Breda, M

Dias, L

Marçal, N

Menezes, A

Pereira, S

Ribeiro, D

Silva, D

Vilarinho, S

English

Institutional repository of Hospital de Braga

SINONASAL ADENOCARCINOMA13 YEARS EXPERTISE OF HOSPITAL DE BRAGA ENT DEPARTMENTMiguel	Breda,	Sara	Pereira,	Diana	Silva,	Ana	Menezes,	Daniela	Ribeiro,	Nuno Marçal,	Sérgio Vilarinho,	Luís DiasENT	Department	of	Hospital	de	BragaRESULTSDISCUSSION & CONCLUSIONReferencesLund V,	StammbergerH,	Nicolai P,	Castelnouvo P,	et.	al.	European Position Paper on EndoscopicManagement	of Tumours of the Nose,	Paranasal	Sinuses and Skull Base.	Rhinology.	Supplement 22.	2010.Lund V,	Howard	D,	Wei W.	Adenocarcinoma.	In:	Lund V,	Howard	D,	Wei W	(Eds.)	Tumors of the nose,	sinuses,	and nasopharynx,	Stuttgart,	Thieme;	2014:pp137-50.Gabory L,	MaunouryA,	Maurice-Tyson S,	Abdulkhaleq HM,	et.	al.	Long-Term Single-Center Results ofManagement	of Ethmoid Adenocarcinoma:	95	Patients over 28	years.	Ann Surg Oncol.	2010	Feb;17:1127-34.Jégoux F,	Métreau A,	Louvel G,	Bedfert C.	Paranasal	sinus câncer.	Eur Ann OtorhinolaryngolHead Neck Dis.	2013	Dec;130(6):327-35.	miguelbreda@gmail.com	- February 2016INTRODUCTIONThe sinonasal cancer (SN) is characterized by its aggressiveness and low incidence (3.5 / 100 000 / year). It corresponds to 3% ofHead and Neck’s tumors, with males affected twice as often as females. The wood dust exposure is a well known risk factor,however, nickel, chromium and tobacco are also associated to SN cancer. Overall, adenocarcinoma (AD) represents about 22% ofcases of malignant SN cancer. AD usually arises in the ethmoid (40%) and maxillary sinus (20%). The surgical approach to ADmainly comprises Endoscopic Sinus Surgery (ESS), External Surgery, and the combination of both techniques. Although there isno consensus, after surgery, most Oncology Centers advocate the use of Radiotherapy (RT).METHODSRetrospective analysis of medical reports of SN cancer’s patients diagnosed andtreated by our department between 2002 and 2014.OnlyAD were included.Finallywe compared our survival rateswith other patient’s series.SPSS® 22 was used for statistic analysis. Survival rates were calculated usingKaplan-Meier.STUDIED VARIABLES• Gender• Age at diagnosis• Profession• Symptoms• Affected nasal sinus• TNM Staging• TreatmentFig.1 – Intestinal AD – All of our patients had this kind of AD.Histologically resembles intestinal mucosa. (Ana Ferreira –Pathology Lab – Hospital de Braga ©)As expected, our population is almost represented by wood workers, all males. The mean age at diagnosis is 60,5, with advanced stage in 11 of 14 cases, which isconsistent with the literature. In fact, the late diagnosis of this disease associated with poor outcomes seriously compromises the prognosis and possible curativetreatment. This review also highlights the greater use of ESS as surgical modality. Some facts have contributed to this tendency: studies performed in patients treatedentirely by ESS were comparable to the results obtained in External approach series[Lund (2007) and Bogaerts (2008)]. In general, the most important OncologyCentres agree that surgery is the mainstay of treatment, regardless of modality. This retrospective analysis shows that our results approaches the practices andnumbers of many series already published. Finally we think that is important to create screening policies directed to the wood workers, in order to recognize early ADpatients and reach better outcomes.7	deathsSample	size (n=14)13	males1	femalemean age:	60,5	+/- 11,5	years1130 2 4 6 8 10 12Wood	WorkerOthersProfessionEpistaxis31%Nasal	Obstruction48%Exophtalmia4%Rhinorrhea17%Main Symptoms12202468101214Ethmoid MaxillaryAffected	Nasal	SinusTREATMENT012345672002 2007 2008 2009 2010 2012 2013 2014Surgical	Modality	(Aggregated)ESS EXTERNAL COMBINEDSURVIVAL	RATESTry see thru thise-endoscope!First Author AD	cases(n) Management 5	y	overallsurvival rateKraus (1992) 8 Ext+RT 37%Dilhuydy (1992) 13 Ext+RT 44%Shah (1997) 17 Ext+RT 57%Liétin (2006) 60 ESS+Ext+RT 46%Michel(2003) 15 Comb/Ext+RT 53%Hospital de	Braga	(2014) 14 ESS+Ext+RT 40%Post-Op Recurrence- n=5			|		Disease-free	Time (mean): 31	months1	after ESS1	after Combined3	after External6102468tumor not	tumorDeath's	cause	30 1301234Surgical	Modality	/	DeathDisease-Free	Survival Rate	(ESS vsExternal)ESS		- 2	and 5	y	– 75%External - 2	and 5	y	– 55%not statistically significantp-value >0,05Log	Rank – 0,760Overall SurvivalRate	(n=14)2	y	– 60%5	y	– 40%Disease-free	SurvivalRate	(	SurgicalPatients n=11)2	and 5	y	– 50%T1N0M0T2N0M0T3N0M0T4aN0M0EXTERNAL 1 0 2 2ESS 1 2 2 1COMBINED 0 0 1 0012Surgical	Modality	by	TNM	Stage112024681012RT	Adjuvant RT	PalliativeRadiotherapy12542012345TNM	StagingAdvancedStagesn=11

Sinonasal Adenocarcinoma 13 years expertise of hospital de braga ENT Department

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Sinonasal Adenocarcinoma 13 years expertise of hospital de braga ENT Department

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