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J Neurol Surg B Skull Base 2012; 73 - A233
DOI: 10.1055/s-0032-1312281

Sinonasal Adenocarcinoma: A Single Surgeon's Experience

Sachin Gupta 1(presenter), Homere Al Moutran 1, Priyam Vyas 1, David Hiltzik 1, Peter Costantino 1
  • 1New York, USA

Background: Malignant sinonasal neoplasms are rare, and most tumors are diagnosed at an advanced stage. Treatment is primarily surgical, whether through an anterior craniofacial resection or a minimally invasive endoscopic approach. Given the rarity of sinonasal adenocarcinoma, there are no established management guidelines. The aim of this study was to review a surgeon's experience with sinonasal adenocarcinoma.

Methods: A retrospective chart review of patients with head and neck adenocarcinoma from 1/1/03–8/1/2011 was performed. Nine patients with sinonasal adenocarcinoma who underwent primary surgery through an anterior craniofacial resection or transnasal endoscopic resection were included in the study. Data regarding recurrence, salvage surgery, adjuvant therapy, and current evidence of disease were reviewed.

Results: Of the nine patients with sinonasal adenocarcinoma, six (67%) underwent anterior craniofacial resection and three (33%) underwent transnasal endoscopic resection. All patients underwent adjuvant therapy, with four (44%) undergoing only radiotherapy, and five (56%) undergoing both radiotherapy and chemotherapy. Recurrence was found in four patients (44%). There was no statistically significant correlation between the extent of primary surgery and rate of recurrence. All patients were followed up with alternating PET scans and MRIs every 3 months for the first 2 years. All four patients with recurrent disease were diagnosed early, underwent salvage surgery, and are clinically free of disease at a mean follow-up time of 22.5 months (range, 3–40 months).

Discussion: Sinonasal adenocarcinoma is a rare tumor and there are no established management guidelines. Depending on the extent of disease, surgical therapy can be effectively performed through either an anterior craniofacial approach or endoscopic approach. The high rate of recurrence, which is found in the literature, highlights the tumor's aggressive behavior and the need for careful surveillance.