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Nose and paranasal sinus tumours: United Kingdom National Multidisciplinary Guidelines

  • V J Lund (a1), P M Clarke (a2), A C Swift (a3), G W McGarry (a4), C Kerawala (a5) and D Carnell (a6)...

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With only limited high-level evidence for management of nasal and paranasal sinus cancers owing to low incidence and diverse histology, this paper provides recommendations on the work up and management based on the existing evidence base.

Recommendations

• Sinonasal tumours are best treated de novo and unusual polyps should be imaged and biopsied prior to definitive surgery. (G)

• Treatment of sinonasal malignancy should be carefully planned and discussed at a specialist skull base multidisciplinary team meeting with all relevant expertise. (G)

• Complete surgical resection is the mainstay of treatment for inverted papilloma and juvenile angiofibroma. (R)

• Essential equipment is necessary and must be available prior to commencing endonasal resection of skull base malignancy. (G)

• Endoscopic skull base surgery may be facilitated by two surgeons working simultaneously, utilising both sides of the nose. (G)

• To ensure the optimum oncological results, the primary tumour must be completely removed and margins checked by frozen section if necessary. (G)

• The most common management approach is surgery followed by post-operative radiotherapy, ideally within six weeks. (R)

• Radiation is given first if a response to radiation may lead to organ preservation. (G)

• Radiotherapy should be delivered within an accredited department using megavoltage photons from a linear accelerator (typical energies 4–6 MV) as an unbroken course. (R)

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Address for correspondence: V J Lund, Royal National Throat Nose and Ear Hospital, Royal Free Hampstead NHS Trust, London, UK E-mail: v.lund@ucl.ac.uk

References

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2 Edge, SB, Compton, CC, Fritz, AG, Greene, FL, Trotti, A. AJCC Cancer Staging Manual, 7th edn. New York: Springer, 2010
3 Dragonetti, A, Gera, R, Sciuto, A, Scotti, A, Bigoni, A, Barbaro, E et al. Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification. Rhinology 2011;49:207–13
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18 Bristol, IJ, Ahamad, A, Garden, AS, Morrison, WH, Hanna, EY, Papadimitrakopoulou, VA et al. Postoperative radiotherapy for maxillary sinus cancer: long term outcomes and toxicities of treatment. Int J Radiat Oncol Biol Phys 2007;68:719–30
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20 Dulguerov, P, Allal, AS. Nasal and paranasal sinus carcinoma: how can we continue to make progress? Curr Opin Otolaryngol Head Neck Surg 2006;14:6772
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