Our experience with topical 5 fluoro uracil in sinonasal neoplasia
Keywords:Fluorouracil, Paranasal sinus, Adenocarcinoma, Inverted papilloma, Squamous cell carcinoma
Sino-nasal neoplasms account for 3% of all head and neck cancers. Adenocarcinoma of the paranasal sinuses accounts for 9% of all sino-nasal malignancies and is the most common malignancy of the ethmoid sinus. Other neoplasms which involve the ethmoidal sinuses include inverted papilloma and squamous cell carcinoma. Traditionally, the treatment of choice for an adenocarcinoma of the ethmoidal sinuses involved craniofacial resection. This procedure is related with high rates of mortality and morbidity. Knegt et al reported greater success, both in terms of clinical outcome and survival data, with a less aggressive surgical approach coupled with repeated topical 5 fluorouracil (5FU) applications as a chemotherapeutic agent. Over the last 10 years we have treated selected cases of sinonasal neoplasia with a protocol similar to Knegt. Two (adenocarcinoma and inverted papilloma) of our four cases remain well and are on follow-up. The other two (undifferentiated carcinoma) were lost to follow-up. The rarity of sino-nasal neoplasms make them an unlikely subject for a randomised control trial. With that in mind surgical debridement and topical 5 fluorouracil seems to offer an acceptable treatment for adenocarcinoma of the sinonasal tract in properly selected cases. It may also have a role in Squamous cell carcinoma of ethmoidal or maxillary sinus and in preventing recurrence of inverted papilloma.
Choussy O, Ferron Ch, Ve´drine PO. Adenocarcinoma of ethmoid: a GETTEC retrospective multicenter study of 418 cases.Laryngoscope. 2008;118:437-43.
Smith R., Kloop C. & Williams J. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer. 1954;7:991-4.
Howard D, Lund V, Wei W. Craniofacial resection for tumours of the nasal cavity and paranasal sinuses: a 25-year experience. Head Neck. 2006;28:867-73.
Knegt P, de Jong P, van Andel J. Carcinoma of the paranasal sinuses: results of a prospective pilot study. Cancer. 1985;56:57-62.
Knegt P, Ah-See K, vd Velden L. Adenocarcinoma of the ethmoid sinus complex: surgical debulking and topica fluorouracil may be the optimal treatment. Arch. Otolarynygol. Head Neck Surg. 2001;127:141-6.
Adriaensen GF, Lim KH, Georgalas C, Reinartz SM, Fokkens WJ. Challenges in the management of inverted papilloma: a review of 72 revision cases. The Laryngoscope. 2016;126(2):322-8.
Lund VJ, Howard DJ, Wei WI, Cheesman AD. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses—a 17‐year experience. Head & Neck: J Sci Specialties Head Neck. 1998;20(2):97-105.
Boyle JO, Shah KC, Shah JP. Craniofacial resection for malignant neoplasms of the skull base: an overview. Journal of surgical oncology. 1998;69(4):275-84.
Almeyda R, Capper J. Is surgical debridement and topical 5 fluorouracil the optimum treatment for woodworkers' adenocarcinoma of the ethmoid sinuses? A case-controlled study of a 20-year experience. Clinical otolaryngology. 2008;33(5):435-41.
Singh N, Wong E, Huang J. Trans-Frontal Five-Fluorouracil (TraFFF): a novel technique for the application of adjuvant topical chemotherapeutic agents in sinonasal adenocarcinoma. BMJ Case Rep. 2018;2018:bcr2018226234.