Results of preoperative chemoradiotherapy for patients with advanced cancer of the nasal cavity and paranasal sinuses

Objectives: Curative treatment of nasal cavity and paranasal sinus cancer is challenging due to the proximity to critical anatomical structures. The purpose of this study was to analyze the impact of trimodality therapy with preoperative chemotherapy and reduced-dose radiotherapy followed by organ-preserving surgery for treating patients with nasal cavity and paranasal sinus cancer.

Methods: This retrospective study included all 156 patients diagnosed with sinonasal cancer in western Sweden between 1986 and 2009. We determined the treatment selection pattern and treatment outcomes for 79 patients treated with preoperative chemoradiotherapy.

Results: Squamous cell carcinoma was the most common histology. The five-year overall survival was 54%, and 85% of these patients had T3 or T4 tumors. The five-year cumulative incidence rate of local recurrence was 32%. The five-year overall survival in patients with squamous cell carcinoma and adenocarcinoma was 45% and 76%, respectively. The median preoperative radiation dose was 48?Gy. Orbital exenteration was performed in 7% of patients.

Conclusions: Preoperative chemoradiotherapy may be beneficial for patients with advanced sinonasal cancer when primary radical surgery is challenging. Survival outcomes were comparable to outcomes reported in the literature despite conservative surgery and relatively low radiation doses in patients with locally advanced tumors.     

Sarcomatoid carcinoma in the sinonasal cavity: A retrospective case series from a single institution

ObjectivesSarcomatoid carcinoma (SC) is rare in the sinonasal cavity with poor prognosis. This study aimed to summarize the clinical characteristics, treatment and prognosis of patients with sinonasal SC from a single tertiary medical center.MethodsRetrospective review of the clinical data of seven patients diagnosed with sinonasal SC from May 1988 to February 2021.ResultsSeven patients with SC in nasal cavity and paranasal sinus, including six males and one female, aged 34-77 years (mean, 58.3 years), were included in this case series. The common presenting symptoms included epistaxis and nasal obstruction. The tumor usually occurred in nasal cavity, maxillary sinus and ethmoid sinus. Most patients were diagnosed at advanced stages with the involvement of orbit and skull base. Open and endoscopic surgery were performed in five and two patients, respectively. The follow-up period ranged from 3 to 26 months. Four patients died of disease within one year, though two received adjuvant chemotherapy and one received radiotherapy. Two patients survived without recurrence at the end of follow-up, both of them underwent adjuvant radiotherapy. One patient received palliative re-irradiation due to local recurrence of the tumor three months after the surgery, however, this patient was lost to follow-up.ConclusionsSinonasal SC is a rare entity with an aggressive behavior and poor prognosis. Early diagnosis and multimodality treatment are recommended to improve the survival.     

Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

ObjectiveThe aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinusesMaterial and methodsWe performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported.ResultsThe average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-yea adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002).ConclusionsCarcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.     

Nasal and paranasal sinus carcinoma: how can we continue to make progress?

PURPOSE OF REVIEW: New developments in the nasal and paranasal sinus cancers are reviewed. RECENT FINDINGS: In addition to woodworking, several risk factors for nasal and paranasal sinus cancers have been identified, most notably smoking. Progress in the differential diagnosis of small round cell nasal and paranasal sinus cancers allows the precise diagnosis of esthesioneuroblastoma. Despite recent improvements, T staging for ethmoid and nasal cavity needs refinement. An association of surgery and radiation therapy remains the best treatment modality. Major developments include endoscopic resection of nasal and paranasal sinus cancers, high-precision radiotherapy techniques such as intensity-modulated radiotherapy, and proton-beam radiotherapy. There is probably no role for chemotherapy in esthesioneuroblastoma. Although chemotherapy is important for aggressive neoplasms, its generalized use for nasal and paranasal sinus cancers awaits the application/development of newer drugs. These drugs might be applied locally since the majority of recurrences remain local. SUMMARY: Progress in the treatment of nasal and paranasal sinus cancers could be achieved through better prevention and the developments of more selective treatments such as endoscopic resection, high-precision radiotherapy, and new chemotherapy drugs.     

原发性鼻腔鼻窦骨外尤文肉瘤/外周原始神经外胚层肿瘤2例并文献复习

目的 分析原发性鼻腔鼻窦骨外尤文肉瘤/外周原始神经外胚层肿瘤的发病特点,为该病的诊疗提供参考。 方法 回顾性分析2014年3月至2019年7月收治入院的2例鼻腔鼻窦骨外尤文肉瘤/外周原始神经外胚层肿瘤患者的临床资料,并检索2006年至2021年国内外相关文献,共48例(含本文2例)患者纳入研究,总结临床表现、治疗方法及预后。 结果 本组患者7~83岁、中位数26岁,男女比例1∶1.5,以鼻部症状为主,鼻塞16/28(57.1%)、鼻出血/涕中带血12/28(42.9%)、头痛3/28(10.7%)、嗅觉减退3/28(10.7%)。病变侵犯部位:鼻腔32/48(66.7%)、上颌窦24/48(50.0%)、筛窦27/48(56.3%)、蝶窦8/48(16.7%)、额窦3/48(6.3%),侵袭眼眶17/48(35.4%)、颅底6/48(12.5%)。单因素分析:综合治疗(P=0.009)、放疗(P=0.014)可明显改善患者预后,病变侵犯蝶窦(P=0.027)、颅底(P=0.002)提示患者预后不良,多因素COX回归分析示侵犯颅底为预后的独立危险因素(P=0.008),与未侵犯颅底的患者相比,侵犯颅底的患者死亡风险更高,HR=8.940(95%CI:1.756~45.506)。 结论 鼻腔鼻窦骨外尤文肉瘤(Extra-skeletal Ewing Sarcoma, EES)好发于青年女性,症状以鼻塞、鼻出血/涕中带血多见,病变范围主要累及鼻腔、上颌窦、筛窦,可侵及眼眶、颅底,病变侵犯颅底为死亡的独立危险因素,治疗以化疗联合放疗的综合治疗为主。     

Mucosal melanoma of the nasal cavity and paranasal sinuses

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation.     

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital.MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system.ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020).ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.     

鼻腔鼻窦神经内分泌癌8例并文献复习

目的 探讨鼻腔鼻窦神经内分泌癌的临床特征、病理表现、治疗手段、预后及影响预后的因素.方法 回顾经病理证实的8例原发性鼻腔鼻窦神经内分泌癌患者的临床病例资料.结果 随访5～70个月,中位随访时间23个月,8例中典型类癌1例、不典型类癌4例、小细胞神经内分泌癌2例、复合型神经内分泌癌1例(低分化神经内分泌癌伴内翻性乳头状瘤...     

The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy

BACKGROUND: Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures. METHODS: Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session. RESULTS: Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640). CONCLUSION: These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.     

鼻腔鼻窦转移性肾透明细胞癌一例报道并文献综述

目的 探讨鼻腔鼻窦转移性肾透明细胞癌的临床特点及诊疗方法.方法 回顾性分析1例肾透明细胞癌转移至鼻腔鼻窦患者病历资料,并检索1993～2020年间国内外发表的相关文献,包括本例共有64篇文献76例患者纳入研究,总结其临床表现、诊断、治疗方法及预后.结果 76例中男61例,女15例.症状出现较多者为鼻出血58例、鼻塞25...     

Sinonasal mucosal melanoma: A 44-case study and literature analysis

Objectives

Sinonasal mucosal melanoma is a rare disease, representing 4% of nasal cavity and paranasal sinus malignancies. The aim of this study was to assess the clinical characteristics, progression and treatment of this disease and to identify prognostic factors.

Malignomas of the nasal cavity and the paranasal sinuses: clinical characteristics, therapy and prognosis of different tumor types

BACKGROUND: Malignomas of the nasal cavity and the paranasal sinuses count for less than 3 % of the ENT-malignancies. PATIENTS AND METHODS: This retrospective chart review reports about 46 patients that were first diagnosed and treated with a nasal cavity or paranasal sinus malignancy between 1998 and 2002 in the ENT department of the Ruhr-Universit?t Bochum. RESULTS: 18 of 46 malignomas were squamous cell carcinomas. At initial diagnose, already 52 % of malignomas were staged T4. Accordingly the origin in 17 % of malignomas could not be determined anymore. Additional 43 % of malignomas originated from the nasal cavity, another 20 % from the maxillary sinus. 11 of 46 patients (24 %) showed histological proven nodal involvement at initial diagnose. 92 % of patients underwent surgical therapy. 25 patients were radiated postoperatively. Over-all 1-year-survival-rate was 75 %, over-all 2-year-survival-rate was 47 %. Beside patients age, tumor free margins at initial surgery and absence of nodal involvement correlated to improved survival. 16 (76 %) of the 21 patients who died had local recurrence. Maxillary sinus malignomas recurred more often than malignomas of the ethmoid and the nasal cavity. CONCLUSIONS: Malignancies of the nasal cavity and paranasal sinuses are very often diagnosed in advanced T-stages because of unspecific symptoms. The limited prognosis mainly depends on free surgical margins at the first resection and nodal involvement at the first diagnose. For improvement in outcome of nasal and paranasal sinuses malignancies, prospective multi-center trials are necessary.     

Semi-automatic segmentation of computed tomographic images in volumetric estimation of nasal airway

The objective of this study was to determine nasal cavity volumes and cross-sectional profiles from segmented coronal high-resolution computed tomography (HRCT) images. Pathological mucosal changes and congenital sinonasal variants were quantitated and three-dimensional (3D) images for determining sinonasal airway diseases evaluated by using the new semiautomatic segmentation software, Anatomatic. Anterior to posterior cross-sectional profiles of the sinonasal airway were obtained from acoustic rhinometry and segmented coronal HRCT images and compared in five patients having complaints of nasal obstruction and chronic sinusitis. Results showed that accurate volumes of air spaces in the nasal cavity and paranasal sinuses were obtained. When compared, the cross-sectional profiles of the nasal cavities obtained from acoustic rhinometry and the segmentation technique were similar in the anterior portion, but differed in the posterior portion. The results obtained by coronal HRCT and segmentation were more reliable than those produced with acoustic rhinometry. 3D images acquired from segmented images were found to help make a good pre-operative assessment of the whole sinonasal compartment. Segmentation and volumetric analysis using the Anatomatic technique also proved to be well suited to the evaluation of the nasal cavity and paranasal sinus geometry in patients with sinonasal diseases. Received: 5 March 1998 / Accepted: 9 June 1998     

Septal deviation and chronic sinus disease

The introduction of computerized tomography in the identification of sinonasal pathology and associated anatomic variants has contributed to a greater understanding of the factors leading to ostiomeatal complex (OMC) obstruction and chronic sinus disease. The OMC and paranasal sinus regions were prospectively evaluated in 150 consecutive patients as a function of the degree of nasal septal deviation and compared with matched controls. These data were correlated with paranasal sinus disease, lateral nasal wall findings, and middle turbinate abnormalities. An increased incidence and severity of bilateral chronic sinus disease was present with increasing septal deviations (p < 0.05). Similarly, patients with increasing nasal septum deviations were noted to have a higher incidence of OMC obstruction (p < 0.05). Ostiomeatal complex obstruction in the direction of septal angulation was associated with nasal septal deformity; however, contralateral OMC obstruction was associated with middle turbinate and lateral nasal wall abnormalities (p < 0.05). The evaluation of the degree of septal angulation has helped better understand the factors contributing to chronic sinus disease and OMC obstruction.     

Adenoid cystic carcinoma of the sinonasal tract: treatment results

OBJECTIVES: Malignancies arising from the sinonasal tract, which includes the nose, paranasal sinuses, and nasopharynx, are uncommon. Although adenoid cystic carcinoma (ACC) is the second most common cancer occurring in the sinonasal tract, only few studies have been reported. This retrospective review was performed to identify the clinical features and treatment outcomes of sinonasal ACC. METHODS: Thirty-five patients diagnosed and treated for ACC of the sinonasal tract were included in this study. Medical records, radiographs, and pathologic slides were retrospectively reviewed. RESULTS: In two thirds of the patients, the maxillary sinus was the site of origin and cribriform was the most common histologic subtype (61%). Seventy-one percent of the patients had advanced disease (T3, T4) at the time of diagnosis. Five-year overall survival rate was 86% and treatment failure occurred in 18 patients (51%). Five-year local recurrence rate and distant metastasis rate were 30% and 25%, respectively. Adjunctive radiotherapy appeared to reduce local recurrence. Presence of distant metastasis correlated with decreased 5-year survival (P = .001). Five-year survival rate after development of distant metastasis or local recurrence were 17% and 58%, respectively. CONCLUSIONS: Based on our findings, we suggest that sinonasal ACC be treated by a combined modality of radical surgery followed by postoperative radiation. The prognosis of sinonasal ACC seems to be determined by the presence of distant metastasis.     

Non-Hodgkin's malignant lymphoma of the sinonasal tract--treatment outcome for 53 patients according to REAL classification

OBJECTIVE: Although the Working Formulation is commonly used to classify NHL in Japan, it has been recognized as imperfect for primary extranodal lymphoma, especially for patients with sinonasal disease because of their histological characteristics. The present study investigated the clinical characteristics and the prognosis of sinonasal lymphomas according to REAL classification. METHODS: Fifty-three patients with non-Hodgkin's malignant lymphoma (NHL) of the sinonasal tract were treated between 1981 and 1997. The age at clinical presentation was from 10 to 84 years (mean, 52.4 years). According to the Ann Arbor system, there were 30 patients with Stage IE, 13 with Stage IIE, 4 with Stage IIIE, and 6 with Stage IVE lymphomas. Twenty-two patients (41.5%) had B symptoms. The primary sites were the nasal cavity (67.8%), maxillary sinus (20.8%), ethmoidal sinus (9.4%), and frontal sinus (1.9%). The survival data was calculated by Kaplan-Meier method. Statistical analysis was performed with a generalized Wilcoxon method. RESULTS: All of the lymphomas showed a diffuse growth pattern. Based on the origin of the tumor cells, the authors classified NHL of the sinonasal tract into five groups with the REAL classification of Japan: diffuse large B-cell lymphoma (22.6%), peripheral T-cell lymphomas (15.1%), angiocentric lymphoma (35.9%), other lymphomas and unclassified types. Of 53 patients, 39 (73.6%) received chemotherapy and radiotherapy, eight patients received chemotherapy alone, and four patients received radiotherapy alone. The cumulative 5-year survival rates were 28.5% for all of the types, 55.0% for diffuse large B-cell lymphoma, 33.3% for peripheral T-cell lymphoma, and 19.7% for angiocentric lymphoma. Results suggest that conventional combined treatment (CHOP chemotherapy+radiotherapy) is ineffective for NHL of the sinonasal tract, and especially so for NHL in the nasal cavity, NHL with tumor cells with positive T-cell markers, NHL further than Stage IIE and NHL with B symptoms. CONCLUSION: (1) In light of this ineffectiveness, new therapies must be developed to improve patient outcome instead of the conventional combined treatment; (2) REAL classification is clear and useful for sinonasal lymphomas in Japan.     

57例鼻腔鼻窦T细胞淋巴瘤临床疗效及预后分析

目的探讨鼻腔鼻窦T细胞淋巴瘤临床疗效及预后因素。方法回顾性分析1983年7月~2001年4月我院收治的57例鼻腔鼻窦T细胞淋巴瘤,其中单纯放疗(R组)22例,放疗 化疗(R C组)35例。Kaplan-Meier法计算3,5年生存率和局控率,Logrank进行显著性检验和单因素分析,Cox模型进行多因素分析。结果放疗组(R组)和放疗 化疗组(R C组)3,5年生存率分别为64.7%,55.2%和74.4%,69.8%。两组3,5年生存率比较有统计学意义(P<0.05)。两组3,5年局控率分别为95.4%,87.2%和94.5%,89.7%。两组3,5年局控率比较无统计学意义(P>0.05)。多因素分析显示,B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的独立预后因素;影响鼻腔鼻窦T细胞淋巴瘤局控率的独立预后因素是累及部位、临床分期、治疗方式、放疗剂量。结论放疗 化疗组(R C组)明显提高了鼻腔鼻窦T细胞淋巴瘤3,5年生存率,但不能改善局控率。B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的重要因素,累及部位、临床分期、治疗方式、放疗剂量与鼻腔鼻窦T细胞淋巴瘤局控有关。     

Sinonasal involvement in sarcoidosis: a report of seven cases and review of literature

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating inflammation involving one or more organs with predilection for pulmonary and upper respiratory tract involvement. It presents with a variety of signs and symptoms which can be generalized or focused on a single organ. Sinonasal involvement is reported in about 1% of cases of sarcoidosis. Sarcoidosis can involve both the mucosa as well as bony structures in the nose and the paranasal sinuses. We present seven cases of sarcoidosis with sinonasal involvement. Four cases presented with nasal and sinus symptoms, and the other three cases developed or presented with nasal and sinus symptoms after the diagnosis of sarcoidosis was confirmed. The nasal and sinus symptoms in these patients were managed by local and systemic steroids. In four patients, endoscopic sinus surgery was performed with good outcome. Nasal and sinus symptoms, differential diagnosis and the treatment are discussed.     

Malignant tumours of the nasal cavity and the paranasal sinuses in a Melanesian population

Malignant tumours of the nasal cavity and paranasal sinuses are usually associated with poor prognosis. From 1986 to 1995, 50 such tumours were managed in Papua New Guinea. Twenty-nine of these arose in the maxillary sinus, 15 in the nasal cavity, four in the ethmoid sinus and two in the frontal sinus. Males were more frequently affected than females. No specific carcinogenic factor was apparent in these patients who were uniformly distributed all over the country. Advanced local disease with multiple symptoms and signs was common during presentation. Systemic and neck node metastases were infrequent. Histopathologically, squamous cell carcinoma was the commonest type of tumour. Satisfactory results were obtained by combination therapy consisting of surgery, irradiation, and systemic chemotherapeutics agents. Better health consciousness and health care delivery system are essential for early diagnosis, regular posttreatment follow-up and improved survival of these patients.