When do you consider upfront surgery for locally advanced (T4) sinonasal CA?
Would you proceed with induction chemotherapy (eg TPF or cis/gem) to downstage or neoadjuvant chemoRT? Would your approach be different if there is orbital apex or focal dural invasion?
Answer from: Radiation Oncologist at Community Practice
I usually favor upfront induction chemotherapy for the unresectable cases or if upfront surgery has the risk of unacceptable morbidity. We then evaluate the role of surgery based on histology. For most histologic sub-types of sino-nasal malignancy, we favor primary surgical resection (salivary gland...
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Answer from: Medical Oncologist at Community Practice
I guess this is SNUC in which case, surgical R0 resection results in best outcomes. If there is intracranial extension or surgery would involve morbid procedures such as orbital exenteration, I would favor neoadjuvant chemo. There is some data for TPF followed by chemoradiation. If there is a trial ...