2025 Poster Presentations
P320: SINONASAL CANCER: A 7-YEAR EXPERIENCE AT A SINGLE INSTITUTION INCLUDING SURGICAL MANAGEMENT OF ADVANCED CANCER STAGES
Valentina Montanez-Azcarate, MD; Alexandra Scheiflinger, MD; Peter Nagy, MD; Scharukh Jalisi, MD, MBA, FACS; Beth Israel Deaconess Medical Center
Introduction: Sinonasal cancer is a rare and aggressive malignancy. Early diagnosis is challenging, frequently going undetected until it reaches a locally advanced stage. These tumors account for approximately 5% of all head and neck cancers and are histologically diverse, with squamous cell carcinoma being the most common type. Treatment typically involves surgical resection, often combined with adjuvant therapy. However, due to the proximity of these tumors to vital structures, achieving complete resection is challenging. Given the rarity and complexity of this disease, there is a need for ongoing characterization of this pathology, treatment approaches and clinical outcomes.
Objective: To describe our experience with patients diagnosed with sinonasal cancer, detailing their stage at diagnosis, tumor characteristics, treatment approaches and outcomes.
Methods: We reviewed the medical records of 20 patients with sinonasal cancer diagnosed between October 2017 and February 2024 at a tertiary care hospital. Collected data included demographic information, tumor characteristics, treatment and survival outcomes.
Results: The median age at diagnosis was 59.5 years (range 28-87). The most frequent histological diagnosis was squamous cell carcinoma, found in 9 cases (45%) and adenocarcinoma in 4 cases (20%). The primary tumor site was the nasal cavity in 7 patients, with the ethmoid and maxillary sinus being the second most common sites (4 patients each). At diagnosis, 5 patients were staged with T1-T3, and 15 with T4 disease (6 with T4a, and 8 with T4b). Lymph node involvement was seen in 3 patients, and 1 patient presented with distant metastasis.
16 patients were treated with surgery followed by adjuvant therapy (7 with radiotherapy and 9 with chemoradiation), 2 underwent surgery without adjuvant therapy, and 2 received palliative care. Among the surgical treated patients, 15 had an open approach, while 3 underwent endoscopic surgery.
The median follow up was 33.2 months (Range=1-75 months). Among the 18 patients treated with curative intent, 55.5% of the patients had no evidence of disease at the last follow up. Throughout the follow up, 6 patients experienced recurrence. Additionally, 3 patients died due to disease-related complications, and 2 developed metastases.
Conclusion: The treatment of sinonasal cancer is challenging, mainly due to its late detection and the difficulty in achieving complete resection. Despite aggressive treatment combining surgery and adjuvant therapies, recurrence and metastasis remain significant issues. However, more than half of our patients treated with curative intent showed no evidence of disease at their last follow-up. We believe surgery should be part of the initial treatment even for advanced stages. Continued advancements in early diagnosis and targeted therapies are crucial to improving outcomes for these patients.
