Chemotherapy for Nasal Cavity and Paranasal Sinus Cancers

Chemotherapy (chemo) is treatment with anti-cancer drugs that are injected into a vein or taken by mouth. These drugs enter the blood and reach most areas of the body.

When is chemotherapy used for nasal cavity or paranasal sinus cancer?

Chemo might be used at different times during treatment for nasal cavity and paranasal sinus cancers.

Neoadjuvant chemo is chemo that is used before surgery. It can be used to try to shrink the tumor and make surgery easier. Chemo is often given by itself first, known as induction chemo, and then along with radiation therapy (known as chemoradiation – see below).

Adjuvant chemo is chemo that is used after surgery, often with radiation therapy (chemoradiation) to try to kill any cancer cells that might have been left behind. This can help lower the chance the cancer will come back, especially if cancer is found at the edges (margins) of the removed tumor, or if the cancer has other features that make it more likely to come back.

Chemo can be used as the main treatment, often along with radiation therapy (chemoradiation), for cancers that are too big or have spread too far into nearby tissues to be removed completely with surgery. Chemoradiation can also be used as the main treatment for people who aren’t healthy enough for surgery or don't want to have surgery.

For metastatic cancer (cancer that has spread to distant organs), chemo can be used to help control cancer growth.

Chemoradiation

Chemoradiation is chemotherapy given at the same time as radiation. This combination has been shown to work better to shrink some of these tumors than using either treatment alone. It also might help lower the chance of cancer recurrence (cancer coming back after treatment).

How is chemotherapy given?

Chemo drugs for nasal cavity or paranasal sinus cancer are given into a vein (IV), often as an infusion over a certain period of time. This can be done in a doctor’s office, infusion center, or in a hospital setting.

You might have a slightly larger and sturdier IV line put into one of your larger veins to get the chemo. This is known as a central venous catheter (CVC), central venous access device (CVAD), or central line. It can be left in place for weeks to months to put chemo and other medicines, blood products, nutrients, or fluids right into your blood, and it can also be used to take blood for testing.

Chemo is given in cycles, followed by a rest period to give you time to recover from potential side effects. For example, chemo might be given once a week or every 3 weeks, but the schedule can vary depending on the drugs used. At the end of the cycle, the chemo schedule repeats to start the next cycle.

The length of chemo treatment depends on why it’s being given, how well it’s working, and what side effects you have. Adjuvant or neoadjuvant chemo is typically given for weeks or months, while chemo for more advanced disease is often continued for as long as it is helpful.

If you’re getting chemo, ask your cancer care team about your treatment plan and what to expect.

Chemotherapy drugs for nasal cavity and paranasal sinus cancers

Nasal cavity and paranasal sinus cancers are rare, so there aren’t many studies to help doctors decide the best way to treat them. Often, doctors treat them with the same chemo drugs that are used for other, more common cancers of the head and neck.

Some of the chemo drugs commonly used to treat these cancers include:

• Cisplatin
• Carboplatin
• 5-fluorouracil (5-FU)
• Docetaxel
• Paclitaxel
• Etoposide
• Capecitabine

Which drugs are used depends on things like the type of cancer, the extent of the cancer, your overall health, and whether chemo is combined with radiation therapy.

Chemotherapy drugs used first typically include cisplatin or carboplatin, alone or in combination with 5-FU, but other combinations are also used. In some situations, chemo might be used along with a targeted therapy or immunotherapy drug.

Different chemo drugs might be used for less common types of nasal cavity and paranasal sinus cancers, such as sarcomas and melanomas.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of specific drugs used and how long you take them. If your treatment plan includes chemotherapy, be sure to discuss the drugs that will be used and their possible side effects.

Once chemotherapy is started, let your health care team know if you have side effects, so they can be managed. There are ways to prevent or treat many side effects.

Short-term side effects of chemo can include:

• Nausea and vomiting
• Loss of appetite or weight loss
• Loss of hair
• Mouth sores
• Diarrhea
• Skin or nail changes
• Ringing in the ears

Chemo can also affect the blood-forming cells in the bone marrow, which can lead to:

• An increased chance of infection from having too few white blood cells
• Easy bleeding or bruising from having too few blood platelets
• Fatigue or shortness of breath from having too few red blood cells

Side effects from certain drugs

Other side effects only happen with certain drugs.

Neuropathy

Neuropathy (nerve damage) is a common side effect of cisplatin, docetaxel, and paclitaxel. It can lead to numbness, tingling, or even pain in the hands and feet. The nerve damage caused by cisplatin can also cause hearing loss.

This might improve once treatment is stopped, but it can last a long time for some people. If you'll be getting any of these drugs, let your team know right away if you develop numbness and tingling sensations or other side effects.

Hand-foot syndrome

This can develop during treatment with capecitabine or 5-FU when it is given as a continuous infusion. It can start out as redness in the hands and feet and then might progress to pain and sensitivity in the palms and soles.

If it worsens, skin might blister or peel, sometimes leading to painful sores. It’s important to tell your team right away about any early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.