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Paranasal Sinus and Nasal Cavity Cancer Treatment 2/2 - National Cancer Institute

Paranasal Sinus and Nasal Cavity Cancer Treatment - National Cancer Institute

National Cancer Institute

Paranasal Sinus and Nasal Cavity Cancer Treatment (Adult) (PDQ®)–Health Professional Version



Stage I Paranasal Sinus and Nasal Cavity Cancer




Stage I disease includes small lesions.
Standard treatment options:
  1. For maxillary sinus tumors (small lesions of the infrastructure):
    • Surgical resection.
    • Postoperative radiation therapy 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:
  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.


Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in ethmoid sinus cancer. Arch Otolaryngol Head Neck Surg 118 (4): 367-72, 1992. [PUBMED Abstract]
  2. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999. [PUBMED Abstract]
  3. Cantù G, Solero CL, Mariani L, et al.: Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients. Head Neck 21 (3): 185-91, 1999. [PUBMED Abstract]
  4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal cavity--results of primary and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 15 (5): 1129-33, 1988. [PUBMED Abstract]
  5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiother Oncol 24 (3): 163-8, 1992. [PUBMED Abstract]
  6. Levendag PC, Pomp J: Radiation therapy of squamous cell carcinoma of the nasal vestibule. Int J Radiat Oncol Biol Phys 19 (6): 1363-7, 1990. [PUBMED Abstract]
  7. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of squamous cell carcinoma of the nasal vestibule. A review. Acta Oncol 27 (3): 203-8, 1988. [PUBMED Abstract]

Stage II Paranasal Sinus and Nasal Cavity Cancer




Stage II disease includes 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 (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:
  4. For nasal cavity tumors (squamous cell carcinomas), treatment preferences are either surgery or radiation therapy, which have equal cure rates:[4]
    • Surgery or radiation therapy for tumors of the septum.
    • Radiation therapy for tumors of the lateral and superior walls. Concomitant chemotherapy and radiation therapy may be considered.
    • 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.


Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in ethmoid sinus cancer. Arch Otolaryngol Head Neck Surg 118 (4): 367-72, 1992. [PUBMED Abstract]
  2. Cantù G, Solero CL, Mariani L, et al.: Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients. Head Neck 21 (3): 185-91, 1999. [PUBMED Abstract]
  3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999. [PUBMED Abstract]
  4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal cavity--results of primary and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 15 (5): 1129-33, 1988. [PUBMED Abstract]
  5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiother Oncol 24 (3): 163-8, 1992. [PUBMED Abstract]
  6. Levendag PC, Pomp J: Radiation therapy of squamous cell carcinoma of the nasal vestibule. Int J Radiat Oncol Biol Phys 19 (6): 1363-7, 1990. [PUBMED Abstract]
  7. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of squamous cell carcinoma of the nasal vestibule. A review. Acta Oncol 27 (3): 203-8, 1988. [PUBMED Abstract]

Stage III Paranasal Sinus and Nasal Cavity Cancer




Stage III disease includes 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:
  4. For nasal cavity tumors (squamous cell carcinomas [SCC]):
    • Surgery alone.
    • Radiation therapy alone.[4] Concomitant chemotherapy and radiation therapy may be considered.
    • 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 radiation therapy.
    • 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:
  1. For maxillary sinus tumors:
    • Superfractionated preoperative or postoperative radiation therapy.[7]
  2. For ethmoid sinus tumors, nasal cavity tumors (SCC), 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.


Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in ethmoid sinus cancer. Arch Otolaryngol Head Neck Surg 118 (4): 367-72, 1992. [PUBMED Abstract]
  2. Cantù G, Solero CL, Mariani L, et al.: Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients. Head Neck 21 (3): 185-91, 1999. [PUBMED Abstract]
  3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999. [PUBMED Abstract]
  4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal cavity--results of primary and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 15 (5): 1129-33, 1988. [PUBMED Abstract]
  5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiother Oncol 24 (3): 163-8, 1992. [PUBMED Abstract]
  6. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of squamous cell carcinoma of the nasal vestibule. A review. Acta Oncol 27 (3): 203-8, 1988. [PUBMED Abstract]
  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): 2749-54, 1992. [PUBMED Abstract]

Stage IV Paranasal Sinus and Nasal Cavity Cancer




Stage IV disease includes advanced lesions.
Standard treatment options:
  1. For maxillary sinus tumors:
    • High-dose radiation therapy is used because extension to base of skull and nasopharynx is a potential, but not absolute, contraindication to surgery. 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 preoperative or postoperative radiation therapy.
    • Concomitant chemotherapy and radiation therapy may be considered for patients with inoperable tumors.
  3. For sphenoid sinus tumors:
  4. For nasal cavity tumors (squamous cell carcinomas):
    • Surgery alone.
    • Radiation alone.[4] Concomitant chemotherapy and radiation therapy may be considered.
    • 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 (i.e., 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:
  1. For maxillary sinus tumors:
    • Superfractionated radiation therapy.[5]
  2. 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 is adjuvant therapy after surgery or after combined modality therapy.
    • Concomitant chemotherapy and radiation therapy may be considered.
Neoadjuvant chemotherapy as employed in clinical trials has been used to shrink tumors and to render them more definitively treatable with either surgery or radiation. This chemotherapy is given prior to the other modalities; therefore, the designation of neoadjuvant is used 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.[6-8]


Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in ethmoid sinus cancer. Arch Otolaryngol Head Neck Surg 118 (4): 367-72, 1992. [PUBMED Abstract]
  2. Cantù G, Solero CL, Mariani L, et al.: Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients. Head Neck 21 (3): 185-91, 1999. [PUBMED Abstract]
  3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999. [PUBMED Abstract]
  4. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal cavity--results of primary and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 15 (5): 1129-33, 1988. [PUBMED Abstract]
  5. 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): 2749-54, 1992. [PUBMED Abstract]
  6. Stupp R, Weichselbaum RR, Vokes EE: Combined modality therapy of head and neck cancer. Semin Oncol 21 (3): 349-58, 1994. [PUBMED Abstract]
  7. Al-Sarraf M: Head and neck cancer: chemotherapy concepts. Semin Oncol 15 (1): 70-85, 1988. [PUBMED Abstract]
  8. Dimery IW, Hong WK: Overview of combined modality therapies for head and neck cancer. J Natl Cancer Inst 85 (2): 95-111, 1993. [PUBMED Abstract]

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 has been used in trials such as UMCC-8810.[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:
  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.[8,9]


Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Kies MS, Levitan N, Hong WK: Chemotherapy of head and neck cancer. Otolaryngol Clin North Am 18 (3): 533-41, 1985. [PUBMED Abstract]
  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. [PUBMED Abstract]
  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): 233-8, 1987. [PUBMED Abstract]
  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): 259-65, 1987. [PUBMED Abstract]
  5. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in ethmoid sinus cancer. Arch Otolaryngol Head Neck Surg 118 (4): 367-72, 1992. [PUBMED Abstract]
  6. Cantù G, Solero CL, Mariani L, et al.: Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients. Head Neck 21 (3): 185-91, 1999. [PUBMED Abstract]
  7. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999. [PUBMED Abstract]
  8. Brasnu D, Laccourreye O, Bassot V, et al.: Cisplatin-based neoadjuvant chemotherapy and combined resection for ethmoid sinus adenocarcinoma reaching and/or invading the skull base. Arch Otolaryngol Head Neck Surg 122 (7): 765-8, 1996. [PUBMED Abstract]
  9. Licitra L, Locati LD, Cavina R, et al.: Primary chemotherapy followed by anterior craniofacial resection and radiotherapy for paranasal cancer. Ann Oncol 14 (3): 367-72, 2003. [PUBMED Abstract]

Changes to This Summary (07/26/2019)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Stage Information for Paranasal Sinus and Nasal Cavity Cancer
Updated staging information for 2017 (cited American Joint Committee on Cancer as reference 3).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

About This PDQ Summary



Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of adult paranasal sinus and nasal cavity cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Reviewers and Updates

This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
  • be discussed at a meeting,
  • be cited with text, or
  • replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Paranasal Sinus and Nasal Cavity Cancer Treatment (Adult) are:
  • Ann W. Gramza, MD (Georgetown Lombardi Comprehensive Cancer Center)
  • Minh Tam Truong, MD (Boston University Medical Center)
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Levels of Evidence

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

Permission to Use This Summary

PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”
The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Paranasal Sinus and Nasal Cavity Cancer Treatment (Adult). Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/head-and-neck/hp/adult/paranasal-sinus-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389272]
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Disclaimer

Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

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