Search Results (81)

Background: Sinonasal neuroendocrine carcinoma (SNEC) is an extremely rare malignancy, and, to date, no clinical reports have detailed the use of proton beam therapy (PBT) for this disease. The present study describes the clinical courses of patients with SNEC treated with PBT and highlights the advantages of PBT. Methods: In this retrospective study, we included patients with pathologically confirmed SNEC without distant metastasis who underwent PBT at our institution between 2006 and 2021. To evaluate the dosimetric advantages of PBT, comparative treatment plans using VMAT were created. Result: Six patients with pathologically diagnosed SNEC without distant metastasis were treated with PBT. Multimodal treatment was applied in five patients, including chemotherapy in four cases and surgery in two cases. The median follow-up period was 37.4 months (range: 6.9 to 108.9 months). At the end of the follow-up, three patients were alive without recurrence, while three had died due to the disease. Recurrence occurred in three cases: one local recurrence, one in cervical lymph nodes, and two distant metastases. A late adverse event of Grade 4 vision decrease was observed in one patient on the ipsilateral side. Compared with VMAT, PBT lowered the average brain dose (median 3.3 Gy (RBE) vs. 12.6 Gy), brainstem D2 cc (10.7 Gy (RBE) vs. 34.9 Gy) and contralateral optic nerve D0.1 cc (47.6 Gy (RBE) vs. 63.3 Gy), while doses to the ipsilateral optic pathway were comparable. Conclusions: PBT in multimodal treatment achieved feasible local control for SNEC. The dose-sparing effect of PBT was more evident in organs distant from the target, although careful consideration is required for adjacent structures. Full article

Background: Rehabilitation of head and neck cancer patients with acquired intraoral defects is challenging and requires multidisciplinary collaboration. This case report describes an integrated surgical and prosthetic approach in which palatal obturator rehabilitation is used to restore palatal integrity, speech, swallowing, aesthetics, and overall quality of life after maxillectomy. The objective is to show how careful surgical planning to optimize prosthetic prognosis, combined with a precisely designed obturator prosthesis, can achieve satisfactory functional rehabilitation. Methods: A man in his 50s with sinonasal carcinoma underwent partial left maxillectomy followed by radiotherapy and chemotherapy. The defect was classified as Aramany class I and Brown class 2b, and the surgical resection was planned to preserve structures favorable to prosthetic support. Prosthetic management included fabrication of a removable partial denture incorporating a hollow-bulb obturator. Results: During trial and delivery, the patient demonstrated improved speech and swallowing, enhanced denture stability, and favorable aesthetics. The patient reported satisfaction with functional and cosmetic outcomes and was provided with instructions for use and cleaning, with a plan for regular follow-up. Conclusions: Palatal obturator prostheses remain a gold standard for unilateral maxillectomy rehabilitation when adequate retention is achievable. Surgical-prosthetic collaboration permits restoring palatal contours, and dentition can normalize speech and swallowing, and substantially improve the quality of life. Full article

Background/Objectives: Sinonasal intestinal-type adenocarcinoma (ITAC) is a rare and aggressive tumor with a lack of specific symptoms, which leads to late diagnosis, and is characterized by frequent local recurrence and low survival rate. The stemness phenotype is one of the main causes leading to tumor proliferation, recurrence, and resistance to standard chemo/radiotherapy. Methods: In this study, genes encoding pluripotency-associated transcription factors, including KLF4, c-MYC, SOX2, OCT4 (Yamanaka factors), and NANOG were evaluated in malignant and non-malignant tissues of a cohort of 54 patients with ITAC, and their expression was related to patient outcome. The c-MYC, SOX2, and OCT4 levels were then confirmed in immunohistochemistry by adding ALDH1A1 as a factor involved in stemness. Results: KLF4, SOX2, and NANOG best distinguished cancer tissue from normal tissue with high sensibility and specificity. Low levels of KLF4, c-MYC, and NANOG and high expressions of SOX2 and OCT4 in tumor tissue correlated with poor overall survival (OS) and disease-free survival (DFS), respectively. Through multivariate analysis, type of surgery was found to be a significant prognostic factor along with c-MYC and OCT4. Notably, tumor positivity for c-MYC and ALDH1A1 was associated with longer disease-specific survival, thus suggesting their role as tumor suppressors. Conclusions: Our findings underline the stemness phenotype as a prognostic model for ITAC, supporting the clinical plausibility of Yamanaka factors in sinonasal cancer prediction. Full article

Background/Objectives: Malignant tumors of the sinonasal tract are rare, accounting for approximately 3–5% of all head and neck tumors. Despite recent advances in therapy, overall survival in sinonasal cancer remains limited, with local recurrence representing the leading cause of treatment failure. Consequently, the preoperative identification of patients at higher risk of recurrence or developing more aggressive tumors is of critical importance to guide treatment strategies and improve outcomes. The aim of this review is to analyze the results of the most recent literature studying the use of radiomics in malignant sinonasal tumors. Methods: A comprehensive literature review was conducted using the PubMed/MEDLINE, EMBASE and Cochrane Library databases, in accordance with the PRISMA review criteria (from 2020 to July 2025). Results: The final analysis comprised a total of five articles and 629 patients. At present, radiomics in sinonasal cancer is mainly applied to the prediction of Ki-67 expression, the early assessment of recurrence risk, and the evaluation of response to induction chemotherapy. Conclusions: The results of this review indicate that radiomics has the potential to play an important role in the management of sinonasal malignant tumors. However, further research is necessary to confirm these findings. Full article

Background/Objectives: Human papillomavirus (HPV) infection is a well-established risk factor for oropharyngeal squamous cell carcinoma (OPSCC), where p16 immunohistochemistry serves as a surrogate marker. However, the role of HPV in sinonasal squamous cell carcinoma (SNSCC) remains less defined, and the reliability of p16 as a standalone surrogate is under debate. This study aimed to assess the concordance between p16 expression and HPV-DNA status in SNSCC and characterize clinicopathologic features in HPV-associated cases. Methods: We retrospectively analyzed 111 SNSCC cases diagnosed between 2008 and 2024 at two German centers. p16 status was determined by immunohistochemistry using site-specific antibody protocols. HPV-DNA testing and genotyping were performed via PCR and reverse hybridization. Clinical and histopathological data were collected and compared between HPV-positive and -negative tumors. Results: HPV-DNA was detected in 31/111 cases (27.9%), with HPV16 and HPV33 (Site A) and HPV 16 and HPV18 (Site B) being the most frequent subtypes. Discordance between p16 and HPV-DNA status was observed in 29.7% of cases, with site-specific discordance rates of 44.6% and 14.5%. Patients with HPV-positive tumors were younger than their HPV-negative counterparts. Conclusions: Our findings underscore the limitations of p16 as a single surrogate marker for detecting HPV-associated sinonasal cancer. Future research on the role of HPV in sinonasal cancer should integrate complementary testing methods (like p16Ink4A immunohistochemistry and HPV DNA/mRNA analysis) and aim for test standardization. Full article

Objective: Sinonasal squamous cell carcinoma (SNSCC) is a rare and aggressive malignancy, with limited treatment strategies in the recurrent or metastatic cases. Although immune checkpoint inhibitors (ICIs) have shown efficacy in head and neck cancers (HNCs), clinical data specific to SNSCC are scarce. This study aimed to evaluate the therapeutic efficacy and prognosis of ICIs in patients with SNSCC. Methods: We conducted a retrospective review of 18 patients with pathologically confirmed SNSCC treated with nivolumab or pembrolizumab at Gifu University Hospital between May 2017 and December 2024. Treatment response was assessed using RECIST v1.1 criteria. Overall response rate (ORR) and disease control rate (DCR) were evaluated as treatment effects, and overall survival (OS) and progression-free survival (PFS) were evaluated as prognoses. Subgroup analyses were performed according to treatment regimen. Results: The ORR and DCR for all patients were 43.8% and 56.3%, respectively. Pembrolizumab-treated patients showed higher response rates (ORR: 66.7%; DCR: 83.3%) compared to those treated with nivolumab (ORR: 30%; DCR: 40%). Median OS and PFS were 21.5 and 7.9 months, respectively. Long-term durable responses exceeding two years were observed in several cases. Although pembrolizumab tended to result in better outcomes, no statistically significant difference was found between groups. Immune-related adverse events were infrequent and manageable. Conclusions: This study suggests that a subset of patients with SNSCC may benefit from ICI therapy, particularly in combination with chemotherapy. Despite the rarity of SNSCC, accumulating clinical evidence—including prospective studies—is essential to establish standardized treatment strategies for this disease. Full article

Background/Objectives: Inverted sinonasal papilloma (IP) is a benign epithelial proliferation that can recur and undergo malignant transformation. We performed a systematic review and meta-analysis to answer the following question: what are the risk factors for malignant transformation in IP? Methods: A search was performed in PubMed and Embase databases. Numbers of affected individuals in exposed versus non-exposed individuals, or odds ratio values, were compared for each specific risk factor examined. The Newcastle–Ottawa Scale (NOS) was used to assess the risk of bias. To assess the overall quality of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were conducted using the fixed-effects and the random effects models. Heterogeneity of the results was assessed by I² statistic output. Meta-analyses and forest plots were obtained using Review Manager (RevMan) software version 5.4. Results: After examining 1875 results (942 from PubMed; 933 from Embase), 26 articles were selected. Among the 26 selected articles, the number of cases examined ranged from 14 to 162. All studies examined a population of 1271 IPs, with a carcinoma incidence of 230/1271 (18.1%). Three meta-analyses were performed for the following risk factors: smoking, alcohol, and HPV. Using the fixed-effects model, significant values were obtained for smoking (p = 0.002) and HPV (p < 0.001), with moderate and low quality of evidence, respectively. Alcohol did not reach statistical significance (p = 0.95). Conclusions: This study demonstrates that both smoking and HPV are risk factors for IP malignant transformation. Possible interventions include smoking cessation and HPV vaccination in individuals affected by IP. Full article

Sinonasal cancer treatment confers extensive and diverse sequela, which may persist for months to years after treatment or manifest as late effects. Furthermore, recurrences are common for some subtypes and may occur beyond five years post-treatment of the initial malignancy. Altogether, these can place a substantial physical, psychosocial, and economic burden on the survivor. Due to the rarity of these cancers, there are limited data to comprehensively elucidate the landscape of treatment-related morbidity in the long term. Furthermore, survivors may lack awareness of the entirety of possible adverse effects, which may exacerbate their long-term psychosocial well-being and quality of life, and delay attainment of appropriate care. To enable the development of patient education strategies and provide clinicians with up-to-date, evidence-based information on the long-term and/or late morbidity associated with sinonasal cancer treatment, a comprehensive review was performed. There is a wide range of issues that survivors face, both due to the sinonasal cancer itself and as a result of the treatment, highlighting the need for multidisciplinary survivorship care. Importantly, survivorship care will greatly benefit from patient and public involvement, alongside input from medical, surgical, and allied health professionals, to ensure that all aspects of care are addressed throughout the survivor journey. Full article

Head and neck cancer encompasses a diverse group of malignant neoplasms originating in regions such as the oral cavity, oropharynx, hypopharynx, larynx, sinonasal cavities, and salivary glands. HNC represents a significant public health challenge, and recent reports indicate an increment in the incidence of HNC in young adults. In 2020, approximately 377,700 new HNC cases and 177,800 HNC-related deaths were reported globally. Major risk factors include tobacco smoking, alcohol consumption, and human papillomavirus (HPV) infections. HNC impacts vital functions such as breathing, swallowing, and speech. Treatments for this type of cancer within this complex anatomy include surgery, radiotherapy, and chemotherapy combinations. Radiotherapy is often an essential component of both curative and palliative HNC treatment, balancing tumor control with the preservation of function and appearance. However, its use can damage adjacent normal tissues, causing acute or chronic toxicity. One complication of HNC irradiation is VF fibrosis, which leads to severe voice impairments, significantly affecting patients’ quality of life. Fibrosis involves excessive and aberrant deposition of extracellular matrix, driven by factors such as TGF-β1 and inflammatory cytokines, which ultimately impair the flexibility and function of VF. Current radiation-induced fibrosis treatments primarily focus on symptom management and include systemic therapies like corticosteroids, anti-inflammatory drugs, and antioxidants. However, these treatments have limited efficacy. Experimental approaches targeting molecular pathways involved in fibrosis are being explored. Given the limitations of these treatments, advancing research is crucial to develop more effective therapeutic strategies that can significantly improve the quality of life for HNC patients, especially those vulnerable to VF fibrosis. Full article

Background/Objectives: This study focuses on examining treatment outcomes of sinonasal squamous cell carcinoma (SNSCC) when induction chemotherapy is added to definitive treatment regimens. A systematic literature search was conducted in the following four bibliographic databases: Embase, MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL). A total of 604 patients across 12 studies were included in the final review. Methods: This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled survival curves were derived from reconstructed individual patient data using Guyot et al.’s methodology, in which K-M curve drops are measured relative to the numbers-at-risk and number of events. Results: In this study, 71% of patients were male and 93% presented with late-stage (T3–4) cancer. The 24-month and 60-month overall survival rates were 55.1% and 35.0%, respectively. The 24-month disease-free survival was 44.4% and remained relatively stable at 42.1% at 60 months. The local control rate remained stable from 24 to 60 months at 72.7%. Conclusions: Compared to the results from the existing literature, this review reveals an overall survival and disease-free survival (DFS) that is comparable to that of other multimodality treatment options. The local control rate (LCR) was also high. This review suggests that induction chemotherapy can be utilised for patients with advanced SNSCC. Full article

Background/Objectives: Chronic inflammation has been implicated in cancer development, but the association between allergic rhinitis (AR) and head and neck cancer (HNC) remains unclear. This study aims to investigate this potential relationship using a population-based dataset. Methods: Utilizing the Taiwan Longitudinal Health Insurance Database 2010, we conducted a case-control study encompassing 14,913 HNC patients and 59,652 propensity-score matched controls. Multivariate logistic regression analyses were performed to quantitatively evaluate the association between HNC and prior AR, adjusting for demographic factors and medical comorbidities such as hyperlipidemia, diabetes, hypertension, tobacco use disorder, HPV infection, and alcohol-related disorders. Results: This study identified that 20.19% of the entire cohort had a prior diagnosis of AR, with a significantly higher prevalence in HNC patients relative to controls (26.2% vs. 18.70%). The adjusted odds ratio (OR) for previous AR in HNC patients was 1.559 (95% CI = 1.494–1.627). Furthermore, site-specific analysis revealed increased odds ratios for AR among patients with cancers of the larynx (OR = 1.537, 95% CI = 1.307–1.807), hypopharynx (OR = 1.220, 95% CI = 1.035–1.437), nasopharynx (OR = 2.933, 95% CI = 2.722–3.160), sinonasal (OR = 3.100, 95% CI = 2.424–3.964), salivary glands (OR = 1.470, 95% CI = 1.158–1.865), and thyroid (OR = 1.566, 95% CI = 1.447–1.693). Conclusions: The findings robustly support a significant link between AR and an elevated risk of developing HNC, notably affecting the nasopharynx, sinonasal cavities, larynx, salivary glands, and thyroid. Full article

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB. Full article

Introduction: Meningeal metastasis (MM) from naso-ethmoidal malignancies (NEMs) is rare, its metastatic route is still debated, and its prognostic impact remains unclear. Our aim is to analyze a retrospective series of NEMs with non-contiguous MM to study the possible route of spread and the prognostic value of MM. Materials and methods: The institutional database of SNC treated at the University of Brescia between 1995 and 2021 was reviewed. Clinical–pathological data were collected, and survivals were estimated with Kaplan–Meier. Univariate and multivariate logistic regression analysis were run to identify predictors of MM. Results: Among 296 patients, 17 experienced non-contiguous MM, all located along the dura. Intestinal-type adenocarcinoma (10/17) and olfactory neuroblastoma (3/17) were the most frequent histologies. At univariate analysis, brain edema (p < 0.0001), resection (p = 0.026) or invasion (p = 0.006) of brain parenchyma, and local (p = 0.0004) and nodal (p = 0.021) recurrence were predictors of MM. At multivariate analysis, local recurrence was confirmed as an independent factor (odds ratio: 11.88, p = 0.0005). Dural surgical resection was not a risk factor. The five-year disease-specific survival was longer in patients with exclusive MM compared with patients with distant metastasis at other sites (64.3% vs. 30.1% p = 0.046). Conclusions: Dural venous shunt is the most likely pathway of spread of MM. Local recurrence is the only independent risk factor. Exclusive MM has a better prognosis than extrameningeal metastasis. Full article

Abstract: Background/Objectives: Sinonasal malignancies are rare and highly diverse cancers that pose significant diagnostic challenges due to their variable histological features and complex anatomical locations. Accurate diagnosis is critical for guiding treatment, yet conventional methods often require multiple biopsies. This study aimed to evaluate the potential of confocal laser endomicroscopy (CLE) for real-time imaging of sinonasal tumors to characterize specific features of different entities and improve diagnostic precision. Methods: Ten patients with various sinonasal malignancies, including squamous cell carcinoma, adenocarcinoma, sinonasal undifferentiated carcinoma, olfactory neuroblastoma, sinonasal mucosal melanoma, and endonasal lymphoma, were examined using CLE during diagnostic endoscopy. CLE images were compared descriptively with histopathological cross-sections to identify unique imaging patterns for each tumor type. Results: CLE was feasible across all cases, with high-quality images obtained despite anatomical challenges in some cases. Characteristic features, such as vascular clusters in undifferentiated carcinoma, mucin-filled bubbles in adenocarcinoma, and small round cells in neuroblastoma, were identified and corresponded well with histopathological findings. CLE also helped guide biopsies by revealing areas with diagnostic relevance. Conclusions: CLE demonstrates promise as an adjunct diagnostic tool in sinonasal malignancies, offering real-time imaging that correlates with histopathological findings and aids in targeted biopsies. While this study provides preliminary insights into the utility of CLE, further research with larger cohorts and statistical validation is necessary to establish its diagnostic reliability and broader clinical application. Full article

Objectives: Occupational respiratory diseases represent a major public health concern worldwide. This study analyses the hospitalization costs and characteristics of four major occupational respiratory diseases: malignant mesothelioma (MM), sinonasal cancer (SNC), pneumoconiosis (PN), and hypersensitivity pneumonitis (HP). The findings are situated within the context of Italy’s population trends and healthcare system, offering insights into the economic and clinical burden of these diseases. Study Design: This retrospective, population-based study examines Italian hospitalizations for MM, SNC, PN, and HP during the period 2010–2021. The primary outcomes were the number of hospitalizations, length of stay, and associated cost. Costs were derived from charges linked to diagnosis-related groups (version 24) and major diagnostic category coding systems. Results: Though the Italian population is rapidly aging, the annual number and rate of hospitalizations declined by 35% over the study period. SNC hospitalizations aligned with the overall trend, PN and MM experienced faster declines, whereas HP admissions remained steady. MM emerged as the most resource-intensive (EUR 25 million yearly, with 86% attributable to occupation), followed by PN (EUR 10 million, entirely occupational), SNC (EUR 5 million, with EUR 650,000 occupational), and HP (EUR 2 million, with EUR 370,000 occupational). All studied diseases had an average length of stay exceeding the national one. The SNC admissions were the shortest (6.5 days) and least expensive (EUR 3647). In contrast, MM, PN, and HP had a mean length of stay exceeding 10 days, with admission costs averaging EUR 4700 for MM and EUR 4000 for PN and HP. The median age was the highest for PN (78 years) and MM (71 years), while SNC and HP patients had a median age of approximately 65 years. Conclusions: Consistent with their anticipated benefits, Italian workplace health regulations over the last three decades, including the 1992 asbestos ban and D.lgs. 81/2008, are associated with significant reductions in the hospitalization burden and an increased median age at discharge for MM and PN. In contrast, fewer conclusions can be drawn for SNC and HP due to their lower occupational fractions (10–20%). This finding suggests adding an occupational exposure flag in hospital records for acknowledged occupational diseases to enhance surveillance. Finally, this study provides the first estimate of the occupational fraction of hospitalization costs for the studied diseases in Italy. Full article