Sinonasal malignancy: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up

Abstract

1. •

   The CPG provides key recommendations and algorithms for managing SMs, excluding mucosal melanoma and soft-tissue sarcomas.

2. •

   The guideline covers diagnosis, staging, risk assessment, treatment and disease monitoring.

3. •

   Technological advancements in treatment with RT are discussed with a special focus on particle therapy.

4. •

   Surgical indications for open and transnasal endoscopic surgery are provided.

5. •

   Neoadjuvant chemotherapy in high-grade, locally advanced SMs helps to select subjects for conservative treatments.

Keywords: (neoadjuvant) chemotherapy; endoscopic surgery; proton therapy; radiotherapy; sinonasal carcinomas.

Figure 1

Management of local and locoregional disease. Purple: algorithm title; orange: surgery; blue: systemic anticancer therapy or their combination; turquoise: non-systemic anticancer therapies or combination of treatment modalities; white: other aspects of management and non-treatment aspects. ChT, chemotherapy; CR, complete response; CRT, chemoradiotherapy; CT, computed tomography; IMPT, intensity-modulated proton therapy; IMRT, intensity-modulated radiotherapy; MRI, magnetic resonance imaging; NACT, neoadjuvant chemotherapy; ONB, olfactory neuroblastoma; PD, progressive disease; PR, partial response; RT, radiotherapy; SCC, squamous-cell carcinoma; SD, stable disease; SCNEC, small-cell neuroendocrine carcinoma; SNEC, sinonasal neuroendocrine carcinoma; SNUC, sinonasal undifferentiated carcinoma; SWI/SNF, SWItch/Sucrose Non-Fermentable. ^aIn SCC, Hyams grade III-IV ONB, SNUC, SNEC, SCNEC, poorly or non-differentiated sinonasal carcinomas not otherwise specified, NUT carcinoma and SWI/SNF complex-deficient sinonasal carcinoma. ^bIn potentially chemosensitive (high-grade and poorly differentiated), locally advanced tumours, in which surgery or RT has a very high morbidity (significant orbital invasion, proximity to the chiasma) [III, C]. ^cNot recommended for low-grade pT1 tumours involving only the infrastructure and with negative margins and no other risk factors [IV, E]. ^dIMRT [IV, A]. ^ePost-operative CRT with platinum-based agents may be considered in high-grade and/or poorly differentiated tumours [IV, C]. ^fThrough contrast-enhanced locoregional imaging (i.e. CT or MRI) at the latest after two cycles. ^gIMRT [IV, A] or IMPT [II, B].

Figure 2

Management of local or regional recurrence. Purple: algorithm title; orange: surgery; dark green: radiotherapy; blue: systemic anticancer therapy or their combination; white: other aspects of management and non-treatment aspects. IMPT, intensity-modulated proton therapy; IMRT, intensity-modulated radiotherapy; reRT, reirradiation. ^aReRT with IMRT [IV, A] or IMPT [II, B].

Figure 3

Management of metastatic disease. Purple: algorithm title; dark green: radiotherapy; blue: systemic anticancer therapy or their combination; white: other aspects of management and non-treatment aspects. CR, complete response; PR, partial response; RT, radiotherapy.