Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive cancer that arises in the nasal cavity and paranasal sinuses. Because of its aggressive nature and complex location near critical structures like the eyes and brain, treating SNUC requires a carefully coordinated, multidisciplinary approach. The main goals of treatment are to remove or destroy the tumor, prevent recurrence, and preserve as much normal function as possible.
**Surgery** is often the first step in treatment when the tumor is operable. The surgical approach aims to remove the tumor completely with clear margins, which means no cancer cells are left at the edges of the removed tissue. Due to the tumor’s location, surgery can be challenging and may involve removing parts of the nasal cavity, sinuses, and sometimes adjacent structures such as the orbit (eye socket) or skull base. In some cases, surgeons may also remove lymph nodes in the neck if there is evidence of spread. Surgery alone is rarely sufficient because SNUC tends to be highly invasive and prone to recurrence.
**Radiation therapy** is a critical component of treatment, often used after surgery to kill any remaining cancer cells and reduce the risk of recurrence. Radiation can also be used before surgery to shrink tumors or as the primary treatment if surgery is not possible. Modern radiation techniques, such as intensity-modulated radiation therapy (IMRT), allow precise targeting of the tumor while sparing nearby healthy tissues, which is especially important in the sinonasal region to protect the eyes, brain, and oral cavity. Radiation is usually delivered over several weeks in daily sessions.
**Chemotherapy** is commonly combined with radiation therapy, either before surgery (neoadjuvant), after surgery (adjuvant), or concurrently with radiation. Chemotherapy drugs, such as cisplatin, help sensitize cancer cells to radiation and attack cancer cells systemically to address microscopic disease that may have spread beyond the primary site. Concurrent chemoradiotherapy has been shown to improve outcomes in aggressive head and neck cancers like SNUC.
**Multimodal treatment**, which combines surgery, radiation, and chemotherapy, is generally considered the standard of care for SNUC because of its aggressive behavior. This approach aims to maximize tumor control by attacking the cancer from multiple angles. The sequence and combination of these treatments depend on the tumor’s size, extent, and patient factors.
**Emerging therapies** are also being explored for SNUC. Targeted therapies, which use drugs designed to attack specific molecules involved in cancer growth, are under investigation but not yet standard for SNUC. Immunotherapy, which harnesses the immune system to fight cancer, has shown promise in other head and neck cancers and may become part of treatment options in the future.
**Supportive care** is an important aspect throughout treatment. Because treatments can affect eating, breathing, and appearance, patients often need nutritional support, speech and swallowing therapy, and psychological support. Side effects from radiation and chemotherapy, such as mucositis (inflammation of the mucous membranes), dry mouth, and fatigue, are managed proactively to maintain quality of life.
In some rare cases, specific subtypes of sinonasal undifferentiated carcinoma, such as those deficient in certain molecular markers, may respond differently to treatment. For example, tumors deficient in SMARCB1 (INI1) protein may have unique features and might respond well to radiotherapy alone, but these cases require specialized pathological diagnosis and tailored treatment plans.
Because SNUC is rare and complex, treatment is best managed by a multidisciplinary team including surgical oncologists, radiation oncologists, medical oncologists, radiologists, pathologists, and supportive care specialists. This team approach ensures that all aspects of the disease and patient needs are addressed comprehensively.
In summary, the treatment of sinonasal undifferentiated carcinoma typically involves a combination of surgery, radiation therapy, and chemotherapy. The exact plan depends on tumor characteristics and patient health, with emerging therapie
