SINONASAL MALIGNANCY скачать в хорошем качестве

SINONASAL MALIGNANCY

Sinonasal malignancies are rare but aggressive cancers arising from the nasal cavity and paranasal sinuses. These tumors are divided into four prognostic groups based on histology and treatment approach: Good, Intermediate, Poor, and Radiation-Treated Tumors. 1. Good Prognostic Group This category includes: • Esthesioneuroblastoma • Low-grade adenocarcinoma Treatment Approach: 1. Surgery: The primary treatment involves complete surgical resection. • Esthesioneuroblastoma may require craniofacial resection for full excision. • Low-grade adenocarcinoma can sometimes be treated using minimally invasive endoscopic techniques. 2. Radiotherapy (RT): • RT is added in cases with close or positive margins or lymph node involvement. • Postoperative RT improves local control and reduces recurrence risk. Outcomes: With early diagnosis and appropriate treatment, long-term control is achievable in most cases. 2. Intermediate Prognostic Group Tumors in this group include: • High-grade adenocarcinoma • Squamous cell carcinoma • High-grade adenoid cystic carcinoma • Adenoid cystic carcinoma Treatment Approach: 1. Surgery: • Radical surgical resection remains the mainstay of treatment. • Deep or extensive tumors may require craniofacial surgery. 2. Radiotherapy (RT): • Postoperative RT is essential, especially for high-grade tumors, to control residual disease. • Advanced techniques like Intensity-Modulated Radiotherapy (IMRT) are preferred to minimize damage to surrounding tissues. These tumors require a multidisciplinary approach due to their high recurrence and metastasis rates. 3. Poor Prognostic Group This group includes highly aggressive malignancies such as: • Sinonasal undifferentiated carcinoma (SNUC) • Melanoma Treatment Approach: 1. Sinonasal Undifferentiated Carcinoma (SNUC): • Initial therapy involves chemoradiation (RT/Ch). • Surgery is considered for residual disease or local control. 2. Sinonasal Melanoma: • Surgery with wide margins is the primary treatment. • Immunotherapy (Ch/Im) with checkpoint inhibitors, such as nivolumab or pembrolizumab, is crucial for systemic control. • Radiotherapy is often reserved for palliative purposes or local recurrence. Prognosis remains poor, requiring individualized treatment plans and close monitoring. 4. Radiation-Treated Tumors This group includes: • Lymphoma • Plasmacytoma • Metastases to the sinonasal region Treatment Approach: 1. Primary Radiation Therapy (RT): • These tumors are often radiosensitive, making RT the preferred treatment modality. • Lymphomas respond well to protocols like involved-site RT or combined chemo-radiotherapy. 2. Plasmacytomas are treated with high-dose RT alone unless systemic disease is detected, requiring management as multiple myeloma. 3. Metastases: Palliative RT is employed for symptom relief and local control. These tumors generally do not require surgical intervention and are managed primarily with radiation-based strategies. Key Takeaways Sinonasal malignancies are managed based on histological type, prognosis, and tumor extent. Treatment strategies span surgery, radiotherapy, and systemic therapies: • Good Prognosis: Surgery + RT for long-term control. • Intermediate Prognosis: Multimodal therapy with surgery and RT. • Poor Prognosis: Chemoradiation and immunotherapy dominate. • Radiation-Treated Tumors: RT is the cornerstone, particularly for lymphoma and plasmacytoma. Prognostic Factors: Early diagnosis, complete resection, and tailored therapy significantly improve outcomes, while high-grade and systemic tumors remain a challenge. #nose #throathealth #ear #ent #science #nosebleed #otolaryngology