ACR appropriateness criteria^® nasal cavity and paranasal sinus cancers

Abstract

The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Here, we present the Appropriateness Criteria for cancers arising in the nasal cavity and paranasal sinuses (maxillary, sphenoid, and ethmoid sinuses). This includes clinical presentation, prognostic factors, principles of management, and treatment outcomes. Controversies regarding management of cervical lymph nodes are discussed. Rare and unusual nasal cavity cancers, such as esthesioneuroblastoma and sinonasal undifferentiated carcinomas, are included. © 2016 American College of Radiology. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 39: 407-418, 2017.

Outcomes and toxicities of definitive radiotherapy and reirradiation using 3‐dimensional conformal or intensity‐modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies

“…The dosimetric benefits of PT are widely accepted, allowing for increased doses to target volumes and reduced doses to surrounding normal tissues, resulting in a further decrease in toxicity. Studies have reported superior LC with PT over photon‐based RT, and as such guidelines recommend the consideration of PT for cases in which constraints to critical structures are not achievable with standard IMRT techniques . Given the rarity of this disease, comparing the outcomes of patients treated with photon‐based versus proton‐based RT is impossible within a single institution.…”

Organ preservation for patients with anterior mucosal squamous cell carcinoma of the nasal cavity: Rhinectomy‐free survival in those refusing surgery

“…There are no randomized studies to guide management, and current treatment guidelines are based on observational studies and consensus opinion . Furthermore, interpretation of retrospective data is complex, as cancers of the nasal cavity are frequently analyzed with cancers of the paranasal sinuses, and most series include a variety of tumor histologies along with various disease stages.…”

“…For SCCs, locoregional control of 80% to 85% can be achieved following total resection and postoperative radiotherapy . Several retrospective series report that patients treated with surgery and radiation have better outcomes than patients treated with radiation alone, but such direct comparisons are hampered by selection bias, older radiotherapy techniques, which utilized inadequate doses of radiotherapy, and the inconsistent use of chemotherapy to enhance the effects radiotherapy.…”

Invasion of Pterygoid Plates; an Indicator for Regional Lymph Node Failure in Maxillary Sinus Cancer

“…There is a paucity of prospective randomized studies to lead clinical practice because of the rarity of this disease. The combination of resection, external beam radiotherapy, and systemic chemotherapy is an international standard treatment [2,3]. The National Comprehensive Cancer Network (NCCN) guidelines recommend elective nodal irradiation (ENI) for patients with T3 or T4 MSC, even in clinical node-negative (cN0) cases [2].…”

“…However, the use of ENI for MSC is controversial because of the variability in the frequency of regional failure of 3-33% [1], and the lack of reliable evidence. Furthermore, the long-term safety of ENI as a treatment for patients with advanced MSC is unknown due to its poor prognosis [3,4].…”