Treatment of Nasal Cavity Cancer in Low- or Intermediate-Grade Sinonasal Tumour
Not all nasal cavity cancers are managed the same way. When tumour grade is low or intermediate, or when the sinonasal tumour is well-differentiated, the clinical pathway follows a distinct approach from higher-grade disease.
Clinical scenario
In low- or intermediate-grade sinonasal tumours, and in well-differentiated sinonasal tumours, neoadjuvant chemotherapy is generally not appropriate as first-line therapy. Surgery with resection to negative margins is indicated as the first step in management for these patients.
Treatment approach (partial overview)
Following surgical resection, post-operative radiotherapy enters the pathway — with intensity-modulated radiotherapy (IMRT) as the established standard of care. In select situations, an alternative radiation technique may also be considered post-operatively. The full indications, technique selection criteria, and sequencing are detailed in the complete protocol.
References
DOI: 10.1016/j.esmoop.2024.104121
- When NACT is not suitable (e.g. low- or intermediate-grade tumours, well-differentiated tumours), surgery with resection in negative margins is indicated as first-line therapy.
- Post-operative RT is recommended for resected locally advanced sinonasal tumours (pT3-T4), positive margins, perineural involvement, positive lymph nodes or high-grade and/or poorly differentiated tumours [IV, A].
- IMRT is highly recommended as the standard of care in both the definitive and post-operative settings [IV, A].
- Intensity-modulated proton therapy (IMPT) can be proposed in the definitive or post-operative settings when dose distribution and toxicity probability are more advantageous compared with IMRT [II, B].
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