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):[1,2,3]
   • 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:
   • Treatment is the same as for nasopharyngeal cancers, primarily radiation therapy. (Refer to the PDQ summary on Nasopharyngeal Cancer for more information.)
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

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I paranasal sinus and nasal cavity cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

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.
2. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 1999.
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.
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.
5. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiother Oncol 24 (3): 163-8, 1992.
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.
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.