Surgical management of advanced sinonasal cancer - a 10-year mono-institutional experience

Sep 21, 2026

Endoscopic endonasal surgery is effective for sinonasal cancers, yet treatment choice remains debated for well-differentiated locally advanced neoplasms and recurrences. This retrospective mono-institutional study analyzes 90 patients treated between 2010 and 2020 using transcranial and/or transfacial resection. Outcomes include overall survival, disease-specific survival, disease-free survival, and recurrence-free survival. Prognosis correlates with pT-classification, histotype, and dural involvement, with independent factors including orbital apex infiltration, age, and adjuvant therapy.

LanguageEnglish

CategoryResearch & Report

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Pages10

Reading Time25 min

AccessFree to download

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ACTA OTORHINOLARYNGOLOGICA ITALICA 2024;44:128-137; doi: 10. 14639/0392-100X-N2375 Skull Base Surgery Surgical management of advanced sinonasal cancer: a 10-year mono-institutional experience Giorgio Sileo1 , Alberto Daniele Arosio1 , Alessia Lambertoni1 , Paolo Battaglia1,2 , Maurizio Bignami2,3 , Mario Cherubino4 , Luigi Valdatta4 , Paolo Antognoni5 , Davide Locatelli6 , Paolo Castelnuovo1,2 , Mario Turri-Zanoni1,2 1 Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASSTSette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy; 2 Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; 3 Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASSTLariana, Ospedale Sant’Anna, Como, Italy; 4 Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, ASSTSette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy; 5 Division of Radiation Oncology, ASSTSette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy; 6 Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASSTSette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy SUMMARY Objective. Endoscopic endonasal surgery is effective in the treatment of sinonasal cancers. However, in cases of well-differentiated locally advanced neoplasms as well as recurrences, the most appropriate treatment is debated. The purpose of this study is to report a monoinstitutional experience on craniofacial surgery performed in a tertiary-care referral centre. Methods. This was a retrospective analysis of 90 patients treated with transcranial and/ or transfacial resection for sinonasal cancer between 2010 and 2020. Outcome measures included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and recurrence-free survival (RFS) . Results. The 5-year OS, DSS and DFS were 48.2%, 60.6% and 28.7%, respectively. Factors correlated with prognosis were pT-classification (p = 0.002), histotype (p = 0.012) and dural involvement (p = 0.004). Independent prognostic factors were orbital apex infiltration (p = 0.03), age (p = 0.002) and adjuvant therapy (p = 0.03) . Conclusions. When endoscopic endonasal surgery is contraindicated and chemoradiotherapy is not appropriate, craniofacial and transfacial approaches still represent an option to consider, despite the non-negligible morbidity. KEY WORDS: craniofacial surgery, paranasal sinus, cancer, skull base, treatment outcome Introduction It is commonly accepted that a combination of surgery and radiotherapy is the mainstay in the management of well-differentiated sinonasal cancer 1-3. Traditionally, because of the complexity of the sinonasal anatomy and close proximity with orbit and brain, craniofacial surgery has been regarded as the standard treatment to obtain ‘en-bloc’ resection 4,5 . Over the past two decades, with advancesin endoscopic endonasal surgical techniques and skull base reconstruction methods, minimally-invasive surgery has emerged as an alternative to an open surgical approach, with the advantages of lower post-operative morbidity and higher quality of life than open surgery 2,6,7 . On the other hand, the appropriateness of endoscopic endonasal surgery has been questioned especially when managing locally-advanced cases, thus opening a diatribe between supporters of the two techniques. What is universally accepted is that a free-margins resection should be obtained in patients considered suitable for surgery after a multidisciplinary consultation. The surgical technique used to reach such a primary goal should be based on the local extension of tumour and the patient’s general conditions. Received: November 14, 2022 Accepted: November 28, 2023 Corresponde

FAQs

What treatment approaches were evaluated in the study?

The study evaluated craniofacial surgery using transcranial and/or transfacial resection for sinonasal cancer, including experience relevant to endoscopic endonasal approaches.

How were patients selected for inclusion?

Patients with missing relevant data, unresectable cancer, distant metastases at presentation, or less than 12 months of follow-up were excluded.

Which factors were associated with prognosis?

Prognosis correlated with pT-classification, histotype, and dural involvement, while independent prognostic factors included orbital apex infiltration, age, and adjuvant therapy.

Sep 21, 2026

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