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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(03): e101-e111
DOI: 10.1055/s-0044-1788310
Original Report

Sinonasal Malignancy Following Cranial Irradiation: A Scoping Review and Case Report of Sinonasal Teratocarcinosarcoma

Ben B. Levy 
1   Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Michael J. De Biasio
2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Nilo Alvarez Toledo
3   Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
,
Sunit Das
3   Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
,
Mandolin Bartling
1   Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Fahad Aldahari
1   Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
John R. de Almeida
1   Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
4   Department of Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Ontario, Canada
,
Ilan Weinreb
5   Department of Pathology, University Health Network, Toronto, Ontario, Canada
6   Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
,
Yvonne Chan
1   Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
7   Department of Otolaryngology–Head and Neck Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
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Abstract

Background Radiation therapy is a mainstay of treatment for brain tumors, but delayed complications include secondary malignancy which may occur months to years after treatment completion.

Methods We reviewed the medical records of a 41-year-old female treated with 60 Gy of radiation for a recurrent astrocytoma, who 6 years later developed a locally advanced sinonasal teratocarcinosarcoma. We searched MEDLINE, Embase, and Web of Science to conduct a scoping review of biopsy-proven sinonasal malignancy in patients who previously received cranial irradiation for a brain tumor.

Results To our knowledge, this is the first report of a patient to present with a sinonasal teratocarcinosarcoma after receiving irradiation for a brain tumor. Our scoping review of 1,907 studies produced 14 similar cases of secondary sinonasal malignancy. Median age of primary cancer diagnosis was 39.5 years old (standard deviation [SD]: 21.9), and median radiation dose was 54 Gy (SD: 20.3). Median latency time between the primary cancer and secondary sinonasal cancer was 9.5 years (SD: 5.8). Olfactory neuroblastoma was the most common sinonasal cancer (n = 4). Fifty percent of patients died from their sinonasal cancer within 1.5 years.

Conclusion Patients who receive radiation exposure to the sinonasal region for treatment of a primary brain tumor, including low doses or scatter radiation, may be at risk of a secondary sinonasal malignancy later in life. Physicians who monitor at-risk patients must be vigilant of symptoms which may suggest sinonasal malignancy, and surveillance should include radiographic review with careful monitoring for a secondary malignancy throughout the entire irradiated field.

Keywords

sinonasal malignancy - cranial irradiation - radiation-induced malignancy - sinonasal teratocarcinosarcoma - radiation therapy - secondary malignancy - scoping review - case report

Supplementary Material



Publication History

Received: 01 March 2024

Accepted: 17 June 2024

Article published online:
05 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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