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:[5,6,7]
   • 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.[8,9]

Information about ongoing clinical trials is available from the NCI Web site.

References:

1. Kies MS, Levitan N, Hong WK: Chemotherapy of head and neck cancer. Otolaryngol Clin North Am 18 (3): 533-41, 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): 233-8, 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): 259-65, 1987.
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.
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.
7. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999.
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.
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.