Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery

Abstract

Radiotherapy plays an important role in the treatment of sinonasal cancer, mainly in the adjuvant setting after surgical resection. Many technological approaches have been described, including intensity-modulated radiotherapy, concomitant chemoradiotherapy, charged particle therapy or combined approaches. The choice is based on general criteria related to the oncological results and morbidity of each technique and their availability, as well as specific criteria related to the tumor (tumor extensions, pathology and quality of margins). The aims of this review are: (i) to provide an overview of the radiotherapy techniques available for the management of sinonasal malignant tumors and (ii) to describe the constraints and opportunities of radiotherapy owing to the recent developments of endonasal endoscopic surgery. The indication and morbidity of the different techniques will be discussed based on a critical literature review.

Leveraging the outcome of a frontal bone tumor facial reconstruction case by a multimodal approach

“…This case exemplifies that to maximize the success of multimodal cancer therapy involving surgery, radiation, chemo- and immunotherapy, a multimodal approach should also include reconstruction and rehabilitation phases [ 9–11 ]. Predisposition for local evolution and recurrence with a severe prognosis of sinusoidal basal squamous cell carcinoma justifies surgical approaches securing the quality of margins as the first objective of treatment with possible “worst-case scenarios” in mind [ 8 , 10 , 11 ].…”

“…In cases such as this where a myriad of challenges to a successful clinical outcome exists, the timely use of an advanced tissue product such as mVASC to restore local blood flow and support rapid closure of the wounds is warranted to minimize infection risk and support the viability of transplanted tissues. Furthermore, additional intracranial operations, frontal sinus cranialization revisions, drainages of abscesses, titanium cranioplasties, pneumococcal meningitis, hydrocephalus, recurrent frontal sinusitis requiring debridement and removal of fat graft and osteomyelitic frontal bone flap for recurrent epidural infection, and such complications as recurrent rhinorrhea and seizures may have been avoided if an aggressive multimodal, multispecialty approach was in place to begin with [ 8 , 9 ].…”

Volumetric evaluation of maxillary sinuses using CBCTS: radiographic study

“…They lighten the skull and provide a structure that can withstand facial trauma while conferring resonance to speech and warming inspired air (Amine et al, 2020). Therefore, it is crucial to study the anatomy and volumetric extension of the maxillary sinus for diagnosis, verification of response to chemoand radiotherapy in malignant tumors, and surgical planning (Thariat et al, 2021). Surgical treatments requiring a study of the full volume of the maxillary sinuses include endoscopy sinus surgery and maxillary floor lift for graft and implant placements (Giovannetti et al, 2019;Raponi et al, 2021).…”

Sinonasal Cancer: Improving Classification, Stratification and Therapeutic Options

“…Thariat et al describe developments in radiotherapy, including precision intensity-modulated radiotherapy and charged particle therapy, techniques that require skill and good knowledge of the anatomy of the sinonasal cavities that can change during the course of radiotherapy. Choices for types of radiotherapy in relation to better local control and decrease toxicity are discussed [ 48 ]. Finally, Eide et al show how all these clinical advances, but also molecular pathological aspects are to be taken into consideration specifically for the treatment of ISP and associated SNSCC, and how they may affect clinical outcome [ 49 ].…”