Radiation Oncology/Head & Neck/Sinonasal/Nasal cavity

Epidemiology M>F 2:1 3% of upper respiratory tract cancers Anatomy For the purpose of staging, is divided into four subsites: septum, floor, lateral wall, and vestible. Nasal vestibule is the anterior nasal cavity extending from the nostrils to the internal nasal valve. Lateral wall of nasal cavity includes the superior, medial and inferior turbinates, the nasolacrimal duct, and the osteomeatus. 5-12% incidence of nodal mets at diagnosis. Draining lymphatics of nasal vestibule include Level I, facial and preauricular. Staging: see Staging Histology Nasal Cavity SCC 50% Esthesioneuroblastoma 13%. Melanoma 10-15% Nasal Vestibule SCC 80% Treatment of Carcinoma of Nasal Vestibule Tumors of the nasal vestibule are typically considered separate from nasal cavity tumors, because they are essentially skin cancers and as such have a different natural history Definitive radiation therapy preferred over primary surgical approach for T1-2N0 SCC of nasal vestibule because of good local control of xrt and major cosmetic sequellae of surgery. Definitive Radiation for Nasal Vestibule The Netherlands, 2004 15275715 -- Langendijk JA et al. "Radiotherapy of squamous cell carcinoma of the nasal vestibule." Int J Radiat Oncol Biol Phys 2004 Aug 1;59(5):1319-25. 56 pts w/ Wang Classification T1 and T2 tumors tx'd w/ external beam xrt +/- endocavitary brachytherapy boost. Local control rate at 2 yrs was 80%. 12% developed nodal metastases. Gainesville, 1999 (1970-1995) 10402517 -- Mendenhall WM et al. "Squamous cell carcinoma of the nasal vestibule." Head Neck. 1999 Aug;21(5):385-93. 56 pts tx'd w/ xrt alone and 4 w/ xrt followed by surg 5yr local control 94%, T4 71% 5yr CSS 94%, T4 86% Denmark, 1984 6331090 -- Johansen LV et al. "Squamous cell carcinoma of the nasal vestibule. Treatment results." Acta Radiol Oncol. 1984;23(2-3):189-92. 66 pts w/ SCC of nasal vestibule, mostly tx'd w/ xrt alone. Cure rate for Wang's T1 (81%) and Wang's T2 (52%). 12/22 local recuurence salvaged successfully w/ surgery. Local recurrence w/ T3 was 88% Prognostic Factors for Nasal Vestibule Princess Margaret, 2007 (1979-2000) 17298305 -- Jeannon J-P et al. "Prognostic indicators in carcinoma of the nasal vestibule." Clin Otolaryngol. 2007 Feb;32(1):19-23. Largest published series of SCC of nasal vestibule. 84 pts w/ SCC of nasal vestibule w/ 77% managed w/ primary xrt 5yr OS 58%, 5yr DFS 52% Wang classification only prognostic indicator significant on multi-variate analysis. MGH, 1976 820421 -- Wang CC. "Treatment of carcinoma of the nasal vestibule by irradiation." Cancer. 1976 Jul;38(1):100-6. 36 pts w/ SCC of nasal vestibule 3yr NED rates were 83% for Wang's T1, 71% for Wang's T2, and 50% for Wang's T3 Pts w/ bone destruction best tx'd w/ primary surgical approach +/- xrt. Treatment of Carcinoma of Nasal Cavity Definitive radiation therapy for nasal cavity is preferred over surgery, and may include a brachytherapy boost. SEER Database analysis, 2002 12220216 -- Bhattacharyya N. "Cancer of the nasal cavity: survival and factors influencing prognosis." Arch Otolaryngol Head Neck Surg 2002 Sep;128(9):1079-83. 981 pts, 97% non-metastatic, SCC 50%, esthesioneuroblastoma 13%, xrt delivered in 50% cases. Overall 5 yr survival 57% MD Anderson, 1992 (1969-1985) 1410570 -- Ang KK. "Carcinomas of the nasal cavity." Radiother Oncol. 1992 Jul;24(3):163-8. 45 pts w/ carcinoma of nasal cavity tx'd curatively (18 xrt alone, 27 surg + xrt) All pts w/ dz originating from septum controlled. 9/31 w/ dz from floor or lateral wall of nasal cavity died of dz OS at 5 yrs 75%, at 10 yrs 60% 4 pts had blindness (2 from xrt, 2 from exenteration). Mallinkrodt, 1988 (1969-84) 2846481 -- Hawkins RB. "Carcinoma of the nasal cavity--results of primary and adjuvant radiotherapy." Int J Radiat Oncol Biol Phys. 1988 Nov;15(5):1129-33. 62 pts w/ CA of nasal cavity tx'd w/ either definitive xrt or surg + xrt. No elective nodal tx given. 52% 5yr OS, 32% 10 yr OS 49% tx'd w/ xrt alone controlled, 82% tx'd w/ surg + xrt controlled 19% failed in nodes in pts who were initially N0.