PDQ Treatment Health Professionals

Paranasal sinus and nasal cavity cancer

Table of Contents

GENERAL INFORMATION

CELLULAR CLASSIFICATION

STAGE INFORMATION

TNM definitions

Stage 0

Stage I

Stage II

Stage III

Stage IV

TREATMENT OPTION OVERVIEW

STAGE I PARANASAL SINUS AND NASAL CAVITY CANCER

Small lesions

STAGE II PARANASAL SINUS AND NASAL CAVITY CANCER

Small and moderately advanced lesions

STAGE III PARANASAL SINUS AND NASAL CAVITY CANCER

Small and moderately advanced lesions

STAGE IV PARANASAL SINUS AND NASAL CAVITY CANCER

Advanced lesions

RECURRENT PARANASAL SINUS AND NASAL CAVITY CANCER

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%-40% of patients who fail 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, Hong WK: Tumors of the nasal cavity and paranasal sinuses, nasopharynx, oral cavity, and oropharynx. In: DeVita VT, Hellman S, Rosenberg SA, Eds.: Cancer: Principles and Practice of Oncology. Philadelphia: JB Lippincott Company, 4th Edition, 1993, pp 574-630.

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 these cancers is squamous cell carcinoma. Minor salivary gland tumors comprise 10%-15% of these neoplasms. Malignant melanoma presents in less than 1% of neoplasms in this region. Some 5% of cases are malignant lymphomas.[1]

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. pp 561-562. In: DeVita VT, Hellman S, Rosenberg SA, Eds.: Cancer: Principles and Practice of Oncology. Philadelphia: JB Lippincott Company, 3rd Edition, 1989.

STAGE INFORMATION

The staging systems are clinical estimates of the extent of disease. The assessment of the tumor is based upon 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 has a staging system agreed upon by the American Joint Committee on Cancer. For cancer of the maxillary sinus, stages are defined by TNM classification.[3]

Primary tumor (T) classification for maxillary sinus tumors:

TX: Minimum requirements to assess the primary tumor cannot be met
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor limited to the antral mucosa with no bone erosion or destruction
T2: Tumor with erosion or destruction of the infrastructure*, including the

hard palate and/or the middle of the nasal meatus

T3: Tumor invades any of the following: skin of cheek, posterior wall of

maxillary sinus, floor or medial wall of orbit, anterior ethmoid sinus

T4: Tumor invades orbital contents and/or any of the following: cribriform

plate, posterior ethmoid or sphenoid sinuses, nasopharynx, soft palate,
pterygomaxillary or temporal fossae or base of skull

Primary tumor (T) classification for nasal cavity cancer:

No definition of the primary tumor (T) classification is available at this
time.

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

Distant metastasis (M)

MX: Minimum requirements to assess the presence of distant metastasis cannot

be met

M0: No (known) distant metastasis
M1: Distant metastasis present

Stage 0 cancer of the maxillary sinus is defined by the following TNM grouping:

Tis, N0, M0

Stage I cancer of the maxillary sinus is defined as the following TNM grouping:

T1, N0, M0

Stage II cancer of the maxillary sinus is defined as the following TNM grouping:

T2, N0, M0

Stage III cancer of the maxillary sinus is defined as any of the following TNM groupings:

T3, N0, M0
T1-3, N1, M0

Stage IV cancer of the maxillary sinus is defined as any of the following TNM groupings:

T4, N0 or N1, M0
Any T, N2 or N3, M0
Any T, any N, M1

1. Schantz SP, Harrison LB, Hong WK: Tumors of the nasal cavity and paranasal sinuses, nasopharynx, oral cavity, and oropharynx. In: DeVita VT, Hellman S, Rosenberg SA, Eds.: Cancer: Principles and Practice of Oncology. Philadelphia: JB Lippincott Company, 4th Edition, 1993, pp 574-630.

2. Laramore GE, Ed.: Radiation Therapy of Head and Neck Cancer. Berlin: Springer-Verlag, 1989.

3. Maxillary Sinus. In: American Joint Committee on Cancer: Manual for Staging of Cancer. Philadelphia: JB Lippincott Company, 3rd ed., 1988, pp 45-50.

TREATMENT OPTION OVERVIEW

Except for T1 mucosal carcinomas, the accepted method of treatment is a combination of radiotherapy 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 radiotherapy preoperatively for all stage II and III tumors and operate four to six weeks later.[1-3] A recent review of published clinical results of radical radiotherapy for head and neck cancer suggests a significant loss of local control when the administration of radiotherapy 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 utilized 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]

In 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, Hong WK: Tumors of the nasal cavity and paranasal sinuses, nasopharynx, oral cavity, and oropharynx. In: DeVita VT, Hellman S, Rosenberg SA, Eds.: Cancer: Principles and Practice of Oncology. Philadelphia: JB Lippincott Company, 4th Edition, 1993, pp 574-630.

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

Treatment options:

Standard:

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] 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 [2] surgery plus radiotherapy for tumors of the septal and lateral walls [3]

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.[4,5] Treatment of the ipsilateral neck should be considered.

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. 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.

3. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.

4. 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.

5. 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

Treatment options:

Standard:

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] 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:[2] surgery or irradiation for tumors of the septum radiation therapy for tumors of the lateral and superior walls surgery plus radiotherapy for tumors of the septal and lateral walls [3]

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.[4,5] Treatment of the neck should be considered.

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. 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.

3. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.

4. 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.

5. 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

Treatment options:

Standard:

1. For maxillary sinus tumors: surgical resection with high-dose preoperative or postoperative radiotherapy

2. For ethmoid sinus tumors: [1] 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 [2] combined surgery and radiation therapy (postoperative radiation therapy is preferred) [2,3]

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.[4] External- beam (photons or electrons) and/or interstitial implantation can be used. Surgery is reserved for salvage.

For maxillary sinus tumors:

Superfractionated preoperative or postoperative radiotherapy [5]

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.

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. 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.

3. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.

4. 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.

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): 2749-2754, 1992.

STAGE IV PARANASAL SINUS AND NASAL CAVITY CANCER

Treatment options:

Standard:

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] 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 [2] combined surgery and radiation therapy (postoperative radiation therapy is preferred) [2]

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.

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.[3-5]

For maxillary sinus tumors:

superfractionated radiotherapy [6]

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.

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. 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.

3. Stupp R, Weichselbaum RR, Vokes EE: Combined modality therapy of head and neck cancer. Seminars in Oncology 21(3): 349-358, 1994.

4. Al-Sarraf M: Head and neck cancer: chemotherapy concepts. Seminars in Oncology 15(1): 70-85, 1988.

5. 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.

6. 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

Treatment options:

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.

Standard:

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:[3] 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 radiotherapy 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

For maxillary sinus tumors, ethmoid sinus tumors, nasal cavity tumors, and
nasal vestibule tumors, clinical trials using chemotherapy should be
considered.[4]

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. 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.

4. Jacobs C, Lyman G, Velez-Garcia E, et al.: A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. Journal of Clinical Oncology 10(2): 257-263, 1992.

5. Vikram B, Strong EW, Shah JP, et al.: Intraoperative radiotherapy in patients with recurrent head and neck cancer. American Journal of Surgery 150(4): 485-487, 1985.

6. 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.

7. 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.

8. Ensley J, Crissman J, Kish J, et al.: The impact of conventional morphologic analysis on response rates and survival in patients with advanced head and neck cancers treated initially with cisplatin-containing combination chemotherapy. Cancer 57(4): 711-717, 1986.

Date Last Modified: 04/97