eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Malignant Tumors of the Nasal Cavity: Follow-up

Author: Weiru Shao, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Tufts University School of Medicine
Coauthor(s): Adarsh Vasanth, MD, Resident Physician, Department of Otolaryngology, New England Medical Center
Contributor Information and Disclosures

Updated: Nov 16, 2007

Outcome and Prognosis

The prognosis of treatment outcome depends on the various factors, as follows:

  • Tumor histopathology: Some pathologic conditions are associated with long-term survival rates with appropriate therapy, while others carry high morbidity and mortality regardless of treatment. Bentz and colleagues (2003) reported disease-specific 5-year survival for various tumor types, based on their management experience:35
    • Esthesioneuroblastoma - 88% (20 patients treated)
    • Sarcoma (low grade) - 80% (5 patients treated)
    • Adenocarcinoma - 68% (20 patients treated)
    • SCCA - 51% (29 patients treated)
    • SCCA (skin) - 50% (11 patients treated)
    • Sarcoma (high grade) - 47% (27 patients treated)
    • Salivary malignancy - 46% (15 patients treated)
    • Undifferentiated or anaplastic carcinoma - 44% (8 patients treated)
    • Melanoma - 18% (17 patients treated)
  • Extent of disease: Local invasion into dura, brain, or orbital contents carries a worse prognosis because of diminished survival and greater rates of local recurrence. The presence of nodal disease or distant metastasis is also strongly indicative of a negative prognostic outcome.
  • Surgical factors: Obtaining clean margins intraoperatively has a prognostic value that is independent of tumor type and disease extent.

Future and Controversies

Treatment of the orbit

Preservation of orbital contents during surgical resection of advanced sinonasal malignant tumors that have encroached on the orbit remains a controversial issue. The 2 main points of contention are oncological safety of orbital preservation and the functional outcome in preserved eyes. More than 30 years ago, the standard surgical treatment for such cancers involved radical excision with orbital exenteration. Radiation therapy was also added perioperatively in an effort to improve survival. Presently, planned combined surgical resection and radiation therapy is the standard of care for sinonasal carcinoma. However, the treatment failure rate is high because of local recurrence; this has not changed significantly since the early 1970s.

Sisson first introduced orbital preservation surgery in 1970, and the indications for orbital exenteration have since evolved. Imola et al use the following indications for orbital exenteration:

  • Involvement of the orbital apex,
  • Involvement of extraocular muscles,
  • Invasion of the bulbar conjunctiva or sclera,
  • Lid involvement beyond a reasonable hope for reconstruction, and
  • Unresectable full-thickness invasion through the periorbita into retrobulbar fat

Studies that examined the oncological safety of selective orbital preservation have largely shown no difference in local recurrence or actuarial survival rates when compared with orbital exenteration. Considerable debate regarding the functional outcome of the preserved eye has taken place. Studies have shown that up to 90% of patients treated with selective orbital preservation achieve a functional eye if appropriate reconstruction such as adequate orbital support, lacrimal stenting, and secondary correction of lid malposition is performed as necessary (Imola, 2002). A significant number of patients with preserved orbits (41% in Imola's series) have some form of tolerable ocular impairment or sequelae.

 


More on Malignant Tumors of the Nasal Cavity

Overview: Malignant Tumors of the Nasal Cavity
Workup: Malignant Tumors of the Nasal Cavity
Treatment: Malignant Tumors of the Nasal Cavity
Follow-up: Malignant Tumors of the Nasal Cavity
References
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Further Reading

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Keywords

malignant tumors of the nasal cavity, epithelial tumors, squamous cell carcinoma, SCCA, glandular tumor, adenocarcinoma, AC, adenoid cystic carcinoma, ACC, undifferentiated carcinoma, soft-tissue tumors, malignant lymphoma, chondrosarcoma, osteosarcoma, hemangiopericytoma, metastatic carcinoma (kidney, lung, breast), miscellaneous tumors, malignant melanoma, esthesioneuroblastoma

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Contributor Information and Disclosures

Author

Weiru Shao, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Tufts University School of Medicine
Weiru Shao, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Adarsh Vasanth, MD, Resident Physician, Department of Otolaryngology, New England Medical Center
Adarsh Vasanth, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

William M Lydiatt, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
William M Lydiatt, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Head and Neck Society, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Department of Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: UST Grant/research funds Consulting

 
 
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