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: [1,2,3]
   • 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. (Refer to the PDQ summary on Nasopharyngeal Cancer for more information.)
   • Concomitant chemotherapy and radiation therapy may be considered.
4. For nasal cavity tumors (squamous cell carcinomas):
   • 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 (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.

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

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III 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. 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.
3. Shah JP: Surgery of the anterior skull base for malignant tumors. Acta Otorhinolaryngol Belg 53 (3): 191-4, 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. 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.
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.