First-line treatment for most types of paranasal sinus and nasal cavity cancer is surgery. The surgeon will remove the cancer and possibly some surrounding tissue. Because there is often local invasion (spread to nearby structures) at diagnosis, a wide excision technique is utilized so as to remove as much of the tumor as possible. If a significant amount of tissue needs to be removed, plastic surgery may be required. In the event that the tumor is small and localized to the nasal cavity, an endoscopic approach known as FESS (functional endoscopic sinus surgery) may be used. This is often done with excision of inverted papillomas.
Because many types of paranasal sinus and nasal cavity cancers are advanced at diagnosis and/or prone to recurrence and metastasis, postoperative radiation therapy is often recommended to improve clinical outcomes. This is especially important in cases of higher-grade or larger tumors, unclean surgical margins (after surgery, the pathology report shows tumor cells extending right up to the margin of the excised area), or evidence of local invasion or metastasis.
Radiotherapy may be used by itself or in combination with chemotherapy in cases where the tumor may be too large to be removed surgically, where surgery would be too disfiguring or if the tumor is unresectable (inoperable) for other reasons. Radiotherapy is also used as the primary treatment modality in cases of where the tumor is in the sphenoid sinus, and in lymphoma (formerly known as midline granuloma). Radiotherapy may also be useful as palliative treatment, i.e., to reduce symptoms such as pain and obstruction. Preoperative radiation may sometimes be employed in order to make the tumor more readily operable.
City of Hope’s Department of Radiation Oncology was the first in the western United States to offer the helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
Two types of technology are integrated – spiral CT scanning and intensity modulated radiation therapy, or IMRT – thus producing hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This also reduces damage to normal tissues and results in fewer complications.
Chemotherapy is sometimes used with radiation in paranasal sinus and nasal cavity cancers in cases where the disease is metastatic, unresectable and/or recurrent. Cancers occurring in the ethmoid and sphenoid sinuses are more likely to be treated with chemotherapy and radiation than cancers occurring in the maxillary sinus (except in maxillary sinus cancers with a late-stage or high-grade designation).
Chemotherapy regimens vary depending on the particular cell type in question. Sometimes, in order to use high-dose chemotherapy regimens (so as destroy the maximum number of tumor cells), autologous peripheral blood stem cell transplantation is performed. This enables a “rescue” of the blood and bone marrow, which are hard hit by the intensive chemotherapy.
City of Hope has several clinical trials involving therapies for advanced solid tumors of the head and neck. Some of these may apply to paranasal sinus and nasal cavity cancer.
Because paranasal sinus and nasal cavity cancers can recur, patients should be followed closely for any signs of recurrence or metastasis. This is accomplished by regular physical exams that include thorough head and neck palpation as well as multiple imaging modalities, e.g., CT, MRI and bone scans.