Dear Editor,
We are concerned to note that Chapter 23 of the latest iteration of the UK National Multidisciplinary Head and Neck Guidelines in Head and Neck Cancer,Reference Homer, Winter, Abbey, Aga, Agrawal and Ap Dafydd1 dealing with cancer of the nose, paranasal sinuses and skull base, makes no mention of the use of limited surgery with the topical application of 5-fluorouracil in the surgical management of adenocarcinoma of the maxillary sinus.
Granted, the evidence is limited and amounts to several case series, which have been recently reviewed by Revercomb et al.Reference Revercomb, Patel, Filimonov, Lerner and Filimonov2 However, as the authors of the chapter mention, the evidence base for management of these lesions is poor; indeed, the use of concurrent chemotherapy is extrapolated from trials of management for pharyngeal squamous carcinoma. The UK National Guidelines are used outside the UK also, and there are many countries where access to radiotherapy and prosthetic services are limited. In such a situation, we feel that a management option which potentially avoids a maxillectomy and radiotherapy (and all the morbidity these carry) in carefully selected cases should not be completely omitted.
Yours sincerely,
Ranjan Raychowdhury
Shaoni Sanyal
• Chapter 23 of the current UK National Guidelines for Head & Neck Cancer deals with the nose, paranasal sinuses and skull base
• The evidence base for these rare lesions is poor
• Unlike previous editions, no mention is made of the option of limited surgery with application of topical 5-fluorouracil in selected cases, which is a potentially organ sparing and radiotherapy sparing treatment
• Several case series of this management strategy have been recently reviewed
• Such a strategy would be invaluable in resource-constrained eynvironments
Financial support
None.
Competing interests
The authors declare none.
