A retrospective review of non‑intestinal‑type adenocarcinoma of nasal cavity and paranasal sinus
- Authors:
- Published online on: February 14, 2023 https://doi.org/10.3892/ol.2023.13718
- Article Number: 132
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Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Abstract
Introduction
Malignant tumors of the sinonasal tract are relatively rare, accounting for 3% of all head and neck malignancies. Adenocarcinomas of various types account for 10–20% of all primary malignant tumors of the nasal cavity and paranasal sinuses (1). According to the 4th edition of the WHO classification, these tumors can be distinguished into salivary and non salivary types (2) and the latter further divided into intestinal (ITAC) and non-intestinal type (n-ITAC) (3). n-ITAC is further subdivided into high-grade (G3) and low-grade (G1) lesions. G3 tumors have an aggressive course and are usually associated with a poor prognosis, with a 3-year survival rate of 20% (4–6). Patients with G3 tumors are 5.4 times more likely to succumb than those with low-grade tumors (P=0.039) (7). Moreover, due to the lack of specific symptoms, diagnosis is usually made when the tumor has spread widely and invaded surrounding tissues (T3 and T4 diseases) (8), which makes the treatment more difficult. At present, the options include open or endoscopic techniques for complete surgical resection, radical or adjuvant radiotherapy, chemotherapy and targeted therapy. However, the literature focusing on n-ITAC is inadequate. Most published series of articles, including homogeneous and relatively large series, are focused on ITAC, describing treatments, outcomes and prognostic factors (9). Regarding n-ITAC studies, most studies include all adenocarcinoma subtypes (10) or focus on low-grade tumors (4) or histological features (11), but lack suggestions for classic treatment. Therefore, the present study analyzed 12 consecutive patients with n-ITAC diagnosed in Nanfang Hospital, Southern Medical University during the last 20 years. The aim of the present study was to explore the clinical characteristics, outcomes, prognostic factors and the best treatment strategy for this particular tumor.
Materials and methods
Patients
The present study was approved by the Ethics Committee of Nanfang Hospital of Southern Medical University (Guangzhou, China; approval no. NFEC-2022-448). A total of 15 patients with n-ITAC were examined using the PACS imaging system of Nanfang Hospital; the patients were admitted to Nanfang Hospital of Southern Medical University between January 2000 and June 2020. Finally, the images and medical records of 12 patients (excluding one with two primary tumors, one without pathological diagnosis and one without treatment) were obtained and reviewed. Of the patients, 10 were men (83.33%) and two were women (16.67%), resulting in a male-to-female ratio of 5.0. The mean age of the patients was 48 years (range, 33–65 years). Epidemiologic and clinical data, surgical and histologic reports, preoperative and postoperative radiologic imaging, data on adjuvant therapy and follow-up data were reviewed. The specific process is shown in Fig. 1.
The extent of the neoplasm was assessed by clinical, endoscopic and radiologic examinations, in particular with multiplanar computed tomography (CT) and contrast enhanced magnetic resonance imaging. Endoscopic biopsies were performed under local anesthesia or pathological biopsies were obtained under general anesthesia. In cases of biopsies performed at an outside institution, the pathologic slides were reviewed at the Nanfang Hospital, Southern Medical University. Distant metastasis was evaluated by bone scan, CT scan and ultrasound. All patients in the series were retrospectively staged using clinical, radiologic and histopathologic evaluations according to the 8th edition of the American Joint Commission on Cancer (AJCC) TNM staging criteria in 2017 (12).
Follow-up and statistical analysis
Follow-up duration was calculated from the date of diagnosis of n-ITAC to the date of last follow-up. The following variables were analyzed with respect to survival: i) patient factors: Age, sex and smoking history; ii) tumor factors: TNM stage and tumor site; iii) pathologic factors: Grade (G1/G3) and status of surgical margins; and iv) treatment: Surgery, radiotherapy, chemotherapy, targeted therapy or a combination of these strategies. Overall survival (OS) was calculated from the date of n-ITAC diagnosis to the date of either mortality or the last follow-up. OS rates were estimated using the Kaplan-Meier method and compared using the log-rank test. All statistical analyses were performed using SPSS version 25.0 software (IBM Corp.). P<0.05 was considered to indicate a statistically significant difference.
Results
Characteristics of patients with n-ITAC
The clinicopathologic characteristics of all 12 patients who were diagnosed with n-ITAC are listed in Table I. Of the patients who were included in the present study, 10 were men (83.33%) and two were women (16.67%), resulting in a slight male predominance with a male-to-female ratio of 5.0. The mean age was 48 years (range, 33–65 years). No clear evidence of occupational predisposing factors was found; five patients were unemployed, three were office clerks, one was professional and technical, and three patients' occupations were unknown. Nasal obstruction and nosebleed were the most frequent symptoms, reported in 10 of 12 patients (83.33%) and a small number of them were accompanied by blurred vision, headache, loss of smell, tears, eye and facial swelling. Mass being found by microscope or macroscopically was reported in two (16.67%) of 12 patients. Of the patients, 9 (75.0%) exhibited n-ITAC only in the nasal cavity and one (8.3%) in the nasal cavity and ethmoid sinus. A total of two patients (16.7%) had lesions in both the nasal cavity and maxillary sinus. Of the 11 patients (91.7%) who underwent surgery for n-ITAC, six (54.5%) who underwent resection had negative margin and five (45.5%) had positive margin. The tumors were staged according to the 8th edition of the AJCC TNM classification in 2017, as follows: Six patients with T1-T3 (50.0%) and 6 patients with T4 (50.0%). Regarding the grade of differentiation, seven tumors were at a low grade (58.33%) and 5 were at a high grade (41.67%).
Pathology of n-ITAC
The pathology of non-intestinal adenocarcinoma came from our patients, including HE staining and immunohistochemistry, as shown in Fig. 2. Fig. 2A represents a low-grade tumor HE staining. The cells are uniformly arranged in compact acinar, back-to-back, confluent glands, cystic space and papillary. They maintain a tall columnar to cuboidal arrangement without much layering. The cytoplasm is usually abundant, but the appearance is variable-basophilic, granular, mucous, eosinophilic and cytolytic. The nuclear atypical is mild to moderate, with little mitosis. Fig. 2C shows a high-grade tumor HE staining, showing significant nuclear polymorphism, nucleolar and mitotic activity. The signet ring cells and necrosis can often be seen. Fig. 2B and D show immunohistochemical results of low-grade and high-grade tumors, respectively.
Treatment of patients with n-ITAC
Of the 12 patients, one patient (8.3%) received concurrent chemo-radiotherapy (platinum 80 mg/m2, q3w) without surgery. The other 11 (91.7%) were treated surgically. The surgical method was basically endoscopic endonasal resection (EER). Of these 11, six (54.5%) achieved gross negative margins (R0) and five (45.5%) had gross or microscopic positive margins (R+) (Fig. 3).
Adjuvant treatment included radiation, chemotherapy and targeted therapy. A total of eight patients (66.7%) underwent radiation, including five with G3 tumors (one T3 and four T4) and three with G1 tumors (one T1, one T3 and one T4). The technique was intensity-modulated radiotherapy (IMRT; Table II). Besides the primary tumor site, most patients also received prophylactic irradiation of the cervical area. The radiation dose for cases without surgery or with positive margin was relatively high: 66–70 Gy/33F for primary tumor and 54–64 Gy/30-33F for prophylactic cervical levels; while for patients with negative margin, the tumor bed was irradiated for 60 Gy/28F and the cervical prophylactic dose was 50 Gy/28F. A total of five patients received concurrent chemotherapy (platinum 80 mg/m2, q3w). Only one patient received targeted therapy with cetuximab.
Prognostic factors for OS of patients with n-ITAC
Mean follow-up time was 47 months (range, 17–106 months) and no patients were lost to follow-up. At the time of the analysis, 10 of 12 patients (83.3%) were alive with no evidence of disease (NED) and 2 patients (16.7%) succumbed to the disease. One patient (8.3%) treated with radiotherapy and chemotherapy and whose tumor was stage T4, grade G3, succumbed to the disease after 8 months. One patient (8.3%) treated with surgery, radiotherapy and chemotherapy, whose tumor was T4, grade G3, and positive surgical margins (R2) succumbed to the disease after 15 months. Of the five patients with positive incisal margin, four patients received radiotherapy and the median OS was 50 months.
The univariate analysis results showed that grade and treatment type of n-ITAC tumor were prognostic factors for OS (Table III). The 1- and 3-year OS rates were 100 and 85.7% for patients with G1 and were 80.0 and 20.0% for patients with G3 (P=0.077; Fig. 4A). In order to analyze the impact of surgery on the survival of patients, the present study divided the patients into surgical (n=11) and non-surgical (n=1) groups. The median follow-up time in the surgical group was 47 months. Of the patients, 10 are still alive and the longest follow-up period is 106 months. One patient succumbed to the disease with an OS of 15 months. The only patient in the non-surgical group succumbed to the disease and their OS was 8 months. The 1-year OS rate and 3-year OS rate of the surgical group were 100 and 63.6%, while the non-operative group were both 0.0% (P=0.0009; Fig. 5A).
In order to further analyze the effect of surgery combined with radiotherapy, the patients were divided into simple operation group and operation combined with radiotherapy group. The 1- and 3-year OS rates for those not receiving radiation were both 100% and for those receiving radiation were 100 and 42.9% (P=0.449; Fig. 5C). Using the average values as cutoff points, patient age was not a significant prognostic factor for OS. Moreover, the univariate analysis results showed that sex, smoking, TMN stage, margin status were also not significantly associated with OS (Fig. 4, Fig. 5, Fig. 6).
Discussion
This retrospective study discussed the clinical characteristics, outcomes, prognostic factors and treatments of a uniform cohort of 12 patients with sinonasal n-ITAC. To the best of the authors' knowledge, there are few reports focusing on n-ITAC treatments and prognosis.
n-ITAC is a rare malignant tumor, defined as an adenocarcinoma without the histopathological features of sinus ITAC or salivary adenocarcinoma (13). In the past 20 years, only 14 patients have been diagnosed in Nanfang Hospital, Southern Medical University and 12 patients were analyzed in the present study. Although it was previously reported that n-ITAC develops mainly in the maxillary sinus, in the present study, the most representative site of origin was the nasal cavity (11, 91.67%). According to the literature (14), the median age was ~60 years old and the female prevalence was very high. In the present study, there was male predominance, with a male-female ratio of 5.0, which may be related to smoking, but there was not have enough evidence to explain it (P=0.901; Fig. 6D).
There has not been any large-scale study on n-ITAC due to its low incidence. Choussy et al (15) considered 418 patients of ITAC or n-ITAC and reported a 5-year OS rate of 64%. Bhayani et al (16) considered 66 patients, of whom 31 had n-ITAC and reported a total 5-year OS rate of 65.9%. Orvidas et al (7) considered 24 patients (58% with n-ITAC) and reported a 5-year OS rate of 58%, but there are no survival data for n-ITAC in their study. To the best of the authors' knowledge, the researches of Chen et al (10), Bignami et al (14) were the only two researches that focused only on n-ITAC. In the study of Chen et al (10), the 5-year disease specific survival for the nonintestinal type was 71.2%. In the study of Bignami et al (14), 5-year OS was 95.2%. The median follow-up time of the present study was 47 months and 1 and 3-year OS rate were 76.9 and 46.2% respectively. The poor prognosis of our patients was mainly due to the fact that most of the tumors were of high T stage (T3-T4). It is reported in the literature that the clinical outcome of patients with sinonasal carcinomas remains poor (8,17,18). The high-grade tumors of nonintestinal sinonasal adenocarcinomas have an aggressive course and are usually associated with a poor prognosis, with a 3-year survival rate of merely 20% (4–6). Orvidas et al (7) reported that patients with high-grade tumors are 5.4 times more likely to succumb to any cause than those with low-grade tumors (P=0.039). By contrast, Choussy et al (15) reported that there was no statistically significant difference in survival rates between low-grade and high-grade tumors. However, in the present study the 1 and 3-year OS rates of patients with low-grade tumors were 100 and 85.7%, respectively, significantly higher than those of patients with high-grade tumors (80.0 and 20.0%; P=0.077; Fig. 4A). It was therefore indicated that high pathological grade may be an adverse prognostic factor. The pathological grade is related to the prognosis, but there was no statistical significance in multivariate analysis, which may be due to the small number of cases. In Bignami et al (14), the 5-year OS was 100% for pT1, pT2 and pT3 and 83.3±1.52% for pT4a and pT4b (P=0.037). However, there is no significant relationship between N stage and prognosis, which may be due to the fact that there are lower probability of lymph node metastasis and a small number of cases in the disease. In the present study, there was a trend in the survival curve of clinical stage (Fig. 4B) and T stage (Fig. 4C), which may be factors affecting the prognosis of patients. P-value was not statistically significant and may be related to the number of cases.
The main therapeutic strategy for n-ITAC is radical surgery with or without adjuvant radiotherapy. Endoscopic rhinoplasty has recently been promoted as the preferred surgical treatment for ITAC with correct planning and indications (19), with encouraging results and the advantage of reducing the incidence. Surgical therapy continues to be a mainstay for curative treatment. The main controversial point is whether to add adjuvant therapy after surgery at present. Some individuals argue that surgery alone is sufficient in patients with early tumors (16,20,21). However, Bignami et al (14) proposed that endoscopic transnasal approach is the preferred surgical method and surgery combined with postoperative radiotherapy is the main treatment in cases of high-stage (T3 and T4) and high-grade tumors (22). Some advocate that postoperative radiotherapy should be performed in all cases, regardless of stage or pathological grade, as most cancers of the nasal cavity and paranasal sinuses present at later stages, often leading to the use of multimodality treatment (23–26). Blanch et al (27) proposed that there was no survival benefit from the addition of radiotherapy to surgery for early-stage lesions. In the present study, the OS of the surgery alone group was slightly higher compared with that of the surgery plus radiotherapy group (P=0.449). It is known that the indications of RT are high-grade tumor, positive surgical margin, high T stage and positive lymph node (14,22). Therefore, the patients in the combined radiotherapy group had more risk factors than the patients with operation alone, resulting in a significant bias in the baseline between the two groups. Unfortunately, no randomly controlled data were available and this certainly is a common limitation of the present and other studies. Prospective studies may be needed in the future to verify the value of radiotherapy. The above results only suggested that surgery combined with radiotherapy is also an alternative treatment mode for patients with high risk factors.
On the mode of radiotherapy, it has been reported in the literature (15,28–30) that for ITAC and n-ITAC, the dosage is 30 fractions of 2 Gy, for a total of 60 Gy, with an extra boost of 6 Gy in case of positive margins. In the present study, the radiation dose for cases without surgery or with positive margin was relatively higher: 66–70 Gy/33F for primary tumor and 54–64 Gy/30-33F for prophylactic cervical levels; while for patients with negative margin, the dose for tumor bed was 60 Gy/28F and the cervical prophylactic dose was 50 Gy/28F. The dose in the present study was higher because it only focused on n-ITAC, which was more aggressive than ITAC. On the technology of radiotherapy, it was delivered by IMRT or three-dimensional radiotherapy, the former provided a local control and survival as well as a reduced toxicity. In previous studies (16,31,32), three-dimensional and conformal radiation therapy were the main technology, while in the present study, all patients received IMRT, which has the advantage of increasing the target dose without significantly increasing side effects. With regard to the scope of exposure, the main controversial point is whether prophylactic cervical lymph node irradiation should be performed. The patients in the present study all received prophylactic cervical irradiation, as suspicious lymph nodes were often seen on images. Besides, the results of the present study showed no obvious complications such as cervical lymphedema and fibrosis after radiotherapy.
Sinus adenocarcinoma often exhibits EGFR overexpression and mutations that determine the constitutive activation of the downstream signaling cascade of EGFR are rare, indicating that these tumors may be good candidates for anti-EGFR therapy (33). Only one of the patients in the present study was tested for EGFR, which showed (++) and the patient was given cetuximab targeted therapy. Since only one patient received targeted therapy, no clear recommendations could be given. Since cetuximab has been validated to be an extremely effective agent in HNSCC and is included in the guidelines, it was hypothesized that targeted therapy such as cetuximab might be an effective candidate for treatment of n-TIAC. Since only a few of the patients in the present study received chemotherapy, it is not clear whether systemic chemotherapy was beneficial or not.
The limitations of the present study are as follows: First, the study was a retrospective analysis and the selection of patients was biased. Patients received both surgery and radiotherapy had more potential risk factors at the baseline. Second, because of the low incidence of n-ITAC, the number of cases was relatively small. Third, longer follow-up time is needed to further verify its conclusions.
n-ITAC is a rare type of tumor. Pathological high grade may be a poor prognostic factor. Surgery is the optimal treatment and negative surgical margins are the ultimate goal of benefiting patients. Patients with no surgery, high-grade tumors and/or positive surgical margins should be given radical radiotherapy and preventive radiotherapy in the drainage area of the lymph node at the same time. If the margins are negative, the radiation dose can be appropriately reduced. Whether combined with chemotherapy and targeted therapy needs further study.
Acknowledgements
Not applicable.
Funding
Funding: No funding was received.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Authors' contributions
JL, BL, JX, HW, QG, FY, YX, SW, SC, YL, JG and BC contributed to the study conception and design. JL wrote the manuscript and collected and analyzed data. BL and BC analyzed data and critically revised the final manuscript. JX wrote the manuscript and searched for related literature. HW, QG, FY, YX, SW, SC, YL and JG searched for related literature. All authors read and approved the final manuscript. JL and BC confirm the authenticity of all the raw data.
Ethics approval and consent to participate
The present study was approved by the Ethics Committee of Nanfang Hospital of Southern Medical University (approval no. NFEC-2022-448). Due to the retrospective nature of the study, the committee agreed to exempt patients from informed consent.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
References
|
Barnes L: Intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses. Am J Surg Pathol. 10:192–202. 1986. View Article : Google Scholar : PubMed/NCBI | |
|
Leivo I: Sinonasal adenocarcinoma: Update on classification, immunophenotype and molecular features. Head Neck Pathol. 10:68–74. 2016. View Article : Google Scholar : PubMed/NCBI | |
|
El-Naggar AK, Chan JKC, Grandis JR, Takata T and Slootweg PJ: WHO classification of head and neck tumours. 4th edition. Lyon; IARC Press: 2017 | |
|
Stelow EB, Jo VY, Mills SE and Carlson DL: A histologic and immunohistochemical study describing the diversity of tumors classified as sinonasal high-grade nonintestinal adenocarcinomas. Am J Surg Pathol. 35:971–980. 2011. View Article : Google Scholar : PubMed/NCBI | |
|
Heffner DK, Hyams VJ, Hauck KW and Lingeman C: Low-grade adenocarcinoma of the nasal cavity and paranasal sinuses. Cancer. 50:312–322. 1982. View Article : Google Scholar : PubMed/NCBI | |
|
Knegt PP, Ah-See KW, vd Velden LA and Kerrebijn J: Adenocarcinoma of the ethmoidal sinus complex: Surgical debulking and topical fluorouracil may be the optimal treatment. Arch Otolaryngol Head Neck Surg. 127:141–146. 2001. View Article : Google Scholar : PubMed/NCBI | |
|
Orvidas LJ, Lewis JE, Weaver AL, Bagniewski SM and Olsen KD: Adenocarcinoma of the nose and paranasal sinuses: A retrospective study of diagnosis, histologic characteristics, and outcomes in 24 patients. Head Neck. 27:370–375. 2005. View Article : Google Scholar : PubMed/NCBI | |
|
Castelnuovo P, Turri-Zanoni M, Battaglia P, Antognoni P, Bossi P and Locatelli D: Sinonasal malignancies of anterior skull base: Histology-driven treatment strategies. Otolaryngol Clin North Am. 49:183–200. 2016. View Article : Google Scholar : PubMed/NCBI | |
|
Fiaux-Camous D, Chevret S, Oker N, TurriZanoni M, Lombardi D, Choussy O, Duprez F, Jorissen M, de Gabory L, Malard O, et al: Prognostic value of the seventh AJCC/UICC TNM classification of intestinal-type ethmoid adenocarcinoma: Systematic review and risk prediction model. Head Neck. 39:668–678. 2017. View Article : Google Scholar : PubMed/NCBI | |
|
Chen MM, Roman SA, Sosa JA and Judson BL: Predictors of survival in sinonasal adenocarcinoma. J Neurol Surg B Skull Base. 76:208–213. 2015. View Article : Google Scholar : PubMed/NCBI | |
|
Choi HR, Sturgis EM, Rashid A, DeMonte F, Luna MA, Batsakis JG and El-Naggar AK: Sinonasal adenocarcinoma: Evidence for histogenetic divergence of the enteric and nonenteric phenotypes. Hum Pathol. 34:1101–1107. 2003. View Article : Google Scholar : PubMed/NCBI | |
|
The 8th edition of the American Joint Commission on Cancer (AJCC) TNM staging criteria in 2017. https://dia.dakapath.com/home/tumour/view/id/3640.html | |
|
Barnes L, Eveson JW, Reichart P and Sidransky D: Pathology and genetics of head and neck tumours. WHO Classification of Tumours. 3rd edition. Vol. 9. Lyon: IARC Press; 2005, https://ovidsp.dc2.ovid.com/ovid–a/ovidweb.cgi?T=JS&PAGE=fulltext&D=ovft&AN=00003524–200685020–00001&NEWS=N&CSC=Y&CHANNEL=PubMed | |
|
Bignami M, Lepera D, Volpi L, Lambertoni A, Arosio A, Pistochini A, Nicolai P and Castelnuovo P: Sinonasal non-intestinal-type adenocarcinoma: A retrospective review of 22 patients. World Neurosurg. 120:e962–e969. 2018. View Article : Google Scholar : PubMed/NCBI | |
|
Choussy O, Ferron C, Vedrine PO, Toussaint B, Liétin B, Marandas P, Babin E, De Raucourt D, Reyt E, Cosmidis A, et al: Adenocarcinoma of ethmoid: A GETTEC retrospective multicenter study of 418 cases. Laryngoscope. 118:437–443. 2008. View Article : Google Scholar : PubMed/NCBI | |
|
Bhayani MK, Yilmaz T, Sweeney A, Calzada G, Roberts DB, Levine NB, DeMonte F, Hanna EY and Kupferman ME: Sinonasal adenocarcinoma: A 16-year experience at a single institution. Head Neck. 36:1490–1496. 2014.PubMed/NCBI | |
|
Robin TP, Jones BL, Gordon OM, Phan A, Abbott D, McDermott JD, Goddard JA, Raben D, Lanning RM and Karam SD: A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer. 123:3040–3049. 2017. View Article : Google Scholar : PubMed/NCBI | |
|
Turner JH and Reh DD: Incidence and survival in patients with sinonasal cancer: A historical analysis of population-based data. Head Neck. 34:877–885. 2012. View Article : Google Scholar : PubMed/NCBI | |
|
Nicolai P, Schreiber A, Bolzoni Villaret A, Lombardi D, Morassi L, Raffetti E, Donato F, Battaglia P, Turri-Zanoni M, Bignami M and Castelnuovo P: Intestinal type adenocarcinoma of the ethmoid: Outcomes of a treatment regimen based on endoscopic surgery with or without radiotherapy. Head Neck. 38 (Suppl 1):E996–E1003. 2016. View Article : Google Scholar : PubMed/NCBI | |
|
Nicolai P, Castelnuovo P, Lombardi D, Battaglia P, Bignami M, Pianta L and Tomenzoli D: Role of endoscopic surgery in the management of selected malignant epithelial neoplasms of the naso-ethmoidal complex. Head Neck. 29:1075–1082. 2007. View Article : Google Scholar : PubMed/NCBI | |
|
Lund VJ, Chisholm EJ, Takes RP, Suárez C, Mendenhall WM, Rinaldo A, Llorente JL, Terhaard CH, Rodrigo JP, Maughan E and Ferlito A: Evidence for treatment strategies in sinonasal adenocarcinoma. Head Neck. 34:1168–1178. 2012. View Article : Google Scholar : PubMed/NCBI | |
|
Bogaerts S, Vander Poorten V, Nuyts S, Van den Bogaert W and Jorissen M: Results of endoscopic resection followed by radiotherapy for primarily diagnosed adenocarcinomas of the paranasal sinuses. Head Neck. 30:728–736. 2008. View Article : Google Scholar : PubMed/NCBI | |
|
Jakobsen MH, Larsen SK, Kirkegaard J and Hansen HS: Cancer of the nasal cavity and paranasal sinuses. Prognosis and outcome of treatment. Acta Oncol. 36:27–31. 1997. View Article : Google Scholar : PubMed/NCBI | |
|
Sakata K, Aoki Y, Karasawa K, Nakagawa K, Hasezawa K, Muta N, Terahara A, Onogi Y, Sasaki Y and Akanuma A: Analysis of the results of combined therapy for maxillary carcinoma. Cancer. 71:2715–2722. 1993. View Article : Google Scholar : PubMed/NCBI | |
|
Harbo G, Grau C, Bundgaard T, Overgaard M, Elbrønd O, Søgaard H and Overgaard J: Cancer of the nasal cavity and paranasal sinuses. A clinico-pathological study of 277 patients. Acta Oncol. 36:45–50. 1997. View Article : Google Scholar : PubMed/NCBI | |
|
Parsons JT, Mendenhall WM, Mancuso AA, Cassisi NJ and Million RR: Malignant tumors of the nasal cavity and ethmoid and sphenoid sinuses. Int J Radiat Oncol Biol Phys. 14:11–22. 1988. View Article : Google Scholar : PubMed/NCBI | |
|
Blanch JL, Ruiz AM, Alos L, Traserra-Coderch J and Bernal-Sprekelsen M: Treatment of 125 sinonasal tumors: Prognostic factors, outcome, and follow-up. Otolaryngol Head Neck Surg. 131:973–976. 2004. View Article : Google Scholar : PubMed/NCBI | |
|
Choussy O, Ferron C, Védrine PO, Toussaint B, Liétin B, Marandas P, Babin E, De Raucourt D, Reyt E, Cosmidis A, et al: Role of radiotherapy in the treatment of nasoethmoidal adenocarcinoma. Arch Otolaryngol Head Neck Surg. 136:143–146. 2010. View Article : Google Scholar : PubMed/NCBI | |
|
Van Gerven L, Jorissen M, Nuyts S, Hermans R and Vander Poorten V: Long-term follow-up of 44 patients with adenocarcinoma of the nasal cavity and sinuses primarily treated with endoscopic resection followed by radiotherapy. Head Neck. 33:898–904. 2011. View Article : Google Scholar : PubMed/NCBI | |
|
Cantù G, Solero CL, Mariani L, Salvatori P, Mattavelli F, Pizzi N and Riggio E: Anterior craniofacial resection for malignant ethmoid tumors-a series of 91 patients. Head Neck. 21:185–191. 1999. View Article : Google Scholar : PubMed/NCBI | |
|
Dirix P, Vanstraelen B, Jorissen M, Vander Poorten V and Nuyts S: Intensity-modulated radiotherapy for sinonasal cancer: Improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys. 78:998–1004. 2010. View Article : Google Scholar : PubMed/NCBI | |
|
Duprez F, Madani I, Morbée L, Bonte K, Deron P, Domján V, Boterberg T, De Gersem W and De Neve W: IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys. 83:252–259. 2012. View Article : Google Scholar : PubMed/NCBI | |
|
Franchi A, Innocenti DR, Palomba A, Miligi L, Paiar F, Franzese C and Santucci M: Low prevalence of K-RAS, EGF-R and BRAF mutations in sinonasal adenocarcinomas. Implications for anti-EGFR treatments. Pathol Oncol Res. 20:571–579. 2014. View Article : Google Scholar : PubMed/NCBI |
