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Laryngorhinootologie 2012; 91(10): 627-632
DOI: 10.1055/s-0032-1321867
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Management und Prognose von Patienten mit Plattenepithelkarzinomen der Nasenhaupt- und Nasennebenhöhlen

Management and prognosis of patients with squamous cell carcinomas of the nasal cavity and the paranasal sinuses
A. Pickhard
1   Hals-Nasen-Ohrenklinik, Technische Universität München, München
,
F. Durst
1   Hals-Nasen-Ohrenklinik, Technische Universität München, München
,
R. Staudenmaier
1   Hals-Nasen-Ohrenklinik, Technische Universität München, München
,
R. Reiter
2   HNO, Sektion Phoniatrie, Univ.-Klinik Ulm, Ulm
› Institutsangaben
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Publikationsverlauf

eingereicht 15. Januar 2012

akzeptiert 10. Juli 2012

Publikationsdatum:
28. August 2012 (online)

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Zusammenfassung

Hintergrund:

Plattenepithelkarzinome der Nasenhaupthöhle und der Nasennebenhöhlen (NH/NNH) stellen eine sehr seltene Tumorentität dar. Wir möchten mit dieser Studie eine Übersicht über klinisch-pathologische Daten, Behandlungsstrategie sowie die Prognose geben.

Material und Methoden:

Es erfolgte eine retrospektive Analyse von 45 Patienten mit einem Plattenepithelkarzinom der NH/NNH (NH=35, NNH=10), die in den Jahren 1994 bis 2010 an der HNO-Klinik der Technischen Universität München therapiert wurden.

Ergebnisse:

Die Tumoren der NH wurden überwiegend im frühen Tumorstadium (97% T1 bzw. T2), die der NNH im fortgeschrittenen Tumorstadium (90% T3 bzw. T4) diagnostiziert. Nur bei zwei Patienten fanden sich bei Erstvorstellung pathologisch gesicherte Lymphknotenmetastasen. Bei 13 (29%) der Patienten war es zu einem lokalen Rezidiv (n=10) und/oder Tumorprogress mit Metastasen in regionären Lymphknoten (n=2) bzw. zu Fernmetastasen (n=4) gekommen. Das Plattenepithelkarzinom der NH/NNH zeigte eine schlechte Prognose (31% 5-Jahres-Überlebensrate, 5-JÜR). Speziell Patienten mit einem Rezidiv hatten ein schlechtes Gesamtüberleben (p=0,06). Statistisch signifikante Korrelationen zwischen klinisch-pathologischen Daten und den Überlebensdaten konnten nicht nachgewiesen werden.

Schlussfolgerung:

Plattenepithelkarzinome der NH/NNH haben eine schlechte Prognose. Die lokale Tumorkontrolle ist entscheidend für die Prognose. Eine abwartende Haltung hinsichtlich einer elektiven Neck dissektion erscheint vor allem dann gerechtfertigt, wenn klinisch kein Anhalt für eine Metastasierung in regionäre Lymphknoten besteht, da in unserem Kollektiv in nur 4% Lymphknotenmetastasen nachgewiesen werden konnten.

Abstract

Management and prognosis of patients with squamous cell carcinomas of the nasal cavity and the paranasal sinuses

Background:

Squamous cell carcinomas (SCC) of the nasal cavity and the paranasal sinuses are a very rare and poorly understood tumor entity. To date, no consistent management strategy exists. The purpose of our study was to demonstrate our therapeutic strategy and to correlate clinicopathological features with clinical follow-up data.

Material and methods:

45 patients with primarily resected SCC of the nasal cavity (n=35) and the paranasal sinuses (n=10) between 1994 and 2010 were reviewed retrospectively (mean follow-up period 2.6 years; range 0.3 to 14.9 years).

Results:

Tumors of the nasal cavity were diagnosed at an early stage (97% T1 and T2) whereas tumors of the parasinuses were found at an advanced stage (90% T3 and T4). Lymph node metastases were only found 2 patients. 13 patients (29%) had a local tumor progress, 2 patients showed lymph node metastases and 4 patients had distant metastases in follow up. The prognosis of tumors of the nasal cavitiy or the paranasal sinuses was bad (31% 5-year overall survival) especially by patients with a relapse.

Reconstructive surgery was performed after 12 months, when early local relapse could be excluded. There was no positive correlation between clinicopathological features and survival data.

Conclusion:

The prognosis of tumors of the nasal cavity and paranasal sinuses depends mainly on the control of local tumor growth. Modern strategies of surgical treatment in combination with radiotherapy need to be implemented in an effort to achieve continuous tumor-free survival.

Schlüsselwörter

Plattenepithelkarzinome - plastische Rekonstruktion - Nase - Nasennebenhöhle - lokale Kontrolle

Key words

squamous cell carcinoma - plastic reconstruction - nose - paranasal sinuses - local tumor growth
 

  • Literatur

  • 1 Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: A historical analysis of population-based data. Head Neck Jun 2012; 34 (06) 877-885 DOI: 10.1002/hed.21830. Epub 2011 Aug 24
    CrossrefPubMedGoogle Scholar
  • 2 Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 2001; 92: 3012-3029
    CrossrefPubMedGoogle Scholar
  • 3 Khademi B, Moradi A, Hoseini S, Mohammadianpanah M. Malignant neoplasms of the sinonasal tract: report of 71 patients and literature review and analysis. Oral Maxillofac Surg 2009; 13 (04) 191-199
    CrossrefPubMedGoogle Scholar
  • 4 Bhattacharyya N. Cancer of the nasal cavity: survival and factors influencing prognosis. Arch Otolaryngol Head Neck Surg 2002; 128: 1079-1083
    CrossrefPubMedGoogle Scholar
  • 5 Porceddu S, Martin J, Shanker G, Weih L, Russell C, Rischin D. Paranasal sinus tumors: Peter Mac Callum Cancer Institute experience. Head Neck. 2004. 26. 322-330
    Google Scholar
  • 6 Benoit MM, Bhattacharyya N, Faquin W, Cunningham M. Cancer of the nasal cavity in the pediatric population. Pediatrics 2008; 121 (01) 141-145
    PubMedGoogle Scholar
  • 7 Betlejewski S, Bilewicz R, Stankiewicz C, Skorek A, Gierek T, Wardas P, Gołqbek W, Szymański M, Gryczyński M, Szmeja Z, Szyfter W, Osuch-Wójcikiewicz E, Korolkowa O, Jurkiewicz D, Kenig D, Pośpiech L, Preś K, Namysłowski G. Malignant tumors of the nose and paranasal sinuses in the years 1992-2001. Otolaryngol Pol 2006; 60 (05) 729-736
    PubMedGoogle Scholar
  • 8 Hoppe BS, Stegman LD, Zelefsky MJ, Rosenzweig KE, Wolden SL, Patel SG, Shah JP, Kraus DH, Lee NY. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting-the MSKCC experience. Int J Radiat Oncol Biol Phys 2007; 67 (03) 691-702
    CrossrefPubMedGoogle Scholar
  • 9 Szutkowski Z, Kawecki A, Wasilewska-Teśluk E, Kraszewska E. Results of treatment in patients with paranasal sinus carcinoma. Analysis of prognostic factors. Otolaryngol Pol 2008; 62 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 10 Patel SG, Shah JP. TNM staging of cancers of the head and neck: striving for uniformity among diversity. CA Cancer J Clin 2005; 55 (04) 242-258
    CrossrefPubMedGoogle Scholar
  • 11 Bames L, Eveson J, Reichart P, Sidransky D. World Health Organization classification of tumours: pathology and genetics – head and neck tumours. Lyon: IARC Press; 2005
    Google Scholar
  • 12 Sobin UICC, TNM classification of malignant tumours. New York: Wiley; 2002
    Google Scholar
  • 13 DiLeo MD, Miller RH, Rice JC, Butcher RB. Nasal septal squamous cell carcinoma: a chart review and meta-analysis. Laryngoscope 1996; 106 (10) 1218-1222
    CrossrefPubMedGoogle Scholar
  • 14 Benninger MS. The impact of cigarette smoking and environmental tobacco smoke on nasal and sinus disease: a review of the literature. Am J Rhinol 1999; 13 (06) 435-438
    CrossrefPubMedGoogle Scholar
  • 15 Mirza S, Bradley PJ, Acharya A, Stacey M, Jones NS. Sinonasal inverted papillomas: recurrence, and synchronous and metachronous malignancy. J Laryngol Otol 2007; 121 (09) 857-864
    PubMedGoogle Scholar
  • 16 Blanch JL, Ruiz AM, Alos L, Traserra-Coderch J, Bernal-Sprekelsen M. Treatment of 125 sinonasal tumors: prognostic factors, outcome, and follow-up. Otolaryngol Head Neck Surg 2004; 131 (06) 973-976
    CrossrefPubMedGoogle Scholar
  • 17 Myers LL, Nussenbaum B, Bradford CR, Teknos TN, Esclamado RM, Wolf GT. Paranasal sinus malignancies: an 18-year single institution experience. Laryngoscope 2002; 112 (11) 1964-1969
    CrossrefPubMedGoogle Scholar
  • 18 Reiter R, Allert M, Knüchel R, Strutz J. Sinugenic metastasis of bilateral renal cell carcinoma (hypernephroma)]. HNO 2002; 50 (02) 165-168
    CrossrefPubMedGoogle Scholar
  • 19 Dulguerov P, Allal AS. Nasal and paranasal sinus carcinoma: how can we continue to make progress?. Curr Opin Otolaryngol Head Neck Surg 2006; 14 (02) 67-72
    PubMedGoogle Scholar
  • 20 Thorup C, Sebbesen L, Dano H, Leetmaa M, Andersen M, Buchwald C, Kristensen CA, Bentzen J, Godballec C, Johansen J, Gran C. Carcinoma of the nasal cavity and paranasal sinuses in Denmark 1995-2004. Acta Oncol Apr 2010; 49 (03) 389-394
    CrossrefPubMedGoogle Scholar
  • 21 Baier G, Völter C, Steigerwald I, Müller J, Schwager K. Malignant paranasal sinus tumors. Diagnosis, therapy and results. HNO 2005; 53 (11) 957-965
    CrossrefPubMedGoogle Scholar
  • 22 González-García R, Ruiz-Laza L, Román-Romero L. Lateral rhinotomy combined with anterior transantral approach for the treatment of large malignant melanoma of the nasal cavity involving the nasopharynx. J Craniomaxillofac Surg Apr 2012; 40 (03) 266-70 Epub 2011 Jun 8
    CrossrefPubMedGoogle Scholar
  • 23 Hosemann W, Dammer R, Bloss HG, Fietkau R. Therapy of malignant tumors in the area of the paranasal sinuses. HNO 2002; 50 (06) 578-592
    CrossrefPubMedGoogle Scholar
  • 24 Myers EN. Operative Otorhinolaryngology – Head and Neck Surgery, Vl.1. WB Saunders; Philadelphia: 1997
    Google Scholar
  • 25 Enepekides DJ. Sinonasal undifferentiated carcinoma: an update. Curr Opin Otolaryngol Head Neck Surg 2005; 13 (04) 222-225
    CrossrefPubMedGoogle Scholar
  • 26 Fornelli RA, Fedok FG, Wilson EP, Rodman SM. Squamous cell carcinoma of the anterior nasal cavity: a dual institution review. Otolaryngol Head Neck Surg 2000; 123: 207-210
    CrossrefPubMedGoogle Scholar
  • 27 Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck 2002; 24 (09) 821-829
    CrossrefPubMedGoogle Scholar
  • 28 Scurry Jr WC, Goldenberg D, Chee MY, Lengerich EJ, Liu Y, Fedok FG. Regional recurrence of squamous cell carcinoma of the nasal cavity: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg 2007; 133 (08) 796-800
    CrossrefPubMedGoogle Scholar
  • 29 Federspil PA. Implant retained epistheses for facial defects. Laryngorhinootologie 2009; 88 (Suppl. 01) S125-S138
    Artikel in Thieme ConnectPubMedGoogle Scholar