Radiation Oncology/Head & Neck/Sinonasal/Staging

Nasal Cavity and Paranasal Sinuses Staging Maxillary Sinus AJCC 7th Edition (2009) Tumor T1 - Tumor limited to the maxillary sinus with no erosion or destruction of bone T2 - Tumor causing bony erosion or destruction including extension into the hard palate, middle nasal meatus, except extension into posterior wall of maxillary sinus and pterygoid plates T3 - Tumor invades any of the following: bone of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses T4a - Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribiform plate, sphenoid or frontal sinuses T4b - Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than CN V2, nasopharynx, or clivus Nodes Metastasis M0 - none M1 - yes Stage Grouping Stage I - T1N0 Stage II - T2N0 Stage III - T3N0, T1-3N1 Stage IVA - T4a or N2 Stage IVB - T4b or N3 Stage IVC - M1 Nasal Cavity and Ethmoid Sinus The nasal cavity and ethmoid sinuses share a common staging system Four subsites: septum, floor, lateral wall, and vestible AJCC 7th Edition (2009) Tumor T1 - Restricted to any one subsite, with or without bony invasion T2 - Invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion T3 - Invades the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate T4a - Invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses T4b - Invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx, or clivus Nodes (same as for most H&N sites) Metastasis M0 - none M1 - yes Stage Grouping Stage I - T1N0 Stage II - T2N0 Stage III - T3N0, T1-3N1 Stage IVA - T4a or N2 Stage IVB - T4b or N3 Stage IVC - M1 Wang Classification (for carcinoma of the nasal vestibule) T1 - Tumor confined to skin T2 - Invades subcutaneous tissue and cartilage T3 - Invades bone Older staging systems AJCC 6th Edition (2006) No changes compared to 7th edition