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Tumoren der Nasennebenhöhlen mit Übergreifen auf die Orbita

Tumors of the paranasal sinus invading the orbit

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Zusammenfassung

Die Invasion der Orbita durch ein Malignom der Nasennebenhöhlen (NNH) bedeutet, dass eine Erkrankung bereits in einem fortgeschrittenen Tumorstadium vorliegt. Die Prognose hat sich trotz aller Bemühungen mittels multimodaler Ansätze in den letzten Jahrzehnten nur wenig verbessert. Die komplette Resektion des Malignoms verspricht weiterhin die beste Prognose. Die Exenteratio der Orbita stellt hierbei einen großen Einschnitt in die Psyche und Lebensqualität der Betroffenen dar. Bei letztsehendem Auge sollte zugunsten der Lebensqualität auf eine Exenteratio verzichtet werden, was jedoch letztendlich dem aufgeklärten Patienten obliegt. Durch chirurgisch rekonstruktive Ansätze und epithetische Verfahren kann die Ästhetik nach Exenteratio wiederhergestellt werden. Die Wahl der Epithesenfixierung sollten mit dem Patienten im Rahmen der Therapieplanung festgelegt werden, den individuellen Ansprüchen gerecht werden und dem manuellen Geschick des Patienten entsprechen. Bei der funktionellen Rehabilitation stehen die Erleichterung der lokalen Pflege und die Verhinderung der endonasalen Krustenbildung durch Wiederherstellung der nasalen Spalträume im Vordergrund. Karzinome der NNH mit Übergreifen auf die Orbita stellen eine diagnostische und therapeutische Herausforderung dar. Die Aufklärung des Patienten über Prognose, therapeutische Ansätze, posttherapeutische Lebensqualität und Möglichkeiten der Rehabilitation sollte am Anfang der Behandlung stehen und von Patient und Therapeut gemeinsam getragen werden.

Abstract

Invasion of the orbit by tumors of the paranasal sinus represents an advanced state of disease. Prognosis has hardly improved in recent decades, despite multimodal therapeutic approaches. Complete resection of the tumor still remains the most promising therapy. Orbital exenteration implies a dramatic event for the patient’s psyche and quality of life. If the eye that would have to be exenterated is the only one remaining with sufficient vision, exenteration should be abandoned in consensus with the patient. Aesthetic improvements following exenteration can be achieved by surgical and prosthetic techniques. The method of prosthesis fixation needs to be determined with respect to the patients’ individual expectations and manual abilities. The main aspects of functional rehabilitation are good local cleanability and sufficient nasal breathing without encrusted mucus, which can be achieved by restoring the natural laminar airflow. Tumors of the paranasal sinus with orbital invasion represent a diagnostic and therapeutic challenge. The information regarding prognosis, therapeutic approaches, post-therapeutic quality of life, and rehabilitation options should be thoroughly discussed by patients and therapists prior to treatment.

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Literatur

  1. Ahn PH, Mitra N, Alonso-Basanta M et al (2016) Nodal metastasis and elective nodal level treatment in sinonasal small-cell and sinonasal undifferentiated carcinoma: a surveillance, epidemiology and end results analysis. Br J Radiol 89(1058):20150488. https://doi.org/10.1259/bjr.20150488

    Article  PubMed  Google Scholar 

  2. Ahn PH, Mitra N, Alonso-Basanta M et al (2016) Risk of lymph node metastasis and recommendations for elective nodal treatment in squamous cell carcinoma of the nasal cavity and maxillary sinus: a SEER analysis. Acta Oncol 55(9–10):1107–1114. https://doi.org/10.1080/0284186X.2016.1216656

    Article  PubMed  Google Scholar 

  3. Ansari M, Guo S, Fakhri S et al (2013) Sinonasal undifferentiated carcinoma (SNUC): morphoproteomic-guided treatment paradigm with clinical efficacy. Ann Clin Lab Sci 43(1):45–53

    CAS  PubMed  Google Scholar 

  4. Bartley GB, Garrity JA, Waller RR, Henderson JW, Ilstrup DM (1989) Orbital exenteration at the Mayo Clinic. 1967–1986. Ophthalmology 96(4):468–473

    Article  CAS  Google Scholar 

  5. Bhide SA, Newbold KL, Harrington KJ, Nutting CM (2012) Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers. Br J Radiol 85(1013):487–494. https://doi.org/10.1259/bjr/85942136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Blanchard P, Gunn GB, Lin A, Foote RL, Lee NY, Frank SJ (2018) Proton therapy for head and neck cancers. Semin Radiat Oncol 28(1):53–63. https://doi.org/10.1016/j.semradonc.2017.08.004

    Article  PubMed  Google Scholar 

  7. Bossi P, Farina D, Gatta G, Lombardi D, Nicolai P, Orlandi E (2016) Paranasal sinus cancer. Crit Rev Oncol Hematol 98:45–61. https://doi.org/10.1016/j.critrevonc.2015.09.009

    Article  PubMed  Google Scholar 

  8. Carrau RL, Segas J, Nuss DW et al (1999) Squamous cell carcinoma of the sinonasal tract invading the orbit. Laryngoscope 109(2 Pt 1):230–235

    Article  CAS  Google Scholar 

  9. Desai DD, Brandon BM, Perkins EL, Ebert CS, Zanation AM, Thorp BD (2017) Staging of sinonasal and ventral skull base malignancies. Otolaryngol Clin North Am 50(2):257–271. https://doi.org/10.1016/j.otc.2016.12.004

    Article  PubMed  Google Scholar 

  10. Dirix P, Vanstraelen B, Jorissen M, Vander Poorten V, Nuyts S (2010) Intensity-modulated radiotherapy for sinonasal cancer: improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys 78(4):998–1004. https://doi.org/10.1016/j.ijrobp.2009.09.067

    Article  PubMed  Google Scholar 

  11. Disa JJ, Liew S, Cordeiro PG (2001) Soft-Tissue reconstruction of the face using the folded/multiple skin island radial forearm free flap. Ann Plast Surg 47(6):612–619

    Article  CAS  Google Scholar 

  12. Farag A, Rosen M, Evans J (2015) Surgical techniques for sinonasal malignancies. Neurosurg Clin N Am 26(3):403–412. https://doi.org/10.1016/j.nec.2015.03.011

    Article  PubMed  Google Scholar 

  13. Federspil PA (2010) Epithetische Versorgung von Gesichtsdefekten (Craniofacial prostheses for facial defects). HNO 58(6):621–631. https://doi.org/10.1007/s00106-010-2087-9 (quiz 632)

    Article  CAS  PubMed  Google Scholar 

  14. Fernström E, Nyman J, Hammerlid E et al (2017) Results of preoperative chemoradiotherapy for patients with advanced cancer of the nasal cavity and paranasal sinuses. Acta Otolaryngol 137(12):1292–1300. https://doi.org/10.1080/00016489.2017.1357081

    Article  CAS  PubMed  Google Scholar 

  15. Goiato MC, Dos SDM, Bannwart LC, Haddad MF, Pereira LV, Filho AJV (2014) Surgical-allogeneic facial reconstruction: facial transplants. J Dent (Tehran) 11(6):733–739

    Google Scholar 

  16. 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 

  17. Hill JL, Rinker B (2011) Microsurgical reconstruction of large, locally advanced cutaneous malignancy of the head and neck. Int J Surg Oncol 2011:415219. https://doi.org/10.1155/2011/415219

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hoffman GR, Jefferson ND, Reid CBA, Eisenberg RL (2016) Orbital exenteration to manage Infiltrative sinonasal, orbital adnexal, and cutaneous malignancies provides acceptable survival outcomes: an institutional review, literature review, and meta-analysis. J Oral Maxillofac Surg 74(3):631–643. https://doi.org/10.1016/j.joms.2015.09.019

    Article  PubMed  Google Scholar 

  19. Holliday EB, Esmaeli B, Pinckard J et al (2016) A multidisciplinary orbit-sparing treatment approach that includes proton therapy for epithelial tumors of the orbit and ocular adnexa. Int J Radiat Oncol Biol Phys 95(1):344–352. https://doi.org/10.1016/j.ijrobp.2015.08.008

    Article  PubMed  Google Scholar 

  20. Huang SH, O’Sullivan B (2017) Overview of the 8th edition TNM classification for head and neck cancer. Curr Treat Options Oncol 18(7):40. https://doi.org/10.1007/s11864-017-0484-y

    Article  PubMed  Google Scholar 

  21. Jeong Y, S‑w L, Kwak J et al (2014) A dosimetric comparison of volumetric modulated arc therapy (VMAT) and non-coplanar intensity modulated radiotherapy (IMRT) for nasal cavity and paranasal sinus cancer. Radiat Oncol 9:193. https://doi.org/10.1186/1748-717X-9-193

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kadah BA, Niewald M, Papaspyrou G, Dzierma Y, Schneider M, Schick B (2016) Customized individual applicators for endocavitary brachytherapy in patients with cancers of the nasal cavity, sinonasal region and nasopharynx. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology—Head and Neck Surgery 273(6):1543–1547. DOI https://doi.org/10.1007/s00405-015-3636-3

    Article  Google Scholar 

  23. Kashat L, Le CH, Chiu AG (2017) The role of targeted therapy in the management of sinonasal malignancies. Otolaryngol Clin North Am 50(2):443–455. https://doi.org/10.1016/j.otc.2016.12.016

    Article  PubMed  Google Scholar 

  24. Kuo P, Manes RP, Schwam ZG, Judson BL (2017) Survival outcomes for combined modality therapy for sinonasal undifferentiated carcinoma. Otolaryngol Head Neck Surg 156(1):132–136. https://doi.org/10.1177/0194599816670146

    Article  PubMed  Google Scholar 

  25. van der Laan TP, Iepsma R, Witjes MJH, van der Laan BFAM, Plaat BEC, Halmos GB (2016) Meta-analysis of 701 published cases of sinonasal neuroendocrine carcinoma: the importance of differentiation grade in determining treatment strategy. Oral Oncol 63:1–9. https://doi.org/10.1016/j.oraloncology.2016.10.002

    Article  PubMed  Google Scholar 

  26. Lagrèze WA, Rössler J, Illerhaus G, Maier W, Grosu A (2011) Therapie anterior gelegener Orbitatumoren (Therapy of tumors of the anterior orbit). Ophthalmologe 108(6):519–530. https://doi.org/10.1007/s00347-010-2191-y

    Article  CAS  PubMed  Google Scholar 

  27. Llorente JL, López F, Suárez C, Hermsen MA (2014) Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nature reviews. Clin Oncol 11(8):460–472. https://doi.org/10.1038/nrclinonc.2014.97

    Article  Google Scholar 

  28. Maghami E, Kraus DH (2004) Cancer of the nasal cavity and paranasal sinuses. Expert Rev Anticancer Ther 4(3):411–424. https://doi.org/10.1586/14737140.4.3.411

    Article  PubMed  Google Scholar 

  29. Mazeron J‑J, Ardiet J‑M, Haie-Méder C et al (2009) GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol 91(2):150–156. https://doi.org/10.1016/j.radonc.2009.01.005

    Article  PubMed  Google Scholar 

  30. Meyer JE, Brocks C, Lamcke P et al (2010) Kombination von Brachytherapie und Chirurgie bei Tumoren mit Orbita‑/Schädelbasisinfiltration (Brachytherapy in combination with function-preserving surgery of cancer of the paranasal sinus). Laryngorhinootologie 89(6):358–366. https://doi.org/10.1055/s-0030-1249631

    Article  CAS  PubMed  Google Scholar 

  31. Michel G, Joubert M, Delemazure AS, Espitalier F, Durand N, Malard O (2013) Adenoid cystic carcinoma of the paranasal sinuses: retrospective series and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 130(5):257–262. https://doi.org/10.1016/j.anorl.2012.09.010

    Article  CAS  PubMed  Google Scholar 

  32. Morand GB, Anderegg N, Vital D et al (2017) Outcome by treatment modality in sinonasal undifferentiated carcinoma (SNUC): a case-series, systematic review and meta-analysis. Oral Oncol 75:28–34. https://doi.org/10.1016/j.oraloncology.2017.10.008

    Article  PubMed  Google Scholar 

  33. Motiee-Langroudi M, Harirchi I, Amali A, Jafari M (2015) Reconstruction of midface and orbital wall defects after maxillectomy and orbital content preservation with titanium mesh and fascia lata: 3‑year follow-up. J Oral Maxillofac Surg 73(12):2447.e1–2447.e5. https://doi.org/10.1016/j.joms.2015.08.011

    Article  Google Scholar 

  34. Nazar G, Rodrigo JP, Llorente JL, Baragaño L, Suárez C (2004) Prognostic factors of maxillary sinus malignancies. Am J Rhinol 18(4):233–238

    Article  Google Scholar 

  35. Osguthorpe JD, Richardson M (2001) Frontal sinus malignancies. Otolaryngol Clin North Am 34(1):269–281

    Article  CAS  Google Scholar 

  36. Perri F, Addeo R, Conson M et al (2017) Locally advanced paranasal sinus carcinoma: a study of 30 patients. Oncol Lett 13(3):1338–1342. https://doi.org/10.3892/ol.2017.5598

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Perry C, Levine PA, Williamson BR, Cantrell RW (1988) Preservation of the eye in paranasal sinus cancer surgery. Arch Otolaryngol Head Neck Surg 114(6):632–634

    Article  CAS  Google Scholar 

  38. Razek AAKA, Sieza S, Maha B (2009) Assessment of nasal and paranasal sinus masses by diffusion-weighted MR imaging. J Neuroradiol 36(4):206–211. https://doi.org/10.1016/j.neurad.2009.06.001

    Article  CAS  PubMed  Google Scholar 

  39. Resto VA, Chan AW, Deschler DG, Lin DT (2008) Extent of surgery in the management of locally advanced sinonasal malignancies. Head Neck 30(2):222–229. https://doi.org/10.1002/hed.20681

    Article  PubMed  Google Scholar 

  40. Reyes C, Mason E, Solares CA, Bush C, Carrau R (2015) To preserve or not to preserve the orbit in paranasal sinus neoplasms: a meta-analysis. J Neurol Surg B Skull Base 76(2):122–128. https://doi.org/10.1055/s-0034-1390403

    Article  PubMed  Google Scholar 

  41. Roush GC (1979) Epidemiology of cancer of the nose and paranasal sinuses: current concepts. Head Neck Surg 2(1):3–11

    Article  CAS  Google Scholar 

  42. Safi A‑F, Behn L, Rothamel D et al (2017) Therapy of sinonasal malignancies invading the orbit-orbital exenteration versus preservation of the orbit plus radiotherapy. J Craniomaxillofac Surg 45(2):258–261. https://doi.org/10.1016/j.jcms.2016.11.013

    Article  PubMed  Google Scholar 

  43. 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 

  44. Spiegel JH, Varvares MA (2007) Prevention of postexenteration complications by obliteration of the orbital cavity. Skull Base 17(3):197–203. https://doi.org/10.1055/s-2007-977468

    Article  PubMed  PubMed Central  Google Scholar 

  45. Suárez C, Ferlito A, Lund VJ et al (2008) Management of the orbit in malignant sinonasal tumors. Head Neck 30(2):242–250. https://doi.org/10.1002/hed.20736

    Article  PubMed  Google Scholar 

  46. Sun G‑W, Yang X‑D, Hu Q‑G et al (2009) Application of titanium mesh and free forearm flap for reconstruction of maxillary defect resulted from tumor resection. Zhonghua Zheng Xing Wai Ke Za Zhi 25(4):251–254

    PubMed  Google Scholar 

  47. Tagliaferri L, Bussu F, Rigante M et al (2015) Endoscopy-guided brachytherapy for sinonasal and nasopharyngeal recurrences. Brachytherapy 14(3):419–425. https://doi.org/10.1016/j.brachy.2014.11.012

    Article  PubMed  Google Scholar 

  48. Teudt IU, Meyer JE, Ritter M et al (2014) Perioperative image-adapted brachytherapy for the treatment of paranasal sinus and nasal cavity malignancies. Brachytherapy 13(2):178–186. https://doi.org/10.1016/j.brachy.2013.10.009

    Article  PubMed  Google Scholar 

  49. Turner JH, Reh DD (2012) Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 34(6):877–885. https://doi.org/10.1002/hed.21830

    Article  PubMed  Google Scholar 

  50. Turri-Zanoni M, Battaglia P, Lambertoni A et al (2015) Treatment strategies for primary early-stage sinonasal adenocarcinoma: a retrospective bi-institutional case-control study. J Surg Oncol 112(5):561–567. https://doi.org/10.1002/jso.24038

    Article  PubMed  Google Scholar 

  51. van de Water TA, Bijl HP, Schilstra C, Pijls-Johannesma M, Langendijk JA (2011) The potential benefit of radiotherapy with protons in head and neck cancer with respect to normal tissue sparing: a systematic review of literature. Oncologist 16(3):366–377. https://doi.org/10.1634/theoncologist.2010-0171

    Article  PubMed  PubMed Central  Google Scholar 

  52. Wong C‑H, Wei F‑C (2010) Microsurgical free flap in head and neck reconstruction. Head Neck 32(9):1236–1245. https://doi.org/10.1002/hed.21284

    Article  PubMed  Google Scholar 

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  1. Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland

    M. Herzog

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Herzog, M. Tumoren der Nasennebenhöhlen mit Übergreifen auf die Orbita. HNO 66, 730–742 (2018). https://doi.org/10.1007/s00106-018-0540-3

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