background and recommendations

Question 1

What is the primary therapy for NC/PNS cancers?

Answer 1

1. Endoscopic surgical resection

2. Neck dissection of any positive nodes

Question 2

When is PORT not necessary?

Answer 2

1. Low grade minor salivary cancers or inverted papillomas resected with negative margins

Question 3

Who needs elective nodal radiation?

Answer 3

1. T3-T4 tumors

2. All high grade salivary gland cancers, esthesineuroblastoma, SNUC

Question 4

What are the elective nodes that must be treated?

Answer 4

Unilateral
1. 5+ for any node positive neck

Bilateral
1. RS space, RP, IB, 2-4, 7

Question 5

Stage I

Answer 5

T1 N0

Question 6

Stage II

Answer 6

T2 N0

Question 7

Stage III

Answer 7

T3 N0 or T1-3 N1

Question 8

Stage IVA

Answer 8

T4a N0-2 or T1-3 N2

Question 9

Stage IVB

Answer 9

T4b or N3

Question 10

Stage IVC

Answer 10

M1

Question 11

T1 maxillary sinus

Answer 11

Confined to sinus, no bone erosion

Question 12

T2 maxillary sinus

Answer 12

bone erosion without involvement of the posterior wall or pterygoid plate

Question 13

T3 maxillary sinus

Answer 13

invasion of the posterior wall of maxillary sinus, pterygoid fossa, floor/wall of orbit, ethmoid sinus

Question 14

T4a maxillary sinus

Answer 14

invasion of the orbital structures, skin of cheek, pterygoid plate, infratemporal fossa, cribriform plate, sphenoid or frontal sinus

Question 15

T4b maxillary sinus

Answer 15

Invasion of orbital apex, nasopharynx, clivus, intracranial extension, CN involvement except V2

Question 16

What is Ohngren’s line?

Answer 16

A plane that extends from the medial canthus of the eye to the angle of the mandble

Question 17

Indications for elective nodal radiation for maxillary sinus tumors?

Answer 17

T3-4 disease

Question 18

What are the nodes at risk for nodal disease?

Answer 18

1. RP nodes (first echelon)
2. RS space
3. Level IB
4. Level II

Question 19

5 year LC for SNT tumors after surgery+RT?

Answer 19

50-60%

Question 20

What type of surgery is needed when the ethmoid sinuses are involved?

Answer 20

Craniofacial resection

Question 21

Indications for adjuvant RT for SNT?

Answer 21

Maxillary sinus T3-4
Ethmoid sinuses T1-4
Node positive disease
\+ Margins 
\+ PNI
\+ Adenoid cystic histology

Question 22

What 8 primary histologies can be found in the sinonasal cavities?

Answer 22

1. Squamous cell
2. Melanoma
3. Adenocarcinoma
4. Adenoid cystic
5. Esthesioneuroblastoma
6. Sarcoma (Rhabdo)
7. Lymphoma
8. Plasmacytoma
9. SNUC
10. Inverted Papilloma

Question 23

Work Up?

Answer 23

H&P
Endoscopy and biopsy 
CT scan of head and neck 
MRI of head and neck 
CT scan of chest