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.

If you smoke, you should quit. Smoking during chemotherapy treatment can cause more side effects and can cause the chemo drugs to not work as well. It can give you a higher chance of getting an infection and is linked to worse outcomes. Smoking also increases the risk of the cancer coming back after treatment and of getting another new cancer. Quitting smoking (before treatment starts, if possible) is the best way to improve your chances of survival. It is never too late to quit.

Chemo may be used at different times during treatment for nasal cavity and paranasal sinuses:

• Before surgery (neoadjuvant or induction chemo), often along with radiation therapy (called chemoradiation), to try to shrink the tumor and make surgery easier. Some call this organ preservation treatment because chemo given before surgery can “preserve” and not damage the structures in and near a critical organ. For example, induction chemo  may be used to try to save the eyeball if the cancer has spread there.
• After surgery (adjuvant chemo), often with radiation therapy (chemoradiation) to try to kill any cancer cells that might have been left behind but can’t be seen on imaging tests. It can also 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.
• As the main (primary) treatment, often along with radiation therapy (chemoradiation) for cancers that are too big or have spread too far into nearby tissues to be completely removed with surgery. Chemoradiation can also be used as the main treatment for people who are too sick for surgery or don't want to have surgery.
• For metastatic cancer (cancer that has spread to distant organs) to control cancer growth when it has spread to other parts of the body and cannot be treated with surgery or radiation.

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 coming back after treatment (cancer recurrence) for some types of cancer.

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.

Often, a slightly larger and sturdier IV access is required in the vein system to administer chemo. These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for testing. There are many different kinds of CVCs. The most common types are the port and the PICC line.

Chemo is given in cycles, followed by a rest period to give you time to recover from potential chemotherapy-related side effects. Cycles can be given weekly or every 3 weeks, but the schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant or neoadjuvant chemo can be given over weeks or months, depending on the drugs used. The length of treatment depends on how well it is working and what side effects you might have. If you have any questions regarding chemotherapy discuss them with your medical oncologist.

Chemotherapy used to treat nasal cavity and paranasal sinus cancers

Chemo for nasal cavity and paranasal sinus cancers may include a combination of several drugs. These 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 drugs that are used for other, more common, cancers of the head and neck.

The most common types of nasal cavity and paranasal sinus cancers–squamous cell carcinoma, adenocarcinoma, and adenoid cystic carcinoma–can be grouped together as carcinomas. Some of the chemo drugs commonly used to treat carcinomas include:

• Cisplatin
• Carboplatin
• 5-fluorouracil (5-FU)
• Docetaxel (Taxotere)
• Paclitaxel (Taxol)
• Methotrexate
• Capecitabine (Xeloda), a pill that is converted to 5-FU once it gets to the tumor

The drugs used depend on many things, including the type of cancer, the extent of the cancer, the person’s overall health, and whether chemo is combined with radiation therapy. Chemotherapy drugs used first include cisplatin or carboplatin alone, or in combination with 5-FU, but other combinations are also available. For people who cannot tolerate chemo, the targeted therapy drug, cetuximab, is often used with radiation instead.

Different chemo drugs are used for nasal cavity and paranasal sinus sarcomas and melanomas. Information about chemotherapy for sarcomas may be found in Sarcoma: Adult Soft Tissue Cancer. Chemo for melanoma is covered in Melanoma Skin Cancer.

Possible side effects of chemotherapy for nasal cavity and paranasal sinus cancers 

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the lining of the mouth and intestines, and the hair follicles, are also dividing quickly. These cells can be affected by chemo too, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of specific drugs used and how long you take them. Short-term side effects of chemo can include:

• Nausea and vomiting
• Loss of appetite or weight loss
• Loss of hair
• Mouth sores
• Diarrhea
• Nail changes
• Skin 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 low white blood cell counts)
• Easy bleeding or bruising (from low blood platelet counts)
• Fatigue or shortness of breath (from low red blood cell counts)

Although most side effects get better once treatment is stopped, some can last a long time or even last forever. If your doctor plans treatment with chemotherapy, be sure to discuss the drugs that will be used and the possible side effects. Once chemotherapy is started, let your health care team know if you have side effects, so they can be treated. There are ways to prevent or treat many of the side effects related to chemotherapy. For instance, there are many drugs that can help prevent or treat nausea and vomiting. Sometimes, the doses of the chemo drugs may need to be lowered or treatment may need to be delayed or stopped to help keep the problem from getting worse.

Other side effects only happen with certain drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting. For example:

Neuropathy (nerve damage) is a common side effect of cisplatin, docetaxel, and paclitaxel which 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 may improve once treatment is stopped, but it can last a long time in some people. If you'll be getting any of the drugs mentioned here, talk with your doctor about the side effects before chemo starts, and let them know right away if you develop numbness and tingling sensations or other side effects.

Hand-foot syndrome 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 may blister or peel, sometimes leading to painful sores. It’s important to tell your doctor right away about any early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.