A Case of Sinonasal Undifferentiated Carcinoma with Brain Metastases

Abstract

Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive neoplasm arising in the nasal cavity and paranasal sinuses. We report a unique case of an 80-year-old man who presented with a locally advanced SNUC involving the ethmoid, sphenoid, and maxillary sinuses and bilateral lymph nodes, clinical T4N2M0. Given his age and the initial extent of his primary tumour, he was treated with neoadjuvant chemotherapy followed by chemoradiation with a split course of 50 Gray (Gy) in 40 fractions delivered twice a day. Four months after his treatments, he developed a recurrence at the left lower eyelid and left frontal sinus, intrabdominal metastases, and a left cerebellar metastasis. A single fraction of 22 Gy was delivered to the cerebellar lesion using stereotactic radiosurgery. He survived 17 months from the initial presentation. We review the available literature regarding treatment of brain metastases and use of hyperfractionated radiotherapy in this rare head and neck cancer.

Keywords: hyperfractionated radiotherapy; induction chemotherapy; palliative radiotherapy; radiosurgery; sinonasal undifferentiated carcinoma; snuc; split course radiotherapy; stereotactic radiosurgery.

Figure 1. Pre-treatment magnetic resonance imaging (MRI)

Clockwise from top left: coronal T1 with gadolinium, axial T1, and sagittal T2

Figure 2. Histologic stains

From left to right: B-cell lymphoma antigen 2 (BCL-2), Ki-67, and cytokeratin 7 (CK7)