title: The role of systemic therapy in the management of sinonasal cancer: A critical review.
abstract: OBJECTIVE
  Due to the rarity and the variety of histological types of sinonasal cancers, there is a paucity of data regarding strategy for their optimal treatment. Generally, outcomes of advanced and higher grade tumors remain unsatisfactory, despite the employment of sophisticated surgical approaches, technical advances in radiation techniques and the use of heavy ion particles. In this context, we critically evaluated the role of systemic therapy as part of a multidisciplinary approach to locally advanced disease.
  
  
  RESULTS
  Induction chemotherapy has shown encouraging activity and could have a role in the multimodal treatment of patients with advanced sinonasal tumors. For epithelial tumors, the most frequently employed chemotherapy is cisplatin, in combination with either 5-fluorouracil, taxane, ifosfamide, or vincristine. Only limited experiences with concurrent chemoradiation exist with sinonasal cancer. The role of systemic treatment for each histological type (intestinal-type adenocarcinoma, sinonasal undifferentiated carcinoma, sinonasal neuroendocrine carcinoma, olfactory neuroblastoma, sinonasal primary mucosal melanoma, sarcoma) is discussed.
  
  
  CONCLUSIONS
  The treatment of SNC requires a multimodal approach. Employment of systemic therapy for locally advanced disease could result in better outcomes, and optimize the therapeutic armamentarium. Further studies are needed to precisely define the role of systemic therapy and identify the optimal sequencing for its administration in relation to local therapies.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: paolo.bossi@istitutotumori.mi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.affiliation: The Winship Cancer Institute of Emory University, Atlanta, GA, USA.
authors.forename: Nabil F
authors.initials: NF
authors.lastname: Saba
authors.affiliation: Antwerp University Hospital, Edegem, Belgium.
authors.forename: Jan B
authors.initials: JB
authors.lastname: Vermorken
authors.affiliation: Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Primoz
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pala
authors.affiliation: UMC Utrecht Cancer Center, Utrecht, The Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Rodrigo
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lopez
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Missak
authors.initials: M
authors.lastname: Haigentz
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Piet J
authors.initials: PJ
authors.lastname: Slootweg
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: International Head and Neck Scientific Group, Italy.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy*; D018278:Carcinoma, Neuroendocrine / Q000188:drug therapy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy; D018304:Esthesioneuroblastoma, Olfactory / Q000188:drug therapy*; D006258:Head and Neck Neoplasms / Q000188:drug therapy; D006801:Humans; D060828:Induction Chemotherapy; D008545:Melanoma / Q000188:drug therapy*; D009669:Nose Neoplasms / Q000188:drug therapy*; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy*; D012509:Sarcoma / Q000188:drug therapy*; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Chemotherapy; Multimodality treatment; Sinonasal cancer; Targeted therapy