Response-Adapted Locoregional Treatment After Neoadjuvant Chemotherapy in High-Grade or Poorly Differentiated Sinonasal Carcinoma
Clinical scenario
This protocol applies to patients with high-grade or poorly differentiated sinonasal carcinoma who have completed neoadjuvant chemotherapy (NACT) and require response-adapted locoregional treatment planning based on imaging assessment.
Tumour types covered
- Squamous-cell carcinoma (high-grade)
- Hyams grade III–IV olfactory neuroblastoma
- Sinonasal undifferentiated carcinoma (SNUC)
- Sinonasal neuroendocrine carcinoma (SNEC)
- Small-cell neuroendocrine carcinoma
- Poorly or non-differentiated sinonasal carcinoma NOS
- NUT carcinoma
- SWI/SNF complex-deficient sinonasal carcinoma
Previous treatment line: NACT
The prior treatment — neoadjuvant chemotherapy (NACT) with a histotype-driven platinum-based regimen — aimed to achieve partial or complete tumour response on contrast-enhanced locoregional imaging (CT or MRI), assessed after the first two cycles. The imaging response outcome at that assessment point determines which locoregional strategy is applied in this step.
Treatment approach (partial overview)
Locoregional treatment is response-adapted: the NACT imaging result guides the selection between distinct locoregional modalities. Adjuvant treatment options may additionally apply based on tumour grade and differentiation. The complete evidence-based algorithm — covering each response category and adjuvant pathway — is available in the full protocol.
References
DOI: 10.1016/j.esmoop.2024.104121
- Neoadjuvant chemotherapy (NACT) may be indicated in high-grade and poorly differentiated tumours.
- NACT should be considered in high-grade and poorly differentiated tumours [III, A].
- In high-grade and poorly differentiated tumours, the locoregional treatment can be adapted to tumour response (definitive CRT in patients with partial or complete response and surgery or CRT, if surgery is not possible, in patients with stable or progressive disease) [III, B].
- Post-operative CRT with platinum-based agents may be considered in high-grade and/or poorly differentiated tumours [IV, C].
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