ESMO Preceptorship Programme

Sinonasal Undifferentiated

Carcinoma (SNUC)

Dr. S. Vinodh kumar, MBBS, DMRT

DNB PG - Radiation Oncology

BIACH&RI, India

Head and Neck - Hong Kong - 13 th & 14th April 2019

ESMO PRECEPTORSHIP PROGRAMME

� No disclosure

ESMO PRECEPTORSHIP PROGRAMME

� She consulted an ENT specialist

� Case historyCase historyCase historyCase history ::::� 28 year old female

� No comorbids & habits

� No family history

� Not on regular medications

� ECOG PS-1

� SymptomsSymptomsSymptomsSymptoms : Sep 18: Sep 18: Sep 18: Sep 18

� Right nasal obstruction

� 2-3 episodes of right nasal bleed

� Anosmia

� Swelling of right side of face

� Headache

ESMO PRECEPTORSHIP PROGRAMME

� Right nasal mass biopsy : AngiomatousAngiomatousAngiomatousAngiomatous polyppolyppolyppolyp

� CECT PNSCECT PNSCECT PNSCECT PNS : : : : � Isodense mass lesion in right nasal

cavity , right maxillary , frontal , B/L ethmoidal and right half of sphenoid sinus

� Destruction of right turbinates, cristagalli, B/L cribriform plate, right medial wall of orbit and walls of frontal and ethmoid sinus and anterior cranial fossa

� Impression : Inverted Inverted Inverted Inverted papillomapapillomapapillomapapilloma/SCC/SCC/SCC/SCC

ESMO PRECEPTORSHIP PROGRAMME

� Nov 2018Nov 2018Nov 2018Nov 2018 : : : : Referred to our centre for further management

� Oct 2018Oct 2018Oct 2018Oct 2018 :::: Underwent endoscopic excision of the mass by ENT surgeon

� PostopPostopPostopPostop HPEHPEHPEHPE : High grade malignant tumor -undifferentiated carcinoma

� to rule outneuroendocrine/ nasopharyngeal carcinoma

SinonasalSinonasalSinonasalSinonasal undifferentiated Caundifferentiated Caundifferentiated Caundifferentiated Ca

S100 focal

weak +

PancytoPancytoPancytoPancyto

keratin+, keratin+, keratin+, keratin+,

CK 7 & 19 CK 7 & 19 CK 7 & 19 CK 7 & 19 focal+focal+focal+focal+

Synaptophysin-

ESMO PRECEPTORSHIP PROGRAMME

L/E

• No neck nodes palpable

Blood investigations

• Normal limits

CXR

• B/L lungs clear

• NAD

US A&P

• Liver normal

• NAD

CECT

• Soft tissue dense thickening in right nasal cavity extending into right maxillary, ethmoid, frontal and sphenoid sinuses.

• Closely abutting lamina papyracea with ?erosion of cribriform plate - ?residue/ ?recurrence.

• Multiple small volume B/L level IB, II, III nodes -non specific.

ESMO PRECEPTORSHIP PROGRAMME

� Nov 2018Nov 2018Nov 2018Nov 2018 : : : : Planned for adjuvant chemoradiationusing IMRT technique

� Jan Jan Jan Jan 2019201920192019 :::: She completed her treatment, a total dose of 66Gy in 33# along with 6 cycles of weekly cisplatin without any treatment breaks. Developed grade II mucositis and CINV.

TD 66Gy to H&N

TD 66Gy to H&N

Phase I 50Gy : PTV50

Phase I 50Gy : PTV50

weekly CDDP

40mg/m

weekly CDDP

40mg/m2

Phase II 66Gy : PTV66

Phase II 66Gy : PTV66

ESMO PRECEPTORSHIP PROGRAMME

� Optimal sequence of treatment modalities - Sx followed by

CRT/ CRT followed by Sx/ ICT followed by Sx or RT ?

� Role of Induction chemotherapy(ICT) - preferred regimen ?

� Role of Cetuximab - induction, concurrent & adjuvant ?

� Role of PETCT in diagnosis and assessment of treatment

response in SNUC ?

ESMO Preceptorship Programme

Thank you for your attention