A Comprehensive Treatment Method for Nose Cancer

Based on an article titled “Multimodal Treatment With Orbital Organ Preservation in Adult Patients With Locally Advanced Small-Round-Cell Malignancy of the Nasal Cavity and Paranasal Sinus”

Originally written by: Chen et al., 2021 https://www.frontiersin.org/articles/10.3389/fonc.2021.650385/full 

Nose Cancer

Nasal and sinus cancer, in general terms known as nose cancer, is a rare type of cancer that affects the nasal cavity, which is the area behind the nose and the sinuses. Nose cancer is different from nasopharyngeal cancer – which affects the site that connects the nose and the throat.¹ In the UK, nose cancer is rare, and only 460 cases of diagnosis occur each year. Several factors tend to increase the likelihood of nose cancer. These include:

• Smoking
• Sex – those assigned male at birth are more prone to nose cancer than those assigned female at birth
• Being exposed to various substances such as wood dust and metal dust
• Human papillomavirus – a group of viruses that affect moist membranes such as the mouth and throat^1,2

Due to the low incidence of nose cancer and the few clinical cases available, diagnosis and providing the best treatment option can be challenging for clinicians. At the patient's first doctor visit, it occurs that cancer would have spread to the muscles surrounding the eyes and specific structures of the brain. Nose cancer spread to the eyes can cause eye movement disorder, vision loss and potentially blindness. In this case, surgery is the preferred choice.³ However, complete removal of the tumour is difficult as the nasal cavity structure is complex. In addition, there are multiple tissues and organs that are found in this area that could be affected.⁴

Furthermore, for nose cancer that has invaded the eyes, removal of the eyeballs is required to achieve complete removal of tumorous tissue; this can have a severe impact on a patient’s life. Preservation of full eye function without affecting the overall survival is a severe clinical issue that requires resolution. Retrospective studies have shown that individuals that received a more comprehensive treatment had a better prognosis in comparison to those that received a single modality treatment.⁵

Design of The Study

The study conducted by Chen et al. focused on combining chemotherapy and helical tomotherapy (a type of radiotherapy) as a comprehensive treatment for patients with nose cancer that has invaded the eyes and brain to avoid potential destructive surgery. A total of 49 patients with nose cancer received complete therapy from December 2009 to January 2019. All patients involved in the study wanted their eyes to be preserved and refused surgery.⁶

Study Results

Overall, by providing patients with this comprehensive treatment method, the study found that there was an improvement in survival rate and a reduced recurrence rate. In addition, they also observed that the tumours had shrunk significantly after induction of chemotherapy. The combination strategy further reduced radiotherapy-induced damage to the eyeballs and provided protection for the eyes. In regards to intracranial tumour invasion from nose cancer, the results showed that chemotherapy was able to shrink the intracranial tumour, which caused it to recede from brain tissue. During the study, 8.2% of patients had obtained complete recovery, while 85.7% of patients obtained a partial response to the treatment.⁶ They obtained a partial response and then underwent further comprehensive treatment by combining chemotherapy and radiotherapy. 

Every group of patients that did not obtain tumour reduction or tumour detachment from the tissues of the eyes had to undergo further comprehensive treatment to achieve a complete response. The patients were then examined one month after completion of treatment; it was found that the large tumours from nose cancer of all 49 patients had a complete response. This, therefore, indicated a response rate from treatment to be at 100%.⁶

Adverse Effects from The Study

List of vision-related and non-vision-related side effects of comprehensive treatment for nose cancer.

Vision Related:

• Non-serious: Xeroma (32.6%)
• Conjunctivitis (14.3%)

Non-vision Related:

• Oropharyngeal mucositis induced by radiation (89.8%)
• Radiation dermatitis (77.6%)
• Nasal obstruction (67.4%)
• Weight loss (63.3%)

Conclusion

In conclusion, the comprehensive treatment therapy for nose cancer has proven to be effective, as observed from the results. Despite the few side effects from radiotherapy, it has proven to protect eye function and has further improved the quality of life. This, therefore, provides a new treatment route for nose cancer patients.

References

1. Nasal and sinus cancer [Internet]. NHS UK. 2021 [cited 1 May 2022]. Available from: https://www.nhs.uk/conditions/nasal-and-sinus-cancer/
2. Nasal (nose) and sinus cancer: University College London Hospitals NHS Foundation Trust [Internet]. UCLH NHS UK. 2022 [cited 1 May 2022]. Available from: https://www.uclh.nhs.uk/our-services/find-service/cancer-services/head-and-neck-cancer/types-head-and-neck-cancer/nasal-nose-and-sinus-cancer
3. Mendenhall WM, Mendenhall CM, Werning JW, Riggs CE, Mendenhall NP. Adult head and neck soft tissue sarcomas. Head Neck. 2005;27:916–22.
4. de Bree R, van der Waal I, de Bree E, Leemans CR. Management of adult soft tissue sarcomas of the head and neck. Oral Oncol. 2010;46:786–90. 
5. Gore MR. Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature. BMC Ear Nose Throat Disord. 2018;18:4.
6. Chen N, Yuan H, Fan W, Ma L, Liu K, Chen L et al. Multimodal Treatment With Orbital Organ Preservation in Adult Patients With Locally Advanced Small-Round-Cell Malignancy of the Nasal Cavity and Paranasal Sinus. Frontiers in Oncology. 2021;11.