Introduction

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.

Methods

A narrative review of most updated literature on SNACs has been conducted.

Results

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.

Conclusions

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.

中文翻译：

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前颅底扩展的鼻窦腺癌的治疗。

介绍

鼻窦腺癌 (SNAC) 是罕见且异质的。SNAC 的管理遵循相当标准化和国际公认的范式。在过去的十年中已经引入了一些改进。

方法

对 SNAC 的最新文献进行了叙述性审查。

结果

SNACs分为肠型和非肠型，根据等级进一步分类。术前检查应包括磁共振成像（或作为次要或补充选择的对比增强计算机断层扫描）和全身麻醉下的活检，或在有木材和/或皮革粉尘接触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特定病例。手术是最常见的前期治疗方式，通常通过经鼻内窥镜方法完成。辅助放疗适用于高级别、局部晚期肿瘤和/或切缘受累的情况。顺铂新辅助化疗，5-氟尿嘧啶和亚叶酸在受肠型腺癌影响的亚组患者中可能提供高反应率和长期控制，特别是那些肿瘤具有功能性 p53 蛋白的患者。SNAC 的大部分生物和免疫治疗潜力仍停留在理论阶段，目前尚无临床数据。

结论

SNAC 的管理包括组织学诊断、放射学分期、根治性手术和辅助放射治疗。新辅助化疗可用于特定病例。生物疗法和免疫疗法的作用仍有待阐明。