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    Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IV Paranasal Sinus and Nasal Cavity Cancer

    Stage IV disease includes advanced lesions.

    Standard treatment options:

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    1. For maxillary sinus tumors:
      • High-dose radiation therapy is used because extension to base of skull and nasopharynx is a potential, but not absolute, contraindication to surgery. 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:[1,2,3]
      • Generally a craniofacial resection in combination with preoperative or postoperative radiation therapy.
      • Concomitant chemotherapy and radiation therapy may be considered for patients with inoperable tumors.
    3. For sphenoid sinus tumors:
      • Treatment is the same as for nasopharyngeal cancers, primarily radiation therapy. (Refer to the Stage IV Nasopharyngeal Cancer section in the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)
      • Concomitant chemotherapy and radiation therapy may be considered.
    4. For nasal cavity tumors (squamous cell carcinomas):
      • Surgery alone.
      • Radiation alone.[4] Concomitant chemotherapy and radiation therapy may be considered.
      • Combined surgery and radiation therapy (postoperative radiation therapy is preferred).[4]
    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 (i.e., photons or electrons) and/or interstitial implantation can be used. Surgery is reserved for salvage. Treatment of the neck should be considered.

    Treatment options under clinical evaluation:

    1. For maxillary sinus tumors:
      • Superfractionated radiation therapy.[5]
    2. 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 is adjuvant therapy after surgery or after combined modality therapy.
      • Concomitant chemotherapy and radiation therapy may be considered.

    Neoadjuvant chemotherapy as employed in clinical trials has been used to shrink tumors and to render them more definitively treatable with either surgery or radiation. This chemotherapy is given prior to the other modalities; therefore, the designation of neoadjuvant is used 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.[6,7,8]

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