Skip to main content

Advertisement

SpringerLink
Log in

Management of squamous cell carcinomas of the skull-base

  • Topic Review
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this review is to assess the recent evidence regarding the management of squamous cell carcinoma of the skull-base and to discuss the implications of these findings on clinical practice.

Method

Free text Medline and MeSH term search of publications relating to Squamous Cell Carcinoma & Skull-base and Skull base, Neoplasm respectively. Multidisciplinary clinical guidelines were also reviewed.

Results

The primary search yielded a total of 271 papers which following initial review was reduced to 28. Secondary search yielded 56 papers. There were no randomised controlled trials relating to squamous cell carcinoma of the skull-base and as such this review is based on cohort studies, case series and expert opinion.

Conclusion

Squamous cell carcinoma (SCC) is the most common cancer occurring in the Head and Neck. Squamous cell carcinoma is also the most common cancer arising within the nose and sinuses of which skull-base squamous cell carcinoma is a rare subgroup.

Evidence relating to the management and survival of skull-base SCC is based on expert opinion and. retrospective analyses Clinical examination and biopsy, imaging and a broad multidisciplinary team are key to the management of skull-base SCC. The information gathered should be used to guide informed discussion by suitably trained experts with patients regarding surgical approach, post-operative recovery and adjuvant or neoadjuvant treatments. The standard of care is currently to perform skull base resection with or without additional craniotomy, pedicled or free flap reconstruction in multiple layers and post-operative radiation (usually photons or protons). Open approaches have traditionally been the mainstay, however in certain cases endoscopic approaches can yield equivalent results and offer many advantages. Despite advances in care survival remains poor with a nearly one in five risk of nodal recurrence within two years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lund VJ, Stammberger H, Nicolai P et al (2010) European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 22:1–143

    PubMed  Google Scholar 

  2. von Buchwald C, Bradley PJ (2007) Risks of malignancy in inverted papilloma of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 15(2):95–98. https://doi.org/10.1097/MOO.0b013e3280803d9b

    Article  Google Scholar 

  3. Tanvetyanon T, Qin D, Padhya T, Kapoor R, McCaffrey J, Trotti A (2009) Survival outcomes of squamous cell carcinoma arising from sinonasal inverted papilloma: report of 6 cases with systematic review and pooled analysis. Am J Otolaryngol 30(1):38–43. https://doi.org/10.1016/j.amjoto.2008.02.005

    Article  PubMed  Google Scholar 

  4. Bhattacharyya N (2002) Cancer of the nasal cavity: survival and factors influencing prognosis. Arch Otolaryngol Head Neck Surg 128(9):1079–1083. https://doi.org/10.1001/archotol.128.9.1079

    Article  PubMed  Google Scholar 

  5. Feiz-Erfan I, Suki D, Hanna E, DeMonte F (2007) Prognostic significance of transdural invasion of cranial base malignancies in patients undergoing craniofacial resection. Neurosurgery 61(6):1178–1185. https://doi.org/10.1227/01.neu.0000306095.53388.f1

    Article  PubMed  Google Scholar 

  6. Wang EW, Gardner PA, Zanation AM (2019) International consensus statement on endoscopic skull-base surgery: executive summary. Int Forum Allergy Rhinol 9(S3):S127–S144. https://doi.org/10.1002/alr.22327

    Article  PubMed  Google Scholar 

  7. Gardner PA, Kassam AB, Rothfus WE, Snyderman CH, Carrau RL (2008) Preoperative and intraoperative imaging for endoscopic endonasal approaches to the skull base. Otolaryngol Clin North Am 41(1):215–230. https://doi.org/10.1016/j.otc.2007.10.010

    Article  PubMed  Google Scholar 

  8. Paleri V, Urbano TG, Mehanna H et al (2016) Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130(S2):S161–S169. https://doi.org/10.1017/S002221511600058X

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ganly I, Patel SG, Singh B et al (2011) Craniofacial resection for malignant tumors involving the skull base in the elderly: an international collaborative study. Cancer 117(3):563–571. https://doi.org/10.1002/cncr.25390

    Article  PubMed  Google Scholar 

  10. Liu JK, Decker D, Schaefer SD et al (2003) Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. Neurosurgery 53(5):1126–1135. https://doi.org/10.1227/01.neu.0000088802.58956.5a

    Article  PubMed  Google Scholar 

  11. Carrau RL, Snyderman CH, Kassam AB, Jungreis CA (2001) Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Laryngoscope 111(3):483–487. https://doi.org/10.1097/00005537-200103000-00019

    Article  CAS  PubMed  Google Scholar 

  12. Wagenmann M, Schipper J (2011) The transnasal approach to the skull base From sinus surgery to skull base surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. https://doi.org/10.3205/cto000081

    Article  PubMed  Google Scholar 

  13. Rawal RB, Gore MR, Harvey RJ, Zanation AM (2012) Evidence-based practice: endoscopic skull base resection for malignancy. Otolaryngol Clin North Am 45(5):1127–1142. https://doi.org/10.1016/j.otc.2012.06.013

    Article  PubMed  Google Scholar 

  14. Wellman BJ, Traynelis VC, McCulloch TM, Funk GF, Menezes AH, Hoffman HT (1999) Midline anterior craniofacial approach for malignancy: results of en bloc versus piecemeal resections. Skull Base Surg 9(1):41–46. https://doi.org/10.1055/s-2008-1058171

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Poetker DM, Mendolia-Loffredo S, Smith TL (2007) Outcomes of endoscopic sinus surgery for chronic rhinosinusitis associated with sinonasal polyposis. Am J Rhinol 21(1):84–88. https://doi.org/10.2500/ajr.2007.21.2978

    Article  PubMed  Google Scholar 

  16. Lund V, Howard DJ, Wei WI (2007) Endoscopic resection of malignant tumors of the nose and sinuses. Am J Rhinol 21(1):89–94. https://doi.org/10.2500/ajr.2007.21.2957

    Article  PubMed  Google Scholar 

  17. Abdelmeguid AS, Raza SM, Su SY et al (2019) Endoscopic resection of sinonasal malignancies. Head Neck. https://doi.org/10.1002/hed.26047

    Article  PubMed  Google Scholar 

  18. Wood JW, Eloy JA, Vivero RJ et al (2012) Efficacy of transnasal endoscopic resection for malignant anterior skull-base tumors. Int Forum Allergy Rhinol 2(6):487–495. https://doi.org/10.1002/alr.21062

    Article  PubMed  Google Scholar 

  19. Abergel A, Cavel O, Margalit N, Fliss DM, Gil Z (2012) Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol Head Neck Surg 138(2):142–147. https://doi.org/10.1001/archoto.2011.1146

    Article  PubMed  Google Scholar 

  20. Castelnuovo P, Lepera D, Turri-Zanoni M et al (2013) Quality of life following endoscopic endonasal resection of anterior skull base cancers. J Neurosurg 119(6):1401–1409. https://doi.org/10.3171/2013.8.JNS13296

    Article  PubMed  Google Scholar 

  21. Larjani S, Monteiro E, Witterick I et al (2016) Preliminary cross-sectional reliability and validity of the Skull Base Inventory (SBI) quality of life questionnaire. J Otolaryngol Head Neck Surg 45(1):45. https://doi.org/10.1186/s40463-016-0158-y

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hanna E, DeMonte F, Ibrahim S, Roberts D, Levine N, Kupferman M (2009) Endoscopic resection of sinonasal cancers with and without craniotomy: oncologic results. Arch Otolaryngol Head Neck Surg 135(12):1219–1224. https://doi.org/10.1001/archoto.2009.173

    Article  PubMed  Google Scholar 

  23. Castelnuovo P, Battaglia P, Turri-Zanoni M et al (2014) Endoscopic endonasal surgery for malignancies of the anterior cranial base. World Neurosurg 82(6 Suppl):S22–31. https://doi.org/10.1016/j.wneu.2014.07.021

    Article  PubMed  Google Scholar 

  24. Nicolai P, Battaglia P, Bignami M et al (2008) Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 22(3):308–316. https://doi.org/10.2500/ajr.2008.22.3170

    Article  PubMed  Google Scholar 

  25. Su SY, Kupferman ME, DeMonte F, Levine NB, Raza SM, Hanna EY (2014) Endoscopic resection of sinonasal cancers. Curr Oncol Rep 16(2):369. https://doi.org/10.1007/s11912-013-0369-6

    Article  PubMed  Google Scholar 

  26. Ziai H, Yu E, Fu T et al (2018) Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion. Journal of neurological surgery. 79(5):419–426. https://doi.org/10.1055/s-0037-1612617

    Article  PubMed  Google Scholar 

  27. Hadad G, Bassagasteguy L, Carrau RL et al (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886. https://doi.org/10.1097/01.mlg.0000234933.37779.e4

    Article  PubMed  Google Scholar 

  28. Price JC, Loury M, Carson B, Johns ME (1988) The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope 98(11):1159–1164. https://doi.org/10.1288/00005537-198811000-00002

    Article  CAS  PubMed  Google Scholar 

  29. Johns ME, Winn HR, McLean WC, Cantrell RW (1981) Pericranial flap for the closure of defects of craniofacial resection. Laryngoscope 91(6):952–959. https://doi.org/10.1288/00005537-198106000-00013

    Article  CAS  PubMed  Google Scholar 

  30. Neligan PC, Mulholland S, Irish J et al (1996) Flap selection in cranial base reconstruction. Plast Reconstr Surg 98(7):1159–1166. https://doi.org/10.1097/00006534-199612000-00005

    Article  CAS  PubMed  Google Scholar 

  31. Germani RM, Vivero R, Herzallah IR, Casiano RR (2007) Endoscopic reconstruction of large anterior skull base defects using acellular dermal allograft. Am J Rhinol 21(5):615–618. https://doi.org/10.2500/ajr.2007.21.3080

    Article  PubMed  Google Scholar 

  32. Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK (2012) Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: is rigid structural reconstruction of the cranial base defect necessary? Laryngoscope 122(12):2652–2657. https://doi.org/10.1002/lary.23539

    Article  PubMed  Google Scholar 

  33. Casiano RR, Numa WA, Falquez AM (2001) Endoscopic resection of esthesioneuroblastoma. Am J Rhinol 15(4):271–279

    Article  CAS  Google Scholar 

  34. Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM (2009) Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope 119(1):13–18. https://doi.org/10.1002/lary.20022

    Article  PubMed  Google Scholar 

  35. Bresler AY, Mir G, Grube J et al (2019) Endoscopic Paramedian Forehead Flap Reconstruction of the Anterior Skull Base for Recalcitrant Cerebrospinal Fluid Leaks: Minimally Invasive Adaptation of Ancient Flap. World Neurosurg 130:37–41. https://doi.org/10.1016/j.wneu.2019.06.162

    Article  PubMed  Google Scholar 

  36. Tabano A, Restelli F, Pozzi F et al (2019) The Helmet-Visor Pericranial Flap as a Viable Option for Anterior Cranial Base Reconstruction in Complex Oncologic Cases. World Neurosurg 128:506–513. https://doi.org/10.1016/j.wneu.2019.05.136

    Article  PubMed  Google Scholar 

  37. Klatt-Cromwell CN, Thorp BD, Del Signore AG, Ebert CS, Ewend MG, Zanation AM (2016) Reconstruction of Skull Base Defects. Otolaryngol Clin North Am 49(1):107–117. https://doi.org/10.1016/j.otc.2015.09.006

    Article  PubMed  Google Scholar 

  38. de Almeida JR, Su SY, Koutourousiou M et al (2015) Endonasal endoscopic surgery for squamous cell carcinoma of the sinonasal cavities and skull base: Oncologic outcomes based on treatment strategy and tumor etiology. Head Neck 37(8):1163–1169. https://doi.org/10.1002/hed.23731

    Article  PubMed  Google Scholar 

  39. Lund VJ, Clarke PM, Swift AC, McGarry GW, Kerawala C, Carnell D (2016) Nose and paranasal sinus tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130(S2):S111–S118. https://doi.org/10.1017/S0022215116000530

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Scangas GA, Eloy JA, Lin DT (2017) The Role of Chemotherapy in the Management of Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 50(2):433–441. https://doi.org/10.1016/j.otc.2016.12.015

    Article  PubMed  Google Scholar 

  41. Dirix P, Nuyts S, Geussens Y et al (2007) Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 69(4):1042–1050. https://doi.org/10.1016/j.ijrobp.2007.04.044

    Article  PubMed  Google Scholar 

  42. Al-Mamgani A, Monserez D, Rooij P, Verduijn GM, Hardillo JA, Levendag PC (2012) Highly-conformal intensity-modulated radiotherapy reduced toxicity without jeopardizing outcome in patients with paranasal sinus cancer treated by surgery and radiotherapy or (chemo)radiation. Oral Oncol 48(9):905–911. https://doi.org/10.1016/j.oraloncology.2012.03.024

    Article  PubMed  Google Scholar 

  43. Michel J, Fakhry N, Mancini J et al (2014) Sinonasal squamous cell carcinomas: clinical outcomes and predictive factors. Int J Oral Maxillofac Surg 43(1):1–6. https://doi.org/10.1016/j.ijom.2013.07.741

    Article  CAS  PubMed  Google Scholar 

  44. Huang D, Xia P, Akazawa P et al (2003) Comparison of treatment plans using intensity-modulated radiotherapy and three-dimensional conformal radiotherapy for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys 56(1):158–168. https://doi.org/10.1016/s0360-3016(03)00080-4

    Article  PubMed  Google Scholar 

  45. Mock U, Georg D, Bogner J, Auberger T, Potter R (2004) Treatment planning comparison of conventional, 3D conformal, and intensity-modulated photon (IMRT) and proton therapy for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys 58(1):147–154. https://doi.org/10.1016/s0360-3016(03)01452-4

    Article  PubMed  Google Scholar 

  46. Chera BS, Malyapa R, Louis D et al (2009) Proton therapy for maxillary sinus carcinoma. Am J Clin Oncol 32(3):296–303. https://doi.org/10.1097/COC.0b013e318187132a

    Article  PubMed  Google Scholar 

  47. Jensen AD, Poulakis M, Nikoghosyan AV et al (2016) High-LET radiotherapy for adenoid cystic carcinoma of the head and neck: 15 year’s experience with raster-scanned carbon ion therapy. Radiother Oncol 118(2):272–280. https://doi.org/10.1016/j.radonc.2015.05.010

    Article  PubMed  Google Scholar 

  48. Zenda S, Kohno R, Kawashima M et al (2011) Proton beam therapy for unresectable malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys 81(5):1473–1478. https://doi.org/10.1016/j.ijrobp.2010.08.009

    Article  PubMed  Google Scholar 

  49. Hoffmann TK (2012) (2012) Systemic therapy strategies for head-neck carcinomas: Current status. GMS Curr Top Otorhinolaryngol Head Neck Surg 11:03. https://doi.org/10.3205/cto000085

    Article  Google Scholar 

  50. Hanna EY, Cardenas AD, DeMonte F et al (2011) Induction chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 137(1):78–81. https://doi.org/10.1001/archoto.2010.231

    Article  PubMed  Google Scholar 

  51. Licitra L, Locati LD, Cavina R et al (2003) Primary chemotherapy followed by anterior craniofacial resection and radiotherapy for paranasal cancer. Ann Oncol 14(3):367–372. https://doi.org/10.1093/annonc/mdg113

    Article  CAS  PubMed  Google Scholar 

  52. Homma A, Oridate N, Suzuki F et al (2009) Superselective high-dose cisplatin infusion with concomitant radiotherapy in patients with advanced cancer of the nasal cavity and paranasal sinuses: a single institution experience. Cancer 115(20):4705–4714. https://doi.org/10.1002/cncr.24515

    Article  CAS  PubMed  Google Scholar 

  53. Hoppe BS, Nelson CJ, Gomez DR et al (2008) Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys 72(3):763–769. https://doi.org/10.1016/j.ijrobp.2008.01.038

    Article  PubMed  Google Scholar 

  54. Ferris RL, Blumenschein G Jr, Fayette J et al (2016) Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med 375(19):1856–1867. https://doi.org/10.1056/NEJMoa1602252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Abdul-Aziz D, Kozin ED, Lin BM et al (2017) Temporal bone computed tomography findings associated with feasibility of endoscopic ear surgery. Am J Otolaryngol 38(6):698–703. https://doi.org/10.1016/j.amjoto.2017.06.007

    Article  PubMed  Google Scholar 

  56. Reeves TD, Hill EG, Armeson KE, Gillespie MB (2011) Cetuximab therapy for head and neck squamous cell carcinoma: a systematic review of the data. Otolaryngol Head Neck Surg 144(5):676–684. https://doi.org/10.1177/0194599811399559

    Article  PubMed  Google Scholar 

  57. Udager AM, Rolland DCM, McHugh JB et al (2015) High-Frequency Targetable EGFR Mutations in Sinonasal Squamous Cell Carcinomas Arising from Inverted Sinonasal Papilloma. Cancer Res 75(13):2600–2606. https://doi.org/10.1158/0008-5472.CAN-15-0340

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Bauml JM, Aggarwal C, Cohen RB (2019) Immunotherapy for head and neck cancer: where are we now and where are we going? Ann Transl Med 7(3):S75. https://doi.org/10.21037/atm.2019.03.58

    Article  PubMed  PubMed Central  Google Scholar 

  59. Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 2001;92(12):3012–29 doi: 10.1002/1097–0142(20011215)92:12<3012::aid-cncr10131>3.0.co

  60. Kilic S, Kilic SS, Baredes S et al (2018) Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients. Int Forum Allergy Rhinol 8(3):421–434. https://doi.org/10.1002/alr.22040

    Article  PubMed  Google Scholar 

  61. Cantu G, Bimbi G, Miceli R et al (2008) Lymph node metastases in malignant tumors of the paranasal sinuses: prognostic value and treatment. Arch Otolaryngol Head Neck Surg 134(2):170–177. https://doi.org/10.1001/archoto.2007.30

    Article  PubMed  Google Scholar 

Download references

Funding

There was no funding granted for this study.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada

    Colin G. Leonard, Vikram Padhye & Ian J. Witterick

Authors
  1. Colin G. Leonard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vikram Padhye
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian J. Witterick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian J. Witterick.

Ethics declarations

Conflict of interest

All authors declare that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leonard, C.G., Padhye, V. & Witterick, I.J. Management of squamous cell carcinomas of the skull-base. J Neurooncol 150, 377–386 (2020). https://doi.org/10.1007/s11060-020-03545-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-020-03545-1

Keywords

Search

Navigation