Oncological outcomes involving interventional radiotherapy (brachytherapy) on the primary lesion and surgery on the neck for squamous cell carcinomas of the nasal vestibule

BackgroundSquamous cell carcinoma of the nasal vestibule (SCC-NV) is an under-recognized often misclassified malignancy, also due to the lack of a specific ICD-O topographic code. Management remains controversial, particularly regarding the clinical staging and the optimal treatment of the primary lesion. The Italian Society of Otolaryngology recently proposed interventional radiotherapy (IRT – brachytherapy) on the primary lesion and surgery on the neck as a standard multimodal approach in these cases.MethodsWe retrospectively analysed 81 patients with SCC-NV treated between 2012 and 2024 in three Italian centres. All patients received IRT for the primary lesion, neck dissection was performed in cN + cases. Tumours were staged using UICC/AJCC, Wang, and Rome classifications.ResultsTwo-year overall survival, disease-specific survival, local relapse-free survival, and regional relapse-free survival were 87%, 91%, 86%, and 90%, respectively. The Rome classification showed superior predictive value for local and regional control compared to UICC/AJCC and Wang.ConclusionThe bimodal approach has provided excellent oncological outcomes in SCC-NV. Accurate baseline staging, including PET-CT and US-guided FNAB, is essential. The Rome T classification appears superior to existing systems and may guide future staging revisions. These findings support recent recommendations from the Italian Society of Otolaryngology.