Sinonasal Malignancy Following Cranial Irradiation: A Scoping Review and Case Report of Sinonasal Teratocarcinosarcoma

Ben B Levy; Michael J De Biasio; Nilo Alvarez Toledo; Sunit Das; Mandolin Bartling; Fahad Aldahari; John R de Almeida; Ilan Weinreb; Yvonne Chan

doi:10.1055/s-0044-1788310

Sinonasal Malignancy Following Cranial Irradiation: A Scoping Review and Case Report of Sinonasal Teratocarcinosarcoma

J Neurol Surg Rep. 2024 Jul 5;85(3):e101-e111. doi: 10.1055/s-0044-1788310. eCollection 2024 Jul.

Authors

Ben B Levy¹, Michael J De Biasio², Nilo Alvarez Toledo³, Sunit Das³, Mandolin Bartling¹, Fahad Aldahari¹, John R de Almeida^{1

4}, Ilan Weinreb^{5

6}, Yvonne Chan^{1

7}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
² Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Pathology, University Health Network, Toronto, Ontario, Canada.
⁶ Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada.

Abstract

Background Radiation therapy is a mainstay of treatment for brain tumors, but delayed complications include secondary malignancy which may occur months to years after treatment completion. Methods We reviewed the medical records of a 41-year-old female treated with 60 Gy of radiation for a recurrent astrocytoma, who 6 years later developed a locally advanced sinonasal teratocarcinosarcoma. We searched MEDLINE, Embase, and Web of Science to conduct a scoping review of biopsy-proven sinonasal malignancy in patients who previously received cranial irradiation for a brain tumor. Results To our knowledge, this is the first report of a patient to present with a sinonasal teratocarcinosarcoma after receiving irradiation for a brain tumor. Our scoping review of 1,907 studies produced 14 similar cases of secondary sinonasal malignancy. Median age of primary cancer diagnosis was 39.5 years old (standard deviation [SD]: 21.9), and median radiation dose was 54 Gy (SD: 20.3). Median latency time between the primary cancer and secondary sinonasal cancer was 9.5 years (SD: 5.8). Olfactory neuroblastoma was the most common sinonasal cancer ( n = 4). Fifty percent of patients died from their sinonasal cancer within 1.5 years. Conclusion Patients who receive radiation exposure to the sinonasal region for treatment of a primary brain tumor, including low doses or scatter radiation, may be at risk of a secondary sinonasal malignancy later in life. Physicians who monitor at-risk patients must be vigilant of symptoms which may suggest sinonasal malignancy, and surveillance should include radiographic review with careful monitoring for a secondary malignancy throughout the entire irradiated field.

Keywords: case report; cranial irradiation; radiation therapy; radiation-induced malignancy; scoping review; secondary malignancy; sinonasal malignancy; sinonasal teratocarcinosarcoma.

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