Retrospektive Analyse der Diagnostik und Therapie von Karzinomen der Nasenhaupt- und Nasennebenhöhlen der Jahre 2004-2015

Background: Sinunasal carcinomas (nasal cavity and paranasal sinus) are rare. They are often only diagnosed in advanced stages, as they grow over a long period of time without symptoms and without the possibility of visualization in the paranasal sinuses. Even though great progress has been made over the last 30 years in terms of therapeutic options, the prognosis is still poor. Due to the lack of prospective, randomised clinical trials with representative cases there is no international consensus regarding the optimal therapy and retrospective analyses are therefore becoming more important. Methods: In this retrospective analysis, 54 patients with sinunasal carcinoma (squamous cell carcinoma (SCC), adenocarcinoma, sinunasal undifferentiated carcinoma (SNUC)) who were treated at the ENT Clinic Marburg between 2004-2015 were included. The patient data were analyzed with regard to tumor localization, therapies, recurrence, cervical lymph node metastases, distant metastases, outcome and more. Results: 54 patients were included (36 SCC, 15 adenocarcinoma, 3 SNUC), of which 61 % were male and 39 % female. The tumor was localized in 28 cases in the nasal cavity, in 19 cases in the paranasal sinuses and in 7 cases in both. The most frequent tumor localization in the paranasal sinuses was the maxillary sinus. SCC were more often found in the nasal cavity, adenocarcinomas and SNUC more frequent in the paranasal sinus. SCC of the nasal cavity were mainly diagnosed in stage T1-2, SCC of the paranasal sinus and adenocarcinomas in stage T3-4. 34 patients with SCC and all adenocarcinomas underwent primary surgical resection of the tumor. Neck dissection was performed in 7 patients with PEC, one patient with adenocarcinoma and one patient with SNUC. An R0 resection was achieved in 19 patients with a tumor of the paranasal sinuses and in 9 patients with a tumor of the nasal cavity. Adjuvant radiotherapy (RT) was performed in 12 patients with SCC and in 7 patients with adenocarcinoma. Adjuvant radiochemotherapy (RCT) was performed in 4 patients with SCC and 3 patients with adenocarcinoma. Two patients with SCC underwent definitive RCT. At initial diagnosis cervical lymph node metastases were detected in 6 patients with a SCC, one patient with an adenocarcinoma and one patient with a SNUC. Distant metastases were diagnosed at initial diagnosis in 3 patients with a SCC, in one patient with an adenocarcinoma and in one patient with a SNUC. In addition, in 10 patients with SCC and in 9 patients with adenocarcinoma a tumor recurrence was observed. 2 patients with a SCC and 1 patient with an adenocarcinoma developed recurrent lymph node metastases in the further course of the disease. Distant metastases were observed in 2 patients with a SCC and in 2 patients with an adenocarcinoma later on. 9 of all patients with SCC and 3 of all patients with adenocarcinoma had died 5 years after initial diagnosis. Discussion: Tumors of the nasal cavitiy were more often found in earlier tumor stages (T 1-2) than tumors of the paranasal sinuses. Moreover, R0 resections were more frequently achieved in tumors of the nasal cavity than in those of the paranasal sinuses. There was no observation of a direct correlation between advanced tumor stage and the occurrence of cervical lymph node metastases. However, distant metastases were observed more often in T3-4 tumor stages in both SCC and adenocarcinoma. The presence of distant or lymph node metastases was associated with a poor prognosis in this analysis. There were less lymph node metastases in adenocarcinoma than in SCC, but tumor recurrence was proportionately more frequent in adenocarcinoma than in SCC. Regarding SCC, lymph node metastases were found equally frequent in tumors of the nasal cavity and the paranasal sinuses. Patients who developed tumor recurrence often also developed lymph node or distant metastases. Regarding patients with SCC, most events like death and tumor recurrence were observed in the first 2 years after initial diagnosis, while in case of adenocarcinoma, most events were not observed until 2-5 years after diagnosis. Because of the heterogeneous therapeutic concepts, a direct comparison of the outcome is difficult. More studies with larger patient groups are needed to further investigate the optimal therapy of carcinomas of the nasal cavity and paranasal sinuses.