Treatment Plan

After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. For most sinonasal cancers, the pre-treatment evaluation will likely include a verification of the pathology of the cancer, a CT or MRI scan with contrast, and a PET/CT to see if the cancer has spread. In general, there are three different options for the treatment of sinonasal cancers that can be used alone or in combination.

Surgery

Surgical removal is generally the first line of treatment for sinonasal cancers. The surgery that a doctor recommends will depend on the location of the cancer, as well as the stage. Often, surgery for sinonasal cancers will involve a maxillectomy.

An important part of the surgical management of sinonasal cancers is the reconstruction after the tumor is removed. A variety of reconstructive options are possible; however, sometimes primary reconstruction will be deferred and an obturator designed by a prosthodontist will be placed at the time of surgery and adjusted on an outpatient basis. Patients and their care teams should discuss the types of surgeries that may be required for the treatment of their cancer.

Radiation

The most common use of radiation for the treatment of sinonasal cancer is called adjuvant radiation, which is radiation given after surgery in order to decrease the chances that the tumour will come back.

Reasons for Post-Surgical Radiation

A doctor may recommend post-surgical radiation in a few scenarios.

  • If the tumour was not completely removed or if the surgical margins were positive for cancer.
  • If the type of cancer was determined to be aggressive or of a high grade or T-stage.
  • If the cancer had spread to lymph nodes in the neck or to other structures, such as nerves or vessels.

In some cases, complete surgical removal of a sinonasal cancer may be impossible or unsafe, and a doctor may recommend radiation therapy as the primary treatment. In this type of treatment, an external beam of radiation is directed at the tumour in order to destroy the rapidly dividing cancer cells.

Chemotherapy

Depending on the type of sinonasal cancer, chemotherapy may be used as the initial treatment in an effort to shrink the primary tumour in preparation for definitive surgical treatment.  This use of chemotherapy is called neoadjuvant treatment. Chemotherapy is also sometimes used concomitantly with radiation in an adjuvant setting after primary surgical treatment.  In very advanced cases, doctors may recommend systemic therapy (such as chemotherapy) or enrolment in a clinical trial.

General Treatment Options for Sinonasal Cancer

As mentioned above, treatment strategies will vary depending on the type of sinonasal cancer.  As an example, the general treatment plan for sinonasal mucosal melanoma is outlined below. In general, it includes surgical removal with or without radiation.

Mucosal melanoma (sinonasal) Stage I-III

  • Wide resection of the main tumour.
  • Possible radiation to the primary site following surgery.

Mucosal melanoma (sinonasal) Stage IVA T4a, N0

  • Wide resection of the main tumour.
  • Radiation to the primary site following surgery.

Mucosal melanoma (sinonasal) Stage IVA T3-4a, N1

  • Wide resection of the main tumour.
  • Neck dissection to look for cancerous lymph nodes in the neck.
  • Radiation to the primary site following surgery.

Mucosal melanoma (sinonasal) Stage IVb

Options include:

  • Radiation therapy with or without systemic therapy.
  • Enrolment in a clinical trial.

Mucosal melanoma (sinonasal) Stage IVC

Options include:

  • Radiation therapy with or without systemic therapy.
  • Enrolment in a clinical trial.

Doctors should undergo an extensive discussion with their patients on options for treatment and symptom control.