Treatment of Sinonasal Undifferentiated Carcinoma with TPF and Concurrent Chemo-Radiation: Case Report and Literature Review

Abstract

Sinonasal undifferentiated carcinoma (SNUC) is a rare, poorly differentiated and aggressive malignancy of the nasal cavity and paranasal sinuses first reported by Frierson et al. in 1986 with less than 300 known cases reported since then. Due to the rarity and aggressive nature of the disease, there is a lack of consensus regarding optimal management in these patients. Treatment decisions have mostly been guided by a small number of cases series and can vary widely between institutions. In this unique case presentation, we review a case of sinonasal undifferentiated carcinoma in a young Hispanic male reviewing the literature on a rare disease, in order to elucidate effective treatment options for improved future outcomes. Based off of literature review and prior case series, the multiple modality approach should result in the best possible outcome for this rare and aggressive disease. In this specific case of a young Hispanic male with Stage IVB SNUC, we proceeded with Neo-adjuvant TPF (Docetaxel, cisplatin and fluorouracil) with effective results, followed by Cisplatin and concurrent radiation once the patient had interval progression, and was deemed unresectable. Given the rarity and complexity of this disease, a prospective randomized controlled study should eventually be pursued to properly determine the most effective mode and combination of therapies. At this time treatment can only be based on reported case series and a small number of retrospective studies, and therefore it is important to continue to evaluate different institutions’ methods of treatment.