Paranasal Sinus Cancer Research Articles

Paranasal sinus cancer

Paranasal sinus cancers are rare, aggressive tumours that are usually diagnosed at an advanced stage. They differ from other upper aerodigestive tract tumours in terms of risk factors (wood dust exposure) and premalignant lesions (inverted papillomas). The diagnosis should be suspected in the presence of unilateral and continuous nasal sinus symptoms or bone lysis or a heterogeneous opacity on imaging. The definitive positive diagnosis is based on histological examination. Staging must comprise face, brain, neck and chest CT as well as face and brain MRI. Tumours are stage T3-T4 in two-thirds of cases and are associated with cervical lymph node involvement in 10% of squamous cell carcinomas and 4% of adenocarcinomas. These tumours must be managed in reference centres experienced in all of the various treatment modalities. Treatment decisions must be based on a multidisciplinary approach comprising local, regional and national REFCOR expertise (French rare head and neck cancer network). Optimal treatment is surgical resection with clear margins associated with adjuvant intensity-modulated radiotherapy (IMRT). Although it has been improved over recent decades, the prognosis remains poor with local recurrences occurring in 38% of cases and a five-year overall survival of about 63%.

A history of second hand smoke exposure: are we asking the right questions?

A history of second hand smoke exposure: are we asking the right questions?

Adaptive Proton Radiation Therapy for Base of Skull Tumors

Proton therapy offers additional sparing of critical organs for head and neck tumors compared to IMRT. However, proton beams are sensitive to changes in tissue densities, and anatomic change during the course of treatment may affect the proton dose distribution. This study investigates whether adaptive replanning is needed to compensate for anatomic change during therapy. Six patients, three with nasopharyngeal carcinoma and three with paranasal sinus cancer, treated with definitive or postoperative proton radiation therapy were analyzed retrospectively. A re-planning CT scan was acquired during mid-late course at a median dose of 53 Gy. The scans were registered rigidly to bony structures of the skull to remove the setup error. A deformable B-spline based registration was then performed to transfer structure contours from the planning CT to the re-planning CT. The original treatment plan was applied to the re-planning CT, and proton dose was re-calculated. Anatomic differences between the two CT scans were analyzed interactively, and dose distributions were evaluated by comparing isodose lines and distance-to-agreement analysis. Dose-volume histograms were compared using transferred contours on the re-planning CT and original contours on the pre-treatment CT. Autotransferred contours for critical organs were evaluated, and found to be satisfactory for critical structures. Target structures were re-delineated manually. Anatomic changes were observed in all six cases. The most significant change in the re-planning CT was the decrease in GTV volume with a median change of -12% (range, 0-36%). As a result of the increase in air in the sinuses, the average density within GTV was decreased from 93 +/- 11 Hounsfield unit (HU) to 37 +/- 36 HU (median, 43 HU). Of the 6 studied cases, the median change in the mean GTV dose was +1% (range, 0 - +1%). Hot spots larger than 1 cm3 within the GTV with dose increase of 6% and 7% were observed in 2 cases. The median GTV volume that received > 110% of the prescribed dose increased from 0.4% to 2.37%. The median of the maximum dose to the GTV nearly unchanged (79.28 vs. 79.44 Gy). There is no significant change in the CTV dose in all the studied cases. The median dose change to the Dmax of brainstem was +8% (range, 0 - +15%). The median dose change to the mean of the brainstem dose was +1.5% (range, -6% - +3%). The median dose change to the Dmax of optic chiasm and optic nerve (left or right), were -3% (range, -11% - 0) and -0.5% (range, -4.5% - +11%), respectively. Our study demonstrates that anatomic change during proton radiation therapy for base of skull tumor, especially tumor shrinkage in the sinuses, can occur. Increased heterogeneity of tissue densities within the GTV can result in hot spots. The results of six additional cases will be presented at the meeting.

Outcomes of Nasal Cavity and Paranasal Sinus Cancers Treated With Proton Therapy

Sixty-eight patients with cancers of the nasal cavity and paranasal sinuses have completed treatment with proton therapy since January of 2007. The disease characteristics, treatment planning and delivery techniques, and follow-up results of 49 patients who have completed treatment more than 1 year ago are presented. Of 49 patients, 43 had prior surgery, 23 with close/positive margins. Six patients had biopsy only. Skull-base invasion was noted in 34 of 49 patients, (69%). Ages ranged from 16 to 82 years with a median of 58 years. Histology included sino-nasal undifferentiated carcinoma, adenoid cystic carcinoma, esthesioneuroblastoma, mucosal melanoma, spindle-cell carcinoma and osteogenic sarcoma. Prescribed doses ranged from 64.8 GyE to 69.6 GyE for post-op negative margins, to 74.4 GyE for presence of positive margins or presence of gross unresectable tumor at 1.2 GyE twice-a-day. Proton treatments were delivered with orthogonal kV x-ray imaging guidance to achieve 1 mm setup accuracy for each fraction. All patients completed their prescribed treatment. Follow-ups ranged from 0.4 to 4.1 years (median 2 years). Brisk skin reactions developed in all patients, and resolved within 4 weeks after completion. Medial retinopathy occurred within the treated volume in 1 patient at 11 months after completion without negative impact on vision. Complete local disease control was noted in 43 of 49 patients (88%). In-field recurrence was noted in 2 post-operative patients at 9 and 12 months; one of them is free of disease after surgical salvage. Progressive meningeal seeding was identified in 1 patient within 2 months after radiation and was salvaged by additional therapy. Six patients who at initial diagnosis were inoperable and received 74.4 GyE had varying local response, succumbed to disease progression in 6 months to 20 months. Five patients who received post-operative proton radiation died of distant metastasis between 12 and 15 months without any evidence of local recurrence. The overall survival at 1- and 2-years was 94% and 73% respectively. Patients with cancers involving the nasal cavity and paranasal sinuses with skull base invasion will benefit from high-dose conformal proton therapy.

Epidemiology of Sinonasal Cancers in the City of São Paulo

Objective: Evaluate epidemiology of nose and paranasal sinus cancer in the city of São Paulo. Method: This was a study based on population cancer registry data of São Paulo from 1997 to 2006. We extracted data of 628 patients (CID-10 C30, C31.x) from a total of 388.950 diagnosed with cancer among all tumors. We aggregated data into the morphologic groups according to ICD-O. Results: The overall estimated incidence of nose and sinus tumors was 0.6 out of 100,000 and it was higher in men (0.7/100,000 vs 0.5/100,000). They are more frequent among fifth and eighth decades. The most common site was maxillary sinus (37.1%) followed by nasal cavity (33.3%). Isolated diagnosis of other sinus cancer was very rare and the most common was from ethmoid sinus (2.5%) The most common morphologic groups were squamous cell (followed by adenoid cystic carcinoma and esthesioneuroblastoma). The epidemiology of each site and each morphology were analyzed in detail. Conclusion: Sinonasal cancers in São Paulo have an incidence comparable to described previously. The analysis of sinonasal cancers from reliable population based registry was not commonly reported and this information can provide us more knowledge about this disease, besides the large case series of large health services.

Highly-conformal intensity-modulated radiotherapy reduced toxicity without jeopardizing outcome in patients with paranasal sinus cancer treated by surgery and radiotherapy or (chemo)radiation

To report oncologic outcomes of patients with paranasal sinus cancer (PNSC) treated by surgery and radiotherapy or (chemo)radiation and to investigate the impact of improving the radiation technique on outcomes and toxicity. Between 1999 and 2010, 82 consecutive patients with PNSC were treated by surgery and radiotherapy or by definitive (chemo)radiation. Three-dimensional conformal (3DCRT) or highly-conformal intensity-modulated RT (IMRT) was used. Endpoints were local control (LC), regional control (RC), disease-free (DFS), cause-specific (CSS), and overall survival (OS), late toxicity, and quality-of-life (QoL). After median follow-up of 51 months, the 5-year actuarial rates of LC, RC, DFS, CSS, and OS were 74%, 94%, 56%, 64%, and 54%, respectively. Grade ≥ 2 late toxicity at 5-years was 28%. High T-stage and perineural invasion were significantly associated with poor LC and RT-technique with late toxicity. Late toxicity was significantly lowered using IMRT, compared to 3DCRT (17% vs. 52%, p<0.0001). Visual preservation were significantly improved using IMRT (88% and 65%, respectively, p=0.01). LC-rate was also improved by IMRT (80% vs. 64%, respectively, p=0.2). QoL-scores deteriorated during and shortly after treatment but returned in almost all scales to baseline levels within 3-12 months. Surgery and radiotherapy or definitive (chemo)radiation resulted in good LC rates but with high rate of late side-effects. However, late toxicity and permanent visual impairment were significantly decreased by using highly-conformal IMRT without jeopardizing outcome. The improvements in the therapeutic ratio achieved by using IMRT would allow dose escalation of RT to further improve outcomes.

Expression of STK15, EGFR, p53 and p16INK4A by Squamous Cell Carcinoma (SCC) of the Nasal Cavity and the Paranasal Sinuses

Expression of STK15, EGFR, p53 and p16INK4A by Squamous Cell Carcinoma (SCC) of the Nasal Cavity and the Paranasal Sinuses Cancers of the nasal cavity or the paranasal sinuses have a low prevalence and incidence. In addition the presentation in various subsites of the nose and the paranasal sinuses and the existence of multiple tumor histopathologies complicate an execution of a study. These cancers represent 0.5% of all malignant neoplasms and 3% of head and neck cancers. 50% of the nasal cancers are squamous cell carcinomas (SCC).

NEW METHOD OF DISCHARGE PRINTING ON COTTON FABRICS USING HORSERADISH PEROXIDASE

Abstract Textile discharge printing is the most versatile and important of the methods used for introducing design to textile fabrics. In discharge styles, the pattern is produced by the chemical destruction of the original dye in the printed areas. The discharging agents used can be oxidising or reducing agents, acids, alkalis and various salts. However, the most important methods of discharging are based formaldehyde sulphoxylates and thiourea dioxide. Recently, environmental and industrial safety concerns have increased the potential for the use of enzymes in textile processing to ensure eco-friendly production. Formaldehyde sulphoxylate (NaHSO2.CH2O.2H2O) is one of the most powerful discharging agents; however, it is quite toxic and produces formaldehyde, a known human carcinogen associated with nasal sinus cancer and nasopharyngeal cancer. In this work, a hazardous chemical has been replaced with eco-friendly horseradish peroxidase enzyme in textile discharge printing. Enzymatic discharge printing was carried out with a phenol oxidising enzyme system such that the reactive dye was selectively discharged from the cotton fabric in selected areas, creating a printed surface. The effects of enzyme concentration, pH of the printing paste, treatment time and the temperature of enzymatic treatment were studied. The optimum conditions for enzymatic discharge printing were found to be pH 8.5 at 70°C with a dye concentration of 80 g/L and 60 min as the treatment time.

On-Board Imaging Validation of Optically Guided Stereotactic Radiosurgery Positioning System for Conventionally Fractionated Radiotherapy for Paranasal Sinus and Skull Base Cancer

To evaluate the positioning accuracy of an optical positioning system for stereotactic radiosurgery in a pilot experience of optically guided, conventionally fractionated, radiotherapy for paranasal sinus and skull base tumors. Before each daily radiotherapy session, the positioning of 28 patients was set up using an optical positioning system. After this initial setup, the patients underwent standard on-board imaging that included daily orthogonal kilovoltage images and weekly cone beam computed tomography scans. Daily translational shifts were made after comparing the on-board images with the treatment planning computed tomography scans. These daily translational shifts represented the daily positional error in the optical tracking system and were recorded during the treatment course. For 13 patients treated with smaller fields, a three-degree of freedom (3DOF) head positioner was used for more accurate setup. The mean positional error for the optically guided system in patients with and without the 3DOF head positioner was 1.4 ± 1.1 mm and 3.9 ± 1.6 mm, respectively (p <.0001). The mean positional error drifted 0.11 mm/wk upward during the treatment course for patients using the 3DOF head positioner (p = .057). No positional drift was observed in the patients without the 3DOF head positioner. Our initial clinical experience with optically guided head-and-neck fractionated radiotherapy was promising and demonstrated clinical feasibility. The optically guided setup was especially useful when used in conjunction with the 3DOF head positioner and when it was recalibrated to the shifts using the weekly portal images.

The potential benefit of radiotherapy with protons in head and neck cancer with respect to normal tissue sparing: a systematic review of literature.

Clinical studies concerning head and neck cancer patients treated with protons reporting on radiation-induced side effects are scarce. Therefore, we reviewed the literature regarding the potential benefits of protons compared with the currently used photons in terms of lower doses to normal tissue and the potential for fewer subsequent radiation-induced side effects, with the main focus on in silico planning comparative (ISPC) studies. A literature search was performed by two independent researchers on ISPC studies that included proton-based and photon-based irradiation techniques. Initially, 877 papers were retrieved and 14 relevant and eligible ISPC studies were identified and included in this review. Four studies included paranasal sinus cancer cases, three included nasopharyngeal cancer cases, and seven included oropharyngeal, hypopharyngeal, and/or laryngeal cancer cases. Seven studies compared the most sophisticated photon and proton techniques: intensity-modulated photon therapy versus intensity-modulated proton therapy (IMPT). Four studies compared different proton techniques. All studies showed that protons had a lower normal tissue dose, while keeping similar or better target coverage. Two studies found that these lower doses theoretically translated into a significantly lower incidence of salivary dysfunction. The results of ISPC studies indicate that protons have the potential for a significantly lower normal tissue dose, while keeping similar or better target coverage. Scanned IMPT probably offers the most advantage and will allow for a substantially lower probability of radiation-induced side effects. The results of these ISPC studies should be confirmed in properly designed clinical trials.

SU‐GG‐T‐568: The Effect of Change in Target Volume and Tissue Heterogenity on Dose Distributions during the Course of Treatment with Intensity Modulated Proton Radiotherapy

Purpose: To investigate the changes in dose distribution due to changes in tissue heterogeneity during the course of treatment with intensity modulated proton radiotherapy (TMPT). Method and materials: A retrorespective study was conducted using CT images acquired from daily CT‐guided IMRT treatments for cancer of paranasal sinus. IMPT planning from the Eclipse treatment planning system (Varian Medical Systems) was used to design and calculate the dose distribution and to evaluate the dose volume histograms of GTV, CTV, PTV, and OAR for the first and consecutive daily CT images acquired on a CT‐on‐rails system. Two‐beam optimization was performed on the acquired CT image for the first day of treatment. A verification plan was calculated on subsequent daily CT images by using the same beams' orientation with the same number of beam spots and fluence patterns as used for the first day. Results: The reduction in volume from the first to last day of treatment for GTV, CTV, and PTV were 5%, 1%, and 1%, respectively. The volumetric coverage of GTV, CTV and PTV by 95% isodose line distribution were reduced by 13%, 6%, and 7%, respectively for the same period. The total dose received by 95% of the GTV, CTV, and PTV volume was reduced by 1.5%, 3%, and 5%, respectively. The maximum dose received by brainstem was actually reduced by 52%. Conclusion: Small volumetric changes in tissue heterogeneity will have a diverse effect on tumor coverage for intensity modulated proton radiotherapy. The heterogeneity changes within the target volume affect the range of individual proton pencil beams that collectively optimize the tumor coverage.

Kombination von Brachytherapie und Chirurgie bei Tumoren mit Orbita-/Schädelbasisinfiltration

Prognosis of patients with advanced/recurrent cancer of paranasal sinuses and orbit with infiltration of the skull base is very bad. Radical surgery does not improve prognosis. A disadvantage of the radical surgery is the functional loss and the residual cosmetic defect. We present the results of a function-preserving surgery in combination with interstitial, image adapted brachytherapy (IABT) for the treatment of these cancers. Ten patients with paranasal sinus cancer and 16 patients with sarcomas (n=26) were retrospectively analysed. After a maximum tumor resection (mostly R1-R2 resections), 2-12 flexible afterloading plastic tubes were implanted. The postoperative IABT total dose was 10-25 Gy in 2.5 Gy fractions twice daily fractions for 5 days. In all cases the eye was obtained without functional damage. The IABT was well tolerated. The visual and cosmetic results were satisfactory. Postoperative complications occurred in 7 out of 26 cases without a serious long-term adverse event. Significant radiation-induced complications were found in patients with orbital or skull base involvement. The three years overall survival was 60% for rhabdomyosarcoma, and 33% for the paranasal sinus cancers. These results show that a combined treatment of function-preserving surgery and a IABT is a feasible, successful and well-tolerated option for curative, salvage and palliative therapy for selected patients with advanced or recurrent carcinoma of the paranasal sinuses and orbit.

Huge Sphenoid Sinus Olfactory Neuroblastoma: A Case Report

Intranasal or paranasal sinus olfactory neuroblastoma is a rare malignant neoplasm of olfactory neuroepithelial origin, accounting for approximately 5% of paranasal sinus cancers. Most of the presenting symptoms include nasal obstruction, nasal bleeding, anosmia, rhinorrhea, and headache. In this present report, we describe a 79-year-old man who presented with bilateral nasal congestion for more than 1 year. Nasoendoscopy showed a huge, smooth, mucosal tumor in the nasopharynx with extension to the posterior nasal septum. The tumor was completely resected under endonasal endoscopy and the pathology revealed olfactory neuroblastoma. Olfactory neuroblastomas usually arise in the cribriform plate and superior turbinate. However, the origin and isolation of olfactory neuroblastomas to the sphenoid sinus is exceedingly rare. Only four cases of olfactory neuroblastoma isolated in the sphenoid sinus have been described in English literature and the frequency of presenting symptoms with cranial neuropathies and headache. We report a case of primary sphenoid sinus olfactory neuroblastoma with the greatest enlargement reported to date.

SU-GG-T-75: IMRT for Cancers of Paranasal Sinuses and Nasal Cavity: A Planning Study

Purpose: to compare intensity-modulated radiotherapy (IMRT) plans generated by segmental multileaf collimator (SMLC, 1-cm leaf width) and helical Tomotherapy (HT) techniques for patients with cancers of paranasal sinuses and nasal cavity. Method and Materials: Five patients with locally advanced cancers of the paranasal sinuses and nasal cavity previously treated using HT technique were selected for this study. Treatment goals included a prescribed dose of 70 Gy to at least 95% of the PTV over 35 treatments while respecting dose-volume constraints to OARs. Each patient was planned using Tomotherapy HI-ART system with 2.5 cm jaw, 0.3 pitch, and 2.5 initial modulation parameters. All five patients were subsequently planned on Pinnacle TPS using the same goals for PTV and OARs for a 9-field SMLC technique on an Elekta Synergy™ LINAC equipped with 1 cm MLC. Dose volume histograms were generated and compared from both planning systems. Results: HT planning results (average ± one standard deviation (SD)) for PTV70 are: V77 (percentage of PTV70 receiving 77 Gy): 8.0% ± 17.7%; V70: 94.9% ± 0.2%; V65.1: 98.3% ± 1.2%. In comparison, SMLC planning results are: V77: 37.4% ± 43.8%; V70: 95.3% ± 0.7%; V65.1: 98.5% ± 1.3%. Maximum point doses for HT technique are: to optic chiasm (40.0 ± 21.9 Gy), ipsi optic nerve (ON) (39.0 ± 26.7 Gy) and contralateral ON (37.1 ± 22.9 Gy). For SMLC technique: to optic chiasm (41.8 ± 30.4 Gy), ipsi ON (45.2 ± 30.2 Gy) and contralateral ON (39.9 ± 30.1 Gy). Summary: Results are consistent with those of others evaluating HT-IMRT for cancers of the head and neck, i.e. HT technique achieved a more homogeneous PTV dose coverage while delivering less dose to OARs compared to 9-field SMLC technique used. Investigations using Synergy-S™ SMLC, 4-mm leaf width are underway and will also be presented.

MO-D-351-07: A System to Dynamically Balance Dose Sparing Between Critical Structures in Intensity Modulated Radiation Therapy (IMRT)

Purpose: The IMRTtreatment planning optimization process typically follows one, somewhat arbitrary, path, based on the manner in which the planner changes the optimization constraints/weights during planning. Thus, the planner usually never fully understands the trade‐off in doses between structures and, thereby, can not optimally distribute critical structuredose sparing. We present a system that enables the planner to generate an optimally balanced plan in real‐time by fully exploiting dose exchange between critical structures.Method and Materials: The system uses pre‐optimized fluences that are generated automatically. An initial baseline optimization is generated by “restricting” doses out of all critical structures equally. From this baseline, optimizations are generated for each critical structure further restricted, with all other critical structures completely relaxed to absorb excess dose (the optimizations explicitly respect target constraints) The fluences during the restricting process are stored, providing a history of the pathway taken by the optimization. A fast strategy is used to generate these optimizations prior to planning. At the time of planning, the system enables the planner to dynamically combine the pre‐computed dose distributions corresponding to the extent that they would like each critical structure to be spared. The results are displayed in histogram‐like form, allowing the planner to evaluate and dynamically balance critical structuredose sparing. Results: The system is illustrated for prostate and paranasal sinus cancer cases. In the prostate case, below a certain extent of rectal and bladder dose sparing, decreasing dose to one structure leads to increasing dose to the other structure. In the paranasal sinus cancer case, lowering the dose below the baseline optimization results in dose trade‐off between the the left eye/optic nerve, chiasm, right optic nerve, and left/right temporal lobes. Conclusion: The system presented here enables maximized dose sparing by optimally balancing IMRTdoses between critical structures in real‐time.

Fistula Formation After Postoperative Radiation Treatment for Paranasal Sinus Cancer

Postoperative radiation is frequently used in the treatment paradigm for paranasal sinus tumors. The development of 3-dimensional conformal radiation treatment and intensity modulated radiotherapy (IMRT) has facilitated the delivery of high doses required for local control of these lesions while simultaneously decreasing toxicity. At Memorial Sloan-Kettering Cancer Center, a radiation dose of 70 Gy is routinely prescribed to gross tumor, and 59.4 Gy is prescribed to a clinical target volume at high risk for subclinical disease and 54 Gy is delivered to a clinical target volume at low risk for subclinical disease. Fistula formation can occur with the delivery of postoperative radiation treatment despite the use of IMRT. Prosthesis fabrication can be used in the short-term management of this unfortunate complication with an acceptable cosmetic result. Patients should be aware of this potential toxicity, which can develop in spite of appropriate management and acceptable dosimetry. Nonetheless, combined modality therapy is recommended for aggressive treatment of paranasal sinus tumors to inhibit local progression. This report describes the clinical scenario and management of the rare incidence of fistula formation after radiation for paranasal sinus malignancy.

Postoperative intensity‐modulated radiation therapy for cancers of the paranasal sinuses, nasal cavity, and lacrimal glands: Technique, early outcomes, and toxicity

Our aim was to review Memorial Sloan-Kettering Cancer Center's experience with postoperative intensity-modulated radiotherapy (IMRT) for paranasal sinus, nasal cavity, and lacrimal gland cancer and report dosimetric measures, toxicity, and outcomes. Between September 2000 and June 2006, 37 patients with paranasal sinus, nasal cavity, or lacrimal gland cancer underwent postoperative IMRT. Median values were as follows: prescription dose, 60 Gy (range, 50-70); PTV(D95), 99% (range, 79-101%); optic nerve Dmax, 53 Gy (range, 2-54); optic chiasm Dmax, 51Gy (range, 2-55). Acute and late toxicities were scored by Radiation Therapy Oncology Group morbidity criteria. Median follow-up was 28 months. Two-year local progression-free and overall survivals were 75% and 80%. No early- or late-grade 3/4 radiation-induced ophthalmologic toxicity occurred. Preliminary results show that adjuvant IMRT in these patients is feasible, allowed for excellent planning target volume (PTV) coverage, and minimized dose delivered to optic structures. Longer follow-up is warranted to assess the extent of late effects and outcomes.

Wyniki leczenia chorych na raka zatok obocznych nosa. Analiza czynników prognostycznych

Analysis was based on the results of successful and unsuccessful treatment of 137 patients with paranasal sinus cancer at the Oncology Centre in Warsaw between 1987–2002. Patients with clinical stages T3 and T4 constituted 87% of cases (110 patients). Radical treatment was performed on 84 patients. Five-year overall survival in 137 cases amounted to 27%; and survival without recurrence was 24%. Five-year overall and recurrence-free survial among patients treated with surgery and radiotherapy were 36% and 32% retrospectively. Multivariate analysis of 61 patients with complete data, who were treated with radical surgery and radiotherapy, emphasized the influence of prognostic factors on survival. A worse prognosis correlated with advanced locoregional T and N stage. It is evident that total dose greater than 6000 cGy had a clear impact on the results of treatment. It was also shown that planning with the manually and hand-measured isodoses impacted negatively on the survival in comparison with 2D and 3D planning. Analysis of recurrence-free survival showed that metastatis to the lymph nodes, and a manually-planned treatment method, had a negative impact on the results of treatment. It is asserted that local recurrences are the main cause of failure in cases treated with surgery and radiotherapy.

Primary carcinoma of the frontal sinus: a case report and a review of literature

Paranasal sinus cancer is rather rare, with an incidence of less than 1 per 100,000 per year, the frontal sinus being the primary site in only 0.3%. Following clinical and radiological examinations, the diagnosis often remains elusive, the condition mistakenly being considered to involve mucocele, pyocele or osteomyelitis. This article reports on a 60-year-old pigeon breeder with squamous cell carcinoma originating in the frontal sinus. The presenting symptoms were a gradually worsening sharp headache, double vision and an oedematous left eyelid. CT and magnetic resonance imaging demonstrated erosion of the orbital roof around an area 10 mm in diameter, without direct infiltration of the bulbus. Twelve months following a frontal craniotomy, tumour excision and postoperative radiotherapy, the patient is symptom-free. A detailed description of this patient and a review of the published work are presented.

Extent of Surgery in the Management of Locally Advanced Sinonasal Malignancies

Introduction: Optimal treatment for malignancies of the sinonasal sinuses involving the anterior skull base remains under evolution. This study evaluates the importance of extent of surgery for patients with locally advanced paranasal sinus cancer treated with combined surgery and proton radiotherapy.