Page 94 - Read Online

Page 2 of 10 Sell et al. Mini-invasive Surg 2024;8:3 https://dx.doi.org/10.20517/2574-1225.2023.105

[3,4]
being local recurrences . Despite the clear need for investigation into optimal treatment strategies for
sinonasal malignancies, patients with these diagnoses have been excluded from most clinical trials testing
[5]
novel therapeutic agents for head and neck cancer patients . In treatment guidelines, sinonasal cancers are
frequently combined into the greater category, head and neck cancers, and surveillance guidelines often
follow these generalized recommendations.

There are limited studies examining optimal posttreatment surveillance strategies for sinonasal pathologies.
Patients often present at an advanced stage, thought to be due to the large potential space of the sinuses
where tumors can grow, and early symptoms, such as nasal obstruction, are often attributed to benign
causes . Additionally, post-operative and post-radiation mucosal inflammation of the paranasal sinuses can
[6]
endure for much longer in the soft tissue of the skull base than in other regions of the head and neck for
[7]
reasons that remain unclear . Sinonasal malignancies possess many features that distinguish them from
other head and neck malignancies, and there are potential pitfalls to not considering these unique features
when planning posttreatment surveillance for these patients.

This review focuses on surveillance following primary treatment for the most common malignancy of the
sinonasal tract: sinonasal squamous cell carcinoma (SNSCC), as well as malignancies occurring solely in the
sinonasal tract, including sinonasal adenocarcinoma (SNAC), sinonasal neuroendocrine carcinoma (SNEC),
sinonasal undifferentiated carcinoma (SNUC), and olfactory neuroblastoma. In addition, the review also
covers other rarer malignancies that can occur in the sinonasal tract, such as primary mucosal melanoma
(PMM), nuclear protein of the testis (NUT) carcinoma, and extranodal neural killer cell (Nk)/T-cell
lymphoma. Due to the unique anatomic presentation, nasopharyngeal carcinoma is not included here. The
goal of this work is to review current recommendations, guidelines, and caveats in the surveillance of the
above malignancies of the sinonasal tract following primary treatment.

SURVEILLANCE OF MALIGNANCIES IN THE SINONASAL TRACT
When achievable, surgical resection is often the standard of care for sinonasal malignancies, which is then
followed by close post-operative surveillance given the high recurrence risk for these patients. The landmark
study by de Visscher and Manni in 1994 first highlighted the importance of surveillance and follow-up for
patients with squamous cell carcinoma (SCC) of the head and neck by demonstrating a significant
improvement in survival when recurrence in asymptomatic patients is detected at routine visits preceding
self-referral . Subsequently, additional studies have made efforts to identify predictors of recurrence,
[8]
including neural invasion, orbital extension, and histologic subtype for patients with sinonasal malignancies
to guide surveillance following treatment [9-11] . According to National Cancer Comprehensive Network
(NCCN) head and neck cancer guidelines, patients with sinonasal malignancies (specifically SNSCC) who
complete multimodal therapy should undergo endoscopy and radiologic imaging for a minimum of five
years due to the high recurrence risk . However, the optimal timing of endoscopy and imaging for cancers
[12]
of the sinonasal tract is poorly defined. Approximately 70% of physicians follow the NCCN guidelines, but
the frequency of surveillance should be individualized based on histology, grade, and other risk factors .
[13]
The following sections will review the existing surveillance modalities for monitoring for recurrence in
patients with sinonasal malignancies and highlight new information and emerging strategies for the
surveillance of different malignancies of the sinonasal tract.

ENDOSCOPY
Posttreatment endoscopic examination is an important part of the current standard of care for surveillance
of patients with sinonasal malignancy. Endoscopy allows for the assessment of the surface of the
nasopharynx and nasal cavity; however, complicated surgical resection and radiation can not only make