Combined Modality Management of Sinonasal Undifferentiated Carcinoma

Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive malignancy of the nose and paranasal sinuses, for which optimal treatment remains unclear. We report our experience and outcomes over an 8-year period at Charing Cross Hospital, London.

Between 2002 and 2010, 14 patients with SNUC who presented to a tertiary referral teaching hospital in London with a multidisciplinary skull base clinic were retrospectively reviewed. Patients were treated with curative intent as follows: with chemoradiotherapy then surgery (six patients), surgery then radiotherapy (five patients), chemoradiotherapy only (one patient), surgery only (one patient), and chemotherapy then surgery then radiotherapy (one patient). Follow-up ranged from 4 to 92 months (median, 38 months); no patients were lost to follow-up. The 2-year outcomes were local control in 72%, and local regional control in 64%; 3-year overall survival was 58%.

Combined modality treatment with three modalities can result in good initial local and locoregional control rates. Intensity-modulated radiotherapy can significantly reduce treatment-related toxicity, and it is possible that upfront radiation or chemoradiation will lead to better control rates, although surgery will remain a key component of treatment. Serious consideration should be given to addressing the cervical nodes at the time of primary treatment.

We have found over time that we increasingly recommend primary chemoradiotherapy followed by surgery, as opposed to upfront surgery with salvage radiotherapy.