Non-hodgkin's lymphoma of the nasal cavity and paranasal sinuses involving the skull base

Purpose: To evaluate the outcome of the patients with NonHodgkin's lymphoma of the nasal cavity and paranasal sinuses with skull base involvement. Materials and Methods: Four patients were identified with Non-Hodgkin's lymphoma of the sinonasal region involving the skull base. These patients were T4 N() M() by the AJCC criteria and stage IE by the Ann-Arbor classification. They received radiotherapy as the primary treatment. Results: The initial site of involvement was frontal sinus in two patients and ethmoid sinus in the other two patients. The commonest signs of CNS invasion were ophthalmoplegia, cranial nerve palsies and optic atrophy. The anterior cranial fossa was most frequently involved. Initially all patients had clinical response to radiotherapy. One patient developed local and distant métastases and he died of disease thirteen months later. The next patient developed a second primary and died eighteen months later from the same. His lymphoma was controlled. The third patient refused chemotherapy and is alive without disease (four months). The last patient is undergoing chemotherapy. Conclusion: Non-Hodgkin's lymphoma is a rare tumor of the head and neck corresponding to less than 5% of the head and neck malignancies. Base skull invasion signifies advanced stage. Local control of this disease by radiation therapy alone is good. We recommend adjuvant chemotherapy after primary radiotherapy to help control distant disease and hopefully translate into an increase in overall survival.