Nose and sinuses

Sinonasal cancers are a group of rare and heterogeneous malignant neoplasms. The sinonasal tract harbours the widest variety in terms of malignant histotypes, each being associated with an incidence that confers the definition of rare cancer.1 Moreover, sinonasal cancers invariably arise in the central portion of the splanchnocranium, thus acquiring critical topographical relationships with vital organs and anatomical areas such as the orbital cavity, central nervous system (CNS), face and oral cavity. Symptoms and signs elicited by these cancers in the early stage are usually non-specific and not sufficiently severe to induce referral to a physician. Indeed, initial misdiagnosis as rhinitis, chronic rhinosinusitis or dental disorders are particularly frequent in the history of patients affected by sinonasal cancer. The characteristics of nasal and paranasal tumours mandate centralising patients in referral centres, where adequate multi-disciplinary expertise can be gathered and maintained. As an additional element of challenge, the evidence does not clearly support one treatment strategy over another in most cases. This fact causes inconsistent strategies among centres and hinders appropriate development of evidence-based recommendation. Treatment of sinonasal cancer has remarkably evolved over the last decades, with main advances related to technical and technological refinement of local treatments, enhanced integration of treatment modalities, and increased biological understanding of certain tumours.2, 3 However, outcomes of treatment have plateaued, with 5-year overall survival settling around 50% when considering the most represented group of sinonasal carcinomas.2.