235: Proton Magnetic Resonance Spectroscopy (1H MRS) of Sputum and Exhaled Breath Condensate: A Non-Invasive Tool for Lung Cancer Screening

Reem Alomran, Naseer Ahmed, Tedros Bezabeh, Renelle Myers, Omkar Ijare, Shantanu Banerji, Zoann Nugent, Zoheir Bshouty
2016 Radiotherapy and Oncology  
Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive neoplasm arising in the nasal cavity and paranasal sinuses. Although intracranial extension from SNUC is common in patients with locally advance disease, distant central nervous system metastasis from SNUC is an extremely rare occurrence. Methods and Materials: Herein, we present a case, and review the limited literature on overall management and outcomes of patients with SNUC and management and outcomes of patients with SNUC with
more » ... ents with SNUC with brain metastases. Results: We report a case of an 80 year old man who presented with a locally advanced SNUC involving ethmoid, sphenoid and maxillary sinuses and bilateral lymph nodes from level I-V, cT4N2cM0. Given his age and the initial extent of his primary tumour, he was treated with neo-adjuvant chemotherapy followed by palliative chemoradiation with a split course of 50 Gy in 40 fractions delivered twice a day. Four months after his treatments, he developed a recurrence at the left lower eyelid and left frontal sinus, intra-abdominal metastases and a left cerebellar metastasis. A single fraction of 22 Gy was delivered to the cerebellar lesion using stereotactic radiosurgery. Upon review of the literature, we found only two cases reported of brain metastases that were not due to local intracranial extension from the original mass, in which detailed treatment information was reported. One patient with partially controlled local disease had a left temporoparietal lesion treated with a combination of bone marrow transplant and CAV chemotherapy and had a partial response. This patient died of disease at 8 months. The second case was treated initially with surgical resection and post-operative chemotherapy and radiation and lived for at least another two years while developing further metastases-at the time of the printed manuscript the patient was still alive. Conclusions: We advocate that aggressive treatment of advanced SNUC may be pursued in selected patients. We suggest a registry for rare head and neck cancers such as SNUC to help guide treatment. 234
doi:10.1016/s0167-8140(16)33634-9 fatcat:7nydrwac5bh2pcobbidqfjup3u