Neoadjuvant chemotherapy in advanced sinonasal teratocarcinosarcoma with intracranial extension: Report of two cases with literature review

Abstract

Sinonasal teratocarcinosarcoma (SNTCS) is a highly aggressive rare tumor of the nasal cavity. Surgery followed by concurrent chemoradiation is the mainstay of treatment in SNTCS. However, intracranial extension may complicate surgical resection, with difficulty in achieving R0 resection. Here we present two cases of SNTCS with intracranial extension; both patients were seen in skull base clinic of our hospital and deemed unsuitable for surgery. These patients then were offered neoadjuvant chemotherapy (NACT), both patients had a partial response with cisplatin and etoposide protocol; subsequently they underwent R0 resection (no macroscopic residual tumor at surgery with all margins were negative for tumor on microscopy). The present cases highlight the fact that NACT with cisplatin and etoposide protocol may be considered in technically unresectable SNTCS.

Sinonasal Teratocarcinosarcoma—A Rare and Highly Aggressive Neoplasm

“…Sinonasal teratocarcinosarcoma can rapidly spread intracranially and has a high rate of recurrence . In almost half of reported cases, the patients died within 3 years of tumor diagnosis, despite aggressive therapy .…”

“…In their 2 cases, Joshi et al used neoadjuvant chemotherapy. Neoadjuvant therapy is being explored as an option for large and unresectable SNTCS in the hope that improved surgical outcomes and reduced morbidity and mortality may be possible in these cases; however, more data are required to assess its efficacy.…”

Sinonasal teratocarcinosarcoma: a case report and literature review

“…13–22,26–29 Recently, neoadjuvant chemotherapy prior to operation has been suggested. 31 The local recurrence rate ranges from 25% to 55%. 5,27–29,32,33 Thus, follow-up nasal endoscopy and/or positron-emission tomography-CT is essential to screen for early recurrence.…”

A rare case of intracranial teratocarcinosarcoma: Case report and review of literature

“…A review of literature revealed 11 cases of TCS with intracranial invasion [ Table 1 ]. [ 3 6 7 8 9 16 17 19 20 21 ] Although the documented cases with predominant intracranial involvement are scarce, treatment with surgical resection with or without adjuvant treatments of chemotherapy and radiation therapy is the most widely accepted with goal for gross total resection. Despite few intracranial cases described in the literature, patients undergoing gross total resection fare better than those with subtotal resection.…”