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Case Report Open Access

Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report

  • Authors:
    • Lianlian Yang
    • Qian Zhao
    • Fang Yi
    • Wenyan Guo
    • Qiongwen Zhang
    • Song Zhou
    • Dong Li
    • Zhihui Li
  • View Affiliations / Copyright

    Affiliations: Department of Oncology, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China, Department of Oncology, Dazhu County People's Hospital, Dazhou, Sichuan 635199, P.R. China, Department of Ultrasound, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China, Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China, Department of Neurosurgery, Dazhu County People's Hospital, Dazhou, Sichuan 635199, P.R. China
    Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 216
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    Published online on: April 2, 2026
       https://doi.org/10.3892/ol.2026.15571
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Abstract

For sinonasal intestinal‑type adenocarcinoma (ITAC), no standardized treatment exists, particularly for cases with advanced‑stage disease with intracranial invasion or recurrence. The present study describes the case of a 60‑year‑old male patient with ITAC and intracranial invasion who underwent surgery followed by radiotherapy; however, this was terminated early after 25 of 30 sessions [equivalent dose in 2‑Gy fractions (EQD2), 54.72 Gy] due to the risk of damaging the optic nerve. The tumor recurred in the same place 12 months after the surgery. A biopsy revealed a combined positive score (CPS) of 5, indicating that the tumor was programmed death‑ligand 1‑positive (PD‑L1‑positive), leading to treatment with albumin‑bound paclitaxel, cisplatin and camrelizumab for 4 cycles, followed by 12 cycles of maintenance therapy with camrelizumab. The patient maintained progression‑free survival for 11 months. On the whole, the present case report highlights the need for sufficient radiotherapy (≥66 Gy EQD2) for ITAC in complex anatomical areas, highlighting the role of advanced techniques to overcome dose limitations. Moreover, the ‘chemo‑immuno induction plus immuno‑maintenance’ approach in PD‑L1‑positive patients exhibits potential for long‑term disease control, providing a novel treatment model for advanced‑stage ITAC.
View Figures

Figure 1

A soft-tissue mass identified in the
ethmoid and sphenoid sinus of the patient. (A) Axial
contrast-enhanced T1-weighted MRI illustrating the tumor with a
measured diameter of 4.5×2.7 cm. (B) Sagittal contrast-enhanced
T1-weighted MRI demonstrating tumor invasion into the intracranial
area (indicated by red arrows). MRI, magnetic resonance
imaging.

Figure 2

Immunohistochemical staining results
suggesting that the tumor is an intestinal-type adenocarcinoma.
Original magnification, ×100. (A) CK7(−), (B) CK20(+), (C) CDX2(+)
and (D) villin(+). CK, cytokeratin; CDX2, caudal-type homeobox
2.

Figure 3

Examples of target volume
delineation. (A-C) Target area contours on axial planes at
different levels of non-contrast computed tomography images. (D-F)
Display of the target contours in (D) axial, (E) sagittal and (F)
coronal views. The red outline represents the gross tumor volume of
the tumor bed and the green outline represents the clinical target
volume 1/high-risk clinical volume.

Figure 4

Positron emission tomography-computed
tomography scan indicating tumor recurrence in the ethmoid and
sphenoid sinus, the anterior portion of the left nasal cavity and
the nasal septum (18F-fluorodeoxyglucose tracer).

Figure 5

Flowchart of the treatment course of
the patient. D, day.

Figure 6

Follow-up assessment of tumor
progression based on Response Evaluation Criteria in Solid Tumors
1.1 criteria (progressive disease, defined as an increase of ≥20%
in the longest diameter of target lesions compared with the
baseline or the last non-progressive assessment, with an absolute
increase of ≥5 mm). (A) Axial view of contrast-enhanced T1-weighted
MRI at the 5th month of follow-up. An enhanced soft-tissue signal
was observed in the ethmoid sinus, with a measured tumor longest
diameter of ~26.5 mm. A clear separation between the tumor and the
orbit was noted (indicated by the red arrow). (B) Axial view of
contrast-enhanced T1-weighted MRI at the 7th month of follow-up.
The shape and scope of the enhanced soft tissue signal in the
ethmoid sinus were almost consistent with those at the 5th month,
with a measured tumor longest diameter of ~26.1 mm. A clear
separation between the tumor and the orbit remained visible
(indicated by the red arrow). (C) Axial view of contrast-enhanced
T1-weighted MRI at the 11th month of follow-up. The enhanced soft
tissue signal in the ethmoid sinus was notably larger than
previously, with a measured tumor longest diameter of ~32.1 mm (an
increase of 23.0% and an absolute increase of 6.0 mm compared with
the 7th month, meeting the progressive disease criteria). The tumor
showed ill-defined boundaries with surrounding tissues, suggesting
an expanded invasive range of the tumor. MRI, magnetic resonance
imaging.
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Copy and paste a formatted citation
Spandidos Publications style
Yang L, Zhao Q, Yi F, Guo W, Zhang Q, Zhou S, Li D and Li Z: Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report. Oncol Lett 31: 216, 2026.
APA
Yang, L., Zhao, Q., Yi, F., Guo, W., Zhang, Q., Zhou, S. ... Li, Z. (2026). Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report. Oncology Letters, 31, 216. https://doi.org/10.3892/ol.2026.15571
MLA
Yang, L., Zhao, Q., Yi, F., Guo, W., Zhang, Q., Zhou, S., Li, D., Li, Z."Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report". Oncology Letters 31.6 (2026): 216.
Chicago
Yang, L., Zhao, Q., Yi, F., Guo, W., Zhang, Q., Zhou, S., Li, D., Li, Z."Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report". Oncology Letters 31, no. 6 (2026): 216. https://doi.org/10.3892/ol.2026.15571
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Spandidos Publications style
Yang L, Zhao Q, Yi F, Guo W, Zhang Q, Zhou S, Li D and Li Z: Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report. Oncol Lett 31: 216, 2026.
APA
Yang, L., Zhao, Q., Yi, F., Guo, W., Zhang, Q., Zhou, S. ... Li, Z. (2026). Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report. Oncology Letters, 31, 216. https://doi.org/10.3892/ol.2026.15571
MLA
Yang, L., Zhao, Q., Yi, F., Guo, W., Zhang, Q., Zhou, S., Li, D., Li, Z."Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report". Oncology Letters 31.6 (2026): 216.
Chicago
Yang, L., Zhao, Q., Yi, F., Guo, W., Zhang, Q., Zhou, S., Li, D., Li, Z."Comprehensive treatment for intracranial invasive sinonasal intestinal‑type adenocarcinoma with a focus on radiotherapy dosage and immunological combination therapy: A case report". Oncology Letters 31, no. 6 (2026): 216. https://doi.org/10.3892/ol.2026.15571
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