology, Physics 31(2): 279-283, 1995.
6. Constine LS: What else don't we know about the late effects of radiation
in patients treated for head and neck cancer? International Journal of
Radiation Oncology, Biology, Physics 31(2): 427-429, 1995.
7. Kish JA, Ensley JF, Jacobs J, et al.: A randomized trial of cisplatin
(CACP) + 5-fluorouracil (5-FU) infusion + CACP + 5-FU bolus for
recurrent and advanced squamous cell carcinoma of the head and neck.
Cancer 56(12): 2740-2744, 1985.
** STAGE I PARANASAL SINUS AND NASAL CAVITY CANCER **
-- Small lesions --
Standard treatment options:
1. For maxillary sinus tumors (small lesions of the infrastructure):
surgical resection
postoperative irradiation should be considered for close margins
(particularly in tumors of the suprastructure)
2. For ethmoid sinus tumors (lesions are usually extensive when
diagnosed):[1-3]
generally, external-beam radiation therapy alone is used for
unresectable lesions
well-localized lesions can be resected, but it generally requires
resection of the ethmoids, maxilla, and orbit with consideration for
a craniofacial approach
if surgery can be done with good functional and cosmetic results,
postoperative radiation therapy should be given even with clear
surgical margins
3. For sphenoid sinus tumors:
treatment is the same as for nasopharyngeal cancers, primarily
radiation therapy
4. For nasal cavity tumors (squamous cell carcinomas), treatment preferences
are either surgery or radiation therapy with equal cure rates:
surgery for tumors of the septum
radiation therapy for tumors of the lateral and superior walls [4]
surgery plus radiation therapy for tumors of the septal and lateral
walls[5]
5. For inverting papilloma:
surgical excision
re-excision for surgery failures
radical surgery may eventually be necessary
radiation has been used successfully for surgical failures
6. For melanomas and sarcomas:
surgical excision if possible
combined surgery, radiation, and chemotherapy are recommended for
rhabdomyosarcoma
7. For midline granuloma:
radiation therapy to nasal cavity and paranasal sinuses
8. For nasal vestibule tumors:
Surgery or radiation may be performed. If lesions are extremely small,
surgery is preferred provided that no deformity is expected and a need
for reconstruction is not anticipated. Radiation therapy is preferred
for other small lesions.[6,7] Treatment of the ipsilateral neck
should be considered.
References:
1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in
ethmoid sinus cancer. Archives of Otolaryngology, Head and Neck Surgery
118(4): 367-372, 1992.
2. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta
Oto-rhino-laryngologica Belgica 53(3): 191-194, 1999.
3. Cantu G, Solero CL, Mariani L, et al.: Anterior craniofacial resection
for malignant ethmoid tumors--a series of 91 patients. Head and Neck
21(3): 185-191, 1999.
4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal
cavity: results of primary and adjuvant radiotherapy. International
Journal of Radiation Oncology, Biology, Physics 15(5): 1129-1133, 1988.
5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal
cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.
6. Levendag PC, Pomp J: Radiation therapy of squamous cell carcinoma of the
nasal vestibule. International Journal of Radiation Oncology, Biology,
Physics 19(6): 1363-1367, 1990.
7. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of
squamous cell carcinoma of the nasal vestibule: a review. Acta
Oncologica 27(3): 203-208, 1988.
** STAGE II PARANASAL SINUS AND NASAL CAVITY CANCER **
-- Small and moderately advanced lesions --
Standard treatment options:
1. For maxillary sinus tumors:
surgical resection with high-dose preoperative or postoperative
irradiation
2. For ethmoid sinus tumors (lesions are usually extensive when
diagnosed):[1-3]
generally, external-beam radiation therapy alone is used and produces
better overall results than surgery
well-localized lesions can be resected, but resection of the ethmoids,
maxilla, and orbit, often with a combined neurosurgical sinus
craniofacial approach, is generally required
if surgery can be done with good functional and cosmetic results,
postoperative radiation therapy should be given even with clear
surgical margins
3. For sphenoid sinus tumors:
treatment is the same as for nasopharyngeal cancers, primarily
radiation therapy
4. For nasal cavity tumors (squamous cell carcinomas), treatment preferences
are either surgery or radiation therapy, which have equal cure rates:[4]
surgery or irradiation for tumors of the septum
radiation therapy for tumors of the lateral and superior walls
surgery plus radiation therapy for tumors of the septal and lateral
walls[5]
5. For inverting papilloma:
surgical excision
re-excision for surgery failures
radiation therapy for radical surgery failures may eventually be
necessary
6. For melanomas and sarcomas:
surgical excision if possible
combined surgery, radiation, and chemotherapy are recommended for
rhabdomyosarcoma
7. For midline granuloma:
radiation therapy to nasal cavity and paranasal sinuses
8. For nasal vestibule tumors:
Surgery or radiation therapy may be performed. If tumors are extremely
small, surgery is preferred provided that no deformity is expected and
a need for reconstruction is not anticipated. Radiation therapy is
preferred for other small lesions.[6,7] Treatment of the neck should
be considered.
References:
1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in
ethmoid sinus cancer. Archives of Otolaryngology, Head and Neck Surgery
118(4): 367-372, 1992.
2. Cantu G, Solero CL, Mariani L, et al.: Anterior craniofacial resection
for malignant ethmoid tumors--a series of 91 patients. Head and Neck
21(3): 185-191, 1999.
3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta
Oto-rhino-laryngologica Belgica 53(3): 191-194, 1999.
4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal
cavity: results of primary and adjuvant radiotherapy. International
Journal of Radiation Oncology, Biology, Physics 15(5): 1129-1133, 1988.
5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal
cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.
6. Levendag PC, Pomp J: Radiation therapy of squamous cell carcinoma of the
nasal vestibule. International Journal of Radiation Oncology, Biology,
Physics 19(6): 1363-1367, 1990.
7. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of
squamous cell carcinoma of the nasal vestibule: a review. Acta
Oncologica 27(3): 203-208, 1988.
** STAGE III PARANASAL SINUS AND NASAL CAVITY CANCER **
-- Small and moderately advanced lesions --
Standard treatment options:
1. For maxillary sinus tumors:
surgical resection with high-dose preoperative or postoperative
radiation therapy
2. For ethmoid sinus tumors: [1-3]
generally a craniofacial resection in combination with postoperative
radiation therapy
3. For sphenoid sinus tumors:
treatment is the same as for nasopharyngeal cancers, primarily
radiation therapy
4. For nasal cavity tumors (squamous cell carcinomas):
surgery alone
radiation therapy alone [4]
combined surgery and radiation therapy (postoperative radiation
therapy is preferred) [4,5]
5. For inverting papilloma:
surgical excision
re-excision for surgery failures
radiation therapy or radical surgery may eventually be necessary
6. For melanomas and sarcomas:
surgical excision if possible, otherwise consider irradiation
combined surgery, radiation, and chemotherapy are recommended for
rhabdomyosarcoma
7. For midline granuloma:
radiation therapy to nasal cavity and paranasal sinuses
8. For nasal vestibule tumors:
Generally, radiation is preferred to minimize deformity.[6] External-
beam (photons or electrons) and/or interstitial implantation can be
used. Surgery is reserved for salvage.
Treatment options under clinical evaluation:
For maxillary sinus tumors:
Superfractionated preoperative or postoperative radiation therapy [7]
For ethmoid sinus tumors, nasal cavity tumors (squamous cell carcinomas), and
nasal vestibule tumors:
Clinical trials using new drug combinations for advanced tumors should be
considered to evaluate chemotherapy preoperatively or before radiation
therapy, or as adjuvant therapy after surgery or after combined modality
therapy.
References:
1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in
ethmoid sinus cancer. Archives of Otolaryngology, Head and Neck Surgery
118(4): 367-372, 1992.
2. Cantu G, Solero CL, Mariani L, et al.: Anterior craniofacial resection
for malignant ethmoid tumors--a series of 91 patients. Head and Neck
21(3): 185-191, 1999.
3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta
Oto-rhino-laryngologica Belgica 53(3): 191-194, 1999.
4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal
cavity: results of primary and adjuvant radiotherapy. International
Journal of Radiation Oncology, Biology, Physics 15(5): 1129-1133, 1988.
5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal
cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.
6. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of
squamous cell carcinoma of the nasal vestibule: a review. Acta
Oncologica 27(3): 203-208, 1988.
7. Johnson CR, Schmidt-Ullrich RK, Wazer DE: Concomitant boost technique
using accelerated superfractionated radiation therapy for advanced
squamous cell carcinoma of the head and neck. Cancer 69(11): 2749-2754,
1992.
** STAGE IV PARANASAL SINUS AND NASAL CAVITY CANCER **
-- Advanced lesions --
Standard treatment options:
1. For maxillary sinus tumors, extension to base of skull and nasopharynx is
potential, but not absolute, contraindication to surgery. Thus, high-dose
radiation therapy is used. If radiation therapy is to be used alone, localized
drainage of the sinus(es) must be established before initiating radiation
therapy treatments.
2. For ethmoid sinus tumors:[1-3]
generally a craniofacial resection in combination with pre- or
postoperative radiation therapy
3. For sphenoid sinus tumors:
treatment is the same as for nasopharyngeal cancers, primarily
radiation therapy
4. For nasal cavity tumors (squamous cell carcinomas):
surgery alone
radiation alone [4]
combined surgery and radiation therapy (postoperative radiation
therapy is preferred) [4]
5. For inverting papilloma:
surgical excision
re-excision for surgery failures
radiation therapy or radical surgery may eventually be necessary
6. For melanomas and sarcomas:
surgical excision if possible
appropriate radiation and various chemotherapy agents should be
considered
7. For midline granuloma:
radiation therapy to nasal cavity and paranasal sinuses
8. For nasal vestibule tumors:
Generally, radiation is preferred to minimize deformity. External-
beam (photons or electrons) and/or interstitial implantation can be
used. Surgery is reserved for salvage. Treatment of the neck should
be considered.
Treatment options under clinical evaluation:
Neoadjuvant chemotherapy as employed in clinical trials has been used to shrink
tumors and thereby render them more definitively treatable with either surgery
or radiation. This chemotherapy is given prior to the other modalities, hence
the designation neoadjuvant to distinguish it from standard adjuvant therapy,
which is given after or during definitive therapy with radiation or after
surgery. Many drug combinations have been used in neoadjuvant
chemotherapy.[5-7]
For maxillary sinus tumors:
superfractionated radiation therapy [8]
For maxillary sinus tumors, ethmoid sinus tumors, nasal cavity tumors, and
nasal vestibule tumors, clinical trials for advanced tumors should be
considered to evaluate chemotherapy preoperatively or before radiation therapy,
as adjuvant therapy after surgery or after combined modality therapy.
References:
1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in
ethmoid sinus cancer. Archives of Otolaryngology, Head and Neck Surgery
118(4): 367-372, 1992.
2. Cantu G, Solero CL, Mariani L, et al.: Anterior craniofacial resection
for malignant ethmoid tumors--a series of 91 patients. Head and Neck
21(3): 185-191, 1999.
3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta
Oto-rhino-laryngologica Belgica 53(3): 191-194, 1999.
4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal
cavity: results of primary and adjuvant radiotherapy. International
Journal of Radiation Oncology, Biology, Physics 15(5): 1129-1133, 1988.
5. Stupp R, Weichselbaum RR, Vokes EE: Combined modality therapy of head and
neck cancer. Seminars in Oncology 21(3): 349-358, 1994.
6. Al-Sarraf M: Head and neck cancer: chemotherapy concepts. Seminars in
Oncology 15(1): 70-85, 1988.
7. Dimery IW, Hong WK: Overview of combined modality therapies for head and
neck cancer. Journal of the National Cancer Institute 85(2): 95-111,
1993.
8. Johnson CR, Schmidt-Ullrich RK, Wazer DE: Concomitant boost technique
using accelerated superfractionated radiation therapy for advanced
squamous cell carcinoma of the head and neck. Cancer 69(11): 2749-2754,
1992.
** RECURRENT PARANASAL SINUS AND NASAL CAVITY CANCER **
Chemotherapy for recurrent head and neck squamous cell cancer has shown
promise. Chemotherapy may be indicated where there is recurrence in either
distant or local disease after primary surgery or radiation, and when there is
residual disease after primary treatment.[1,2] Survival may be improved in
those achieving a complete response to chemotherapy.[3] Combined modality
therapy with platinum and radiation therapy have been used.[4]
Standard treatment options:
1. For maxillary sinus tumors:
after surgery, radiation therapy or craniofacial resection with
postoperative radiation therapy
after radiation therapy, craniofacial resection if indicated
chemotherapy should be considered after failure of the above
2. For ethmoid sinus tumors:[5-7]
after limited surgery, craniofacial resection or radiation therapy or
both
after radiation therapy, craniofacial resection
chemotherapy should be considered after failure of the above
3. For sphenoid sinus tumors:
treatment is the same as for nasopharyngeal cancers, primarily
radiation therapy
chemotherapy should be considered after failure of the above
4. For nasal cavity tumors (squamous cell carcinomas) salvage is possible in
approximately 25% of patients:
for failure after radiation therapy, craniofacial resection
for failure after surgery, radiation therapy
chemotherapy should be considered after failure of the above
5. For inverting papilloma:
surgical excision
re-excision for surgery failures
radical surgery or radiation therapy may eventually be necessary
6. For melanomas and sarcomas:
surgical excision if possible
appropriate chemotherapy geared specifically to cell type (see
specific sections elsewhere in PDQ)
7. For midline granuloma:
radiation therapy to nasal cavity and paranasal sinuses
8. For nasal vestibule tumors:
for radiation therapy failures, surgery
for surgery failures, radiation therapy or a combination of surgery and
radiation therapy
chemotherapy should be considered after failure of the above
Treatment options under clinical evaluation:
For maxillary sinus tumors, ethmoid sinus tumors, nasal cavity tumors, and
nasal vestibule tumors, clinical trials using chemotherapy should be
considered.[8]
References:
1. Kies MS, Levitan N, Hong WK: Chemotherapy of head and neck cancer.
Otolaryngologic Clinics of North America 18(3): 533-541, 1985.
2. LoRusso P, Tapazoglou E, Kish JA, et al.: Chemotherapy for paranasal
sinus carcinoma: a 10-year experience at Wayne State University. Cancer
62(1): 1-5, 1988.
3. Al-Kourainy K, Kish J, Ensley J, et al.: Achievement of superior survival
for histologically negative versus histologically positive clinically
complete responders to cisplatin combination in patients with locally
advanced head and neck cancer. Cancer 59(2): 233-238, 1987.
4. Al-Sarraf M, Pajak TF, Marcial VA, et al.: Concurrent radiotherapy and
chemotherapy with cisplatin in inoperable squamous cell carcinoma of the
head and neck: an RTOG study. Cancer 59(2): 259-265, 1987.
5. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in
ethmoid sinus cancer. Archives of Otolaryngology, Head and Neck Surgery
118(4): 367-372, 1992.
6. Cantu G, Solero CL, Mariani L, et al.: Anterior craniofacial resection
for malignant ethmoid tumors--a series of 91 patients. Head and Neck
21(3): 185-191, 1999.
7. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta
Oto-rhino-laryngologica Belgica 53(3): 191-194, 1999.
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Date Last Modified: 03/2002
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