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Review
. 2021 Sep 25;13(19):4802.
doi: 10.3390/cancers13194802.

Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery

Juliette Thariat  1   2   3 , Florent Carsuzaa  4 , Pierre Yves Marcy  5 , Benjamin Verillaud  6 , Ludovic de Gabory  7 , Francois Regis Ferrand  8   9
Affiliations
Review

Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery

Juliette Thariat et al. Cancers (Basel). .

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.

Keywords: cancer; endoscopic; radiotherapy; sinonasal/nasal cavity/paranasal/sinus; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prerequisite for adjuvant radiotherapy planning in sinonasal carcinomas. Legend: importance of time between surgery and radiotherapy on tumor control; RO: radiation oncologist.
Figure 2
Figure 2
Perspectives of radiotherapy after endoscopic endonasal resection; a mini morbid multimodal strategy. Assessment of disease and therapeutic steps before radiotherapy planning in an olfactive neuroblastoma of the ethmoid. (A1): preoperative T1-gadolinium enhanced MR of the tumor, frontal view. (A2): preoperative T2 MR of the tumor, frontal view. (A3): preoperative CT of the tumor, frontal view. (B): endoscopic view of the tumor following resection. (C): postoperative CT at day 20 following tumor resection and base of skull reconstruction with abdominal fat flap, showing proper closure and no residual tumor.
Figure 3
Figure 3
Perspectives of radiotherapy after endoscopic endonasal resection; a mini morbid multimodal strategy. Endonasal endoscopic resection of an adenocarcinoma of the ethmoid. (A,B): Pathologic mapping: of samples and margins using Bastier’s anatomical diagram for sinonasal malignant tumor resection/additional margins/biopsies of tumor bed on pathological report; grey-dashed grey areas representing safe margins, and black structures representing involved structures among resected structures [24]. (C): Accurate surgical sampling, peroperative sample annotation and localization of samples on operative report. Dashed areas representing resected structures.
Figure 4
Figure 4
Surgical excision of an adenoid cystic carcinoma of the right nasal fossa using a surgical navigation system. (A): pre-operative contrast-enhanced T1-weighted MRI displays a right nasal fossa tumor invading the root of the pterygoids and the pterygoid muscles (arrowhead). (B): intraoperative computer-assisted surgical navigation system (DigiPointeur®, Collin, France) helps to correlate endoscopic and CT visualization of the tumor extension within the pterygoid muscles. (C): contrast-enhanced T1-weighted MRI confirms that the patient is free of local recurrence after 14 years of follow-up.
See this image and copyright information in PMC

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