Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances

Abstract

The sinonasal cavities represent an anatomical region affected by a variety of tumours with clinical, aetiological, pathological, and genetic features distinct from tumours at the main head and neck cancer localizations. Together, squamous-cell carcinoma and adenocarcinoma account for 80% of all sinonasal tumours, and are aetiologically associated with professional exposure to wood and leather dust particles and other industrial compounds, and therefore, are officially recognized as an occupational disease. Owing to their distinctive characteristics, sinonasal tumours should be considered as separate entities, not to be included in the miscellany of head and neck cancers. Sinonasal tumours are rare, with an annual incidence of approximately 1 case per 100,000 inhabitants worldwide, a fact that has hampered molecular-genetic studies of the tumorigenic pathways and the testing of alternative treatment strategies. Nevertheless, the clinical management of sinonasal cancer has improved owing to advances in imaging techniques, endoscopic surgical approaches, and radiotherapy. Genetic profiling and the development of in vitro cell lines and animal models currently form the basis for future targeted anticancer therapies. We review these advances in our understanding and treatment of sinonasal tumours.

Sinonasal Squamous Cell Carcinoma: A Review with Emphasis on Emerging Histologic Subtypes and the Role of Human Papillomavirus

“…Tumors occur predominantly in men (twice as commonly as in women) in their 50's and 60's. Professionals who work with wood have up to a 20 fold increased risk of developing sinonasal SCC, and leather dust and some other chemical substances used in industry have also been associated with its development [3]. While chronic inflammation can be invoked as a risk factor for tumor development in many different parts of the body, data for sinonasal SCC are limited.…”

“…However, studies have not associated non-''irritant'' chronic inflammation or sinonasal inflammatory polyposis with SCC development. Smoking, a very strong risk factor for SCC across head and neck subsites, only increases the risk of sinonasal SCC development by two to three fold [3].…”

“…However, surgical resection with postoperative radiotherapy appears to be the optimal approach [3]. Endoscopic approaches are being used increasingly because they are less invasive, less morbid, and have less surgical complications [3].…”

“…However, surgical resection with postoperative radiotherapy appears to be the optimal approach [3]. Endoscopic approaches are being used increasingly because they are less invasive, less morbid, and have less surgical complications [3]. Interestingly, while positive margin status has been shown to be adverse in sinonasal cancer resection, surgery with widely negative margins isn't clearly better than more conservative ones, as long as clinically negative margins are achieved.…”

“…Interestingly, while positive margin status has been shown to be adverse in sinonasal cancer resection, surgery with widely negative margins isn't clearly better than more conservative ones, as long as clinically negative margins are achieved. Further, although no large, or randomized, studies have been performed for comparison, piecemeal resection via endoscopic approaches appears to be as effective as en bloc resection [3,29]. Precision radiotherapy, such as intensity modulated radiation therapy and gamma knife have improved treatment and lessened morbidity, particularly for those patients with tumors adjacent to the orbits, skull base, and brain.…”