What’s New in Nasal Cavity and Paranasal Sinus Cancer Research?

Research on prevention of and better treatment for nasal cavity and paranasal sinus cancers is now being done at many medical centers, university hospitals, and other institutions across the nation.

Genetics

Little is known about the gene changes in nasal cavity and paranasal sinus cancer because this cancer is so rare. Still, scientists have found some changes in the genes of some head and neck cancer cells that may be related to the change of normal cells to cancer cells. But more research is needed to identify these changes clearly and link them to nasal cavity and paranasal sinus cancers.

Understanding these gene changes may help find better ways to diagnose these cancers. It may also lead to treatments that work better and have fewer side effects than those used today.

For example, a new type of cancer has been found in the nasal cavity and paranasal sinuses called NUT carcinoma (cancer). NUT stands for the NUTM1 gene that is abnormal and causes this type of cancer that mostly grows in the nasal cavity and paranasal sinuses. Studies are being done to see if certain targeted drugs might be used against this abnormal gene.

Treatment

Surgery

Surgeons are looking at new ways to remove these cancers while doing as little damage as possible to nearby normal tissues. Researchers are also looking for better ways to combine surgery with other cancer treatments to get better outcomes.

Studies are looking at ways to reconstruct, or rebuild the affected bony parts of the face, and how to best do it. Bone and tissue grafts, as well as man-made materials are being looked at.

Radiation therapy

Doctors are always looking for better ways to focus radiation on tumors more precisely to get more radiation to the tumor while limiting damage to nearby areas. This is especially important for head and neck tumors like nasal cavity and paranasal sinus cancers, where there are many important structures (like the eyes and brain), blood vessels, and nerves close to the tumor.

Intensity modulated radiation therapy or IMRT is the type of radiation most often used today to treat nasal cavity or paranasal sinus cancers. Research is showing that proton therapy (which uses proton beams instead of x-rays) could work as well as IMRT. Proton therapy could allow doctors to give higher doses of radiation to the cancer with less damage to the tissues the rays pass through. This might also cause fewer side effects, like mouth pain, eating problems, and weight loss. Proton therapy or IMRT can be used to treat these cancers, but more studies are needed with proton therapy to evaluate long-term side effects. Also, proton therapy is not available everywhere. 

Different radiation schedules are also being studied. For instance, instead of giving one large dose of radiation each day, the cancer might be better controlled with the same dose of radiation given 6 days a week instead of 5, over a shorter period of time. This is called accelerated fractionation and needs to be studied more.

Improvements in radiation have also led doctors to test giving radiation in the same area for cancers that come back after the initial course of treatment.

Chemotherapy

Doctors are looking at how chemotherapy can be used with other treatments to improve outcomes, especially for bigger cancers that may have already spread. Induction chemotherapy -- chemo given before surgery and/or radiation -- is of special interest because studies suggest that it may help save the eyeball in people with advanced disease. It's also been linked to longer survival. Studies are also looking at whether giving chemotherapy regularly after surgery (adjuvant chemotherapy) is helpful in keeping the cancer from coming back (recurring). 

More research is needed to know when to use chemotherapy and which chemo drug combinations are the best for these cancers.

Targeted drug therapy

Clinical trials are studying several targeted therapies that block the action of the substances (such as growth factors and growth factor receptors) that cause head and neck cancers to grow and spread. Cetuximab is already used in some cases. Many studies are testing combinations of targeted therapies plus chemo or radiation. As has been the case with many other kinds of cancer, targeted therapies may prove to be a great advancement in treating nasal cavity and paranasal sinus cancers.

Immunotherapy

Immunotherapy has been studied more in other types of head and neck cancer, such as laryngeal and hypopharyngeal cancers. There is not much information on their use for nasal cavity or paranasal sinus cancers since they are rare. More research is being done to better understand immunotherapy drugs in these specific cancers.

Because nasal cavity and paranasal sinus cancers are rare, nearly all clinical trials include patients with other types of head and neck cancer as well. Although these studies are not specific to nasal cavity and paranasal sinus cancers, doctors often apply the results when choosing treatment for patients with nasal cavity and paranasal sinus cancers. Contact the nearest cancer center to find out what clinical trials are being done in your community.