# Radiation Oncology/Head & Neck/Sinonasal/Nasal cavity

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## Epidemiology

* M>F 2:1
* 3% of upper respiratory tract cancers

## Anatomy

* For the purpose of staging, is divided into four subsites: septum, floor, lateral wall, and vestible.
* Nasal vestibule is the anterior nasal cavity extending from the nostrils to the internal nasal valve.
* Lateral wall of nasal cavity includes the superior, medial and inferior turbinates, the nasolacrimal duct, and the osteomeatus.
* 5-12% incidence of nodal mets at diagnosis.
* Draining lymphatics of nasal vestibule include Level I, facial and preauricular.
Staging: see Staging

## Histology

Nasal Cavity
* SCC 50%
* Esthesioneuroblastoma 13%.
* Melanoma 10-15%
Nasal Vestibule
* SCC 80%

## Treatment of Carcinoma of Nasal Vestibule

* Tumors of the nasal vestibule are typically considered separate from nasal cavity tumors, because they are essentially skin cancers and as such have a different natural history
* Definitive radiation therapy preferred over primary surgical approach for T1-2N0 SCC of nasal vestibule because of good local control of xrt and major cosmetic sequellae of surgery.

### Definitive Radiation for Nasal Vestibule

* The Netherlands, 2004 PMID 15275715 -- Langendijk JA et al. "Radiotherapy of squamous cell carcinoma of the nasal vestibule." Int J Radiat Oncol Biol Phys 2004 Aug 1;59(5):1319-25.
** 56 pts w/ Wang Classification T1 and T2 tumors tx'd w/ external beam xrt +/- endocavitary brachytherapy boost.
** Local control rate at 2 yrs was 80%. 12% developed nodal metastases.
* Gainesville, 1999 (1970-1995) PMID 10402517 -- Mendenhall WM et al. "Squamous cell carcinoma of the nasal vestibule." Head Neck. 1999 Aug;21(5):385-93.
** 56 pts tx'd w/ xrt alone and 4 w/ xrt followed by surg
** 5yr local control 94%, T4 71%
** 5yr CSS 94%, T4 86%
* Denmark, 1984 PMID 6331090 -- Johansen LV et al. "Squamous cell carcinoma of the nasal vestibule. Treatment results." Acta Radiol Oncol. 1984;23(2-3):189-92.
** 66 pts w/ SCC of nasal vestibule, mostly tx'd w/ xrt alone.
** Cure rate for Wang's T1 (81%) and Wang's T2 (52%). 12/22 local recuurence salvaged successfully w/ surgery.
** Local recurrence w/ T3 was 88%

### Prognostic Factors for Nasal Vestibule

* Princess Margaret, 2007 (1979-2000) PMID 17298305 -- Jeannon J-P et al. "Prognostic indicators in carcinoma of the nasal vestibule." Clin Otolaryngol. 2007 Feb;32(1):19-23.
** Largest published series of SCC of nasal vestibule.
** 84 pts w/ SCC of nasal vestibule w/ 77% managed w/ primary xrt
** 5yr OS 58%, 5yr DFS 52%
** Wang classification only prognostic indicator significant on multi-variate analysis.
* MGH, 1976 PMID 820421 -- Wang CC. "Treatment of carcinoma of the nasal vestibule by irradiation." Cancer. 1976 Jul;38(1):100-6.
** 36 pts w/ SCC of nasal vestibule
** 3yr NED rates were 83% for Wang's T1, 71% for Wang's T2, and 50% for Wang's T3
** Pts w/ bone destruction best tx'd w/ primary surgical approach +/- xrt.

## Treatment of Carcinoma of Nasal Cavity

* Definitive radiation therapy for nasal cavity is preferred over surgery, and may include a brachytherapy boost.
* SEER Database analysis, 2002 PMID 12220216 -- Bhattacharyya N. "Cancer of the nasal cavity: survival and factors influencing prognosis." Arch Otolaryngol Head Neck Surg 2002 Sep;128(9):1079-83.
** 981 pts, 97% non-metastatic, SCC 50%, esthesioneuroblastoma 13%, xrt delivered in 50% cases.
** Overall 5 yr survival 57%
* MD Anderson, 1992 (1969-1985) PMID 1410570 -- Ang KK. "Carcinomas of the nasal cavity." Radiother Oncol. 1992 Jul;24(3):163-8.
** 45 pts w/ carcinoma of nasal cavity tx'd curatively (18 xrt alone, 27 surg + xrt)
** All pts w/ dz originating from septum controlled. 9/31 w/ dz from floor or lateral wall of nasal cavity died of dz
** OS at 5 yrs 75%, at 10 yrs 60%
** 4 pts had blindness (2 from xrt, 2 from exenteration).
* Mallinkrodt, 1988 (1969-84) PMID 2846481 -- Hawkins RB. "Carcinoma of the nasal cavity--results of primary and adjuvant radiotherapy." Int J Radiat Oncol Biol Phys. 1988 Nov;15(5):1129-33.
** 62 pts w/ CA of nasal cavity tx'd w/ either definitive xrt or surg + xrt. No elective nodal tx given.
** 52% 5yr OS, 32% 10 yr OS
** 49% tx'd w/ xrt alone controlled, 82% tx'd w/ surg + xrt controlled
** 19% failed in nodes in pts who were initially N0.