Abstract
With the progress of recent surgical devices including endoscopes, endoscopic endonasal surgeries are commonly performed not only for chronic sinusitis but also for benign tumors such as papilloma. Furthermore, endoscopic endonasal surgeries have been employed for sinonasal malignancies, in particular histological types such as olfactory neuroblastoma, with outcomes comparable to those of incisional surgeries.
Radiotherapy and chemotherapy often play a key role in the treatment of sinonasal malignancies of common histological types such as squamous cell carcinoma, adenoid cystic carcinoma, and anaplastic carcinoma. Concurrent chemoradiation therapy （CCRT） or superselective intra-arterial infusion therapy of high-dose cisplatin and concomitant radiotherapy （RADPLAT） is regularly performed for the most common histological type of sinonasal malignancies, squamous cell carcinoma, in some T2 and cases severer than T3. Since August 2012, we have performed endoscopic endonasal surgeries in addition to these procedures, and have obtained excellent outcomes.
Here we report our experience with 15 cases of sinonasal malignancies. These included 5 malignant melanoma, 4 squamous cell carcinoma, 2 metastasis from renal cancer, 1 malignant solitary fibrous tumor, 1 adenocarcinoma, 1 anaplastic carcinoma, and 1 adenoid cystic carcinoma. In seven cases, the patients underwent the operation for residual or recurrent tumors after CCRT or RADPLAT. Endoscopic endonasal surgery was performed in 7 patients as the primary treatment. Three patients underwent endoscopic endonasal skull base surgery with no severe complications. One patient experienced local recurrence and underwent reoperation of endoscopic endonasal surgery without recurrence to date.
We show that the short-term treatment outcome of endoscopic endonasal surgery for sinonasal malignancy is comparable to that of open rhinosurgery such as lateral rhinotomy. No serious intra or postoperative complication was observed, and the duration of hospitalization was shortened compared to that of open rhinosurgery. We conclude that endoscopic endonasal surgery is an effective salvage surgery for the residual disease of high-grade sinonasal malignancy after CCRT or RADPLAT, and that it is also an effective initial treatment with rigorous indication.
