The challenge of clinical management of nasal sinus cancer is that because its early symptoms are easily ignored, it is sometimes treated as a nasal polyp and removed as a mass in ENT department, and when it is found to be a malignant tumor most of the patients have developed localized lesions to a more advanced stage. Squamous carcinoma is the most common pathological type of nasal septal sinus tumor. The nasal septal sinus is adjacent to the eye, skull base and brain, which often makes clinical radiotherapy and surgeons hesitant due to the involvement of tumors in these areas, resulting in tumors that are not easily controlled. Therefore, in order to better improve the survival rate and quality of life of patients, it is necessary to further explore the treatment effect and prognosis of nasal septal sinus squamous carcinoma, so that the treatment of nasal septal sinus squamous carcinoma can be standardized to achieve the maximum treatment of tumor.
1.Comprehensive treatment Comprehensive treatment is the main means to treat middle and late stage nasal septal sinus cancer. The survival rate of preoperative or postoperative radiotherapy increases more than 10% compared with radiotherapy alone, and the survival rate of preoperative or postoperative radiotherapy as two ways of comprehensive treatment is statistically significant compared with radiotherapy group. However, with the development of new technologies in radiotherapy, the survival rate of intensity-modulated radiotherapy has been greatly improved compared with that of conventional radiotherapy.
It can be said that early cases can achieve ideal treatment effect through surgery alone, and it can be said that early cases can obtain better cure rate through surgery alone. In cases with suspected residual after preoperative radiotherapy or surgery, the presence or absence of tumor residual on pathological examination after reoperation has a different prognosis, and cases without tumor residual can have a higher survival rate. Despite the negative pathology, some patients still recurred after surgery, which may be related to the degree of clarity of the primary site of the tumor site.
The relationship between stage, pathological differentiation and surgery and survival rate TNM stage is the key to determine the prognosis of treatment. Most of the patients with squamous carcinoma of nasal septum have reached stage III or IV when they are diagnosed, while early cases can achieve a high survival rate with surgery alone. The survival rate of patients with lymphatic metastasis is only 21.3%, while that of patients without lymphatic metastasis can reach 53.7%, which is also an important indicator of prognosis, and it has been reported that lymphatic metastasis is also an independent prognostic factor.
The degree of differentiation of squamous carcinoma also has some relationship with prognosis, the lower the degree of differentiation the higher the rate of distant metastasis, but there is no clear relationship between the degree of differentiation and survival rate, and the addition of chemotherapy is necessary for hypofractionated squamous carcinoma, which needs further confirmation.
Surgical procedures have some relationship with prognosis in the following aspects. The survival rate of patients with clean tumor resection can reach 70.0%, while the survival rate of those with residual tumor is poor or even very low, only 11.1%, as judged by clinicians in surgical operation. Patients with general resection of orbital contents or skull base tend to have late stage and lower survival rate, and the surgery is not easy to remove cleanly. In contrast, patients who do not require resection of the orbital contents or skull base have a higher survival rate. Good preoperative blood preparation, flap design, and good enhanced CT or MRI in some advanced tumors are crucial for the thoroughness of surgery. Because the nasal septal sinus site is limited and adjacent to maxillary sinus, eye, skull base and brain, especially the judgment of whether the tumor invades the cavernous sinus is important to cut the tumor cleanly. Nasal endoscopic surgery to remove nasal septal sinus tumor has become more common, and it is reported that nasal endoscopic surgery can achieve ideal resection effect, but postoperative radiotherapy is necessary.
3. Analysis of the causes of recurrence and death Through analysis, we know that the recurrence rate of tumor is not correlated with the treatment method, but closely related to the stage, the later the stage, the higher the recurrence rate, and most cases recurrence occurs within 3 years, so it must be closely reviewed within 3 years to detect local recurrence early for further treatment.
The main cause of death in nasal septal sinus squamous carcinoma is local recurrence, followed by distant metastasis, because the lymphatic metastasis rate in the neck is low, so neck metastasis is not the main cause of death. Short-term deaths are mostly caused by local recurrence, and deaths occurring in cases with longer survival are mostly related to distant metastasis and second primary cancer. The necessity of adjuvant chemotherapy for hypofractionated carcinoma in order to control distant metastasis has not been confirmed in the literature.
In addition to the combination of radiotherapy and surgery, the addition of high-dose arterial infusion chemotherapy with radiotherapy can also achieve better results, which needs to be further investigated.
In conclusion, at present, the choice of treatment modality for squamous carcinoma of the nasal sieve sinus is firstly radiation therapy plus surgery or a combination of surgery plus radiation therapy, and in the case where it is possible to preserve the orbital contents and skull base, radiation therapy plus surgery is chosen as much as possible in order to improve the survival rate while preserving the appearance and organs. Early stage tumors can be treated with a single treatment to achieve the desired outcome.