Treatment of Unresectable Sinonasal Tumour with Orbital Apex, Cavernous Sinus, or Critical Structure Involvement
Clinical Scenario
This protocol addresses nasal cavity cancer in patients whose sinonasal tumour cannot be surgically removed, either because of the anatomical extent of disease or because of a contraindication to surgery. Unresectability is defined by involvement of specific critical structures.
Unresectability Criteria
A sinonasal carcinoma is considered unresectable when any of the following sites are involved:
- Orbital apex
- Cavernous sinus or optic chiasm
- Encasement of the internal carotid artery
- Massive brain invasion with perilesional oedema
- Involvement of major vessels (e.g. anterior cerebral artery)
Patients with a contraindication to surgery — whether due to medical comorbidity or patient preference — are also managed within this pathway.
Treatment Approach (Summary)
The treatment mainstay for unresectable disease is definitive radiotherapy, which may be delivered with or without concurrent systemic therapy. A specific advanced radiotherapy technique is recommended as the standard of care, with additional modalities available depending on histology and institutional capability.
Full regimen, sequencing, and modality selection available in the structured protocol →
References
DOI: 10.1016/j.esmoop.2024.104121
- Sinonasal carcinoma should be considered unresectable when one of the following sites is involved: orbital apex, cavernous sinus or optical chiasm, encasement of the internal carotid artery, massive brain invasion with perilesional oedema or involvement of major vessels (i.e. anterior cerebral artery) [IV, A].
- For patients with contraindications to surgery, either due to preference or tumour unresectability, RT is the mainstay of treatment; it may consist of concurrent CRT.
- Definitive RT with or without systemic therapy can be recommended for unresectable tumours [IV, B].
- 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].
- Carbon ions can be proposed for unresected radioresistant histologies [II, B].
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