Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.
J Neurooncol. 2020 Dec;150(3):405-417. doi: 10.1007/s11060-019-03385-8. Epub 2020 Jan 3.
Sinonasal adenocarcinomas (SNAC) are rare and heterogeneous. Management of SNAC follows a rather standardized and internationally accepted paradigm. Several refinements have been introduced during the last decade.
A narrative review of most updated literature on SNACs has been conducted.
SNACs are classified as intestinal-type and non-intestinal-type, which are further categorized according to grade. Preoperative work-up should include magnetic resonance imaging (or contrast-enhanced computed tomography as a secondary or complementary choice) and biopsy under general anesthesia, or under local anesthesia in case of a history of exposure to wood and/or leather dust. Positron emission tomography, neck ultrasound, and fine-needle aspiration cytology are indicated in selected cases. Surgery represents the most common upfront modality of treatment and is usually accomplished via a transnasal endoscopic approach. Adjuvant radiation therapy is indicated for high-grade, locally advanced tumors and/or in case of margins involvement. Neoadjuvant chemotherapy with cisplatin, 5-fluorouracil and leucovorin may offer high response rates and long-term control in a subgroup of patients affected by intestinal-type adenocarcinoma, and in particular in those whose tumors harbor a functional p53 protein. Most of the bio- and immune-therapeutic potentials on SNACs still remain theoretical, and no clinical data are currently available.
Management of SNAC consists of histological diagnosis, radiological staging, radical surgery, and adjuvant radiation therapy. Neoadjuvant chemotherapy can be indicated in selected cases. The role of biotherapy and immune therapy still needs to be elucidated.
鼻窦腺癌（SNAC）较为罕见且具有异质性。SNAC 的治疗遵循相当标准化和国际公认的模式。在过去十年中，已经引入了一些改进措施。
对 SNAC 的最新文献进行了叙述性综述。
SNAC 分为肠型和非肠型，根据分级进一步分类。术前检查应包括磁共振成像（或增强计算机断层扫描作为二级或补充选择）和全身麻醉下活检，或在有接触木材和/或皮革粉尘史的情况下在局部麻醉下进行活检。正电子发射断层扫描、颈部超声和细针抽吸细胞学检查适用于选定病例。手术是最常见的初始治疗方式，通常通过经鼻内镜进行。对于高级别、局部晚期肿瘤和/或边缘受累的患者，应进行辅助放疗。顺铂、5-氟尿嘧啶和亚叶酸钙的新辅助化疗可能在一组肠型腺癌患者中提供高缓解率和长期控制，特别是在那些肿瘤具有功能性 p53 蛋白的患者中。SNAC 的大多数生物和免疫治疗潜力仍然是理论上的，目前尚无临床数据。
SNAC 的治疗包括组织学诊断、影像学分期、根治性手术和辅助放疗。在选定病例中可以考虑新辅助化疗。生物治疗和免疫治疗的作用仍有待阐明。
