New standards for the management of nose vestibule malignancies

Abstract

Background

Nasal vestibule squamous cell carcinoma (NVSCC) is an ill-defined underestimated condition.

Aim/objective

To define the current standard of care.

Material and methods

We review recent acquisitions concerning clinical features and therapeutic approaches.

Results

The current AJCC staging system, which attributes to nasal vestibule the same topographic code as nasal cavity proper and the same T-classification criteria as ethmoid, appears inadequate.

As for treatment of primary lesions without bone invasion, current evidence suggests that brachytherapy is at least equivalent to surgery and superior to external beams in terms of oncological outcomes, and superior to both modalities in terms of cosmesis and function.

Conclusions

As for classification and staging, the nasal vestibule should be defined as a subsite of the nose and paranasal sinuses, distinct from the ‘nasal cavity proper and ethmoid’, with specific topographic code and T-classification criteria. This will improve the assessment of prognosis and prevalence, underestimated also because of misdiagnosis with skin cancers.

Secondly, brachytherapy should become the new standard for the treatment of primary lesions without bone invasion. To optimize the advantages of brachytherapy, we propose novel anatomic criteria for the implantation.

Significance

Increasing evidence supports a paradigm shift in staging and treatment of NVSCC.

Chinese Abstract

背景：鼻前庭鳞状细胞癌 (NVSCC) 是一种定义不明确且被低估的疾病。

目的：定义当前的护理标准。

材料和方法：我们回顾了最近获得的有关临床特征和治疗方法的资料。

结果：当前的 AJCC 分期系统似乎不够适合, 它将与鼻腔本身相同的形态编码和与筛骨相同的 T 分类标准都归于鼻前庭。至于无骨侵犯的原发灶治疗, 目前的证据表明, 就肿瘤学结果而言, 贴近放射治疗至少等同于手术并优于外照射, 并且在美观和功能方面优于这两种方式。

结论：至于分类和分期, 鼻前庭应定义为鼻子的亚区和鼻旁窦, 不同于“鼻腔和筛窦”, 具有特定的形态编码和 T 分类标准。 这将改善对预后和患病率的评估, 它也因为皮肤癌的误诊而被低估。其次, 贴近放射治疗应成为无骨侵犯原发灶治疗的新标准。 为了优化贴近放射治疗的优势, 我们提出了用于植入的新解剖学标准。

意义：越来越多的证据支持 NVSCC 分期和治疗的模式转变。

Keywords:

• Nasal vestibule carcinoma
• squamous cell carcinoma
• TNM classification
• brachytherapy
• total rhinectomy
• interventional radiotherapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data is available when it is requested for motivated reasons.