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 PMID 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) PMID 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 PMID 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) PMID 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 PMID 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 PMID 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) PMID 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) PMID 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.