My own view, in terms of what we are now doing, which is treating gross disease
, is that gross disease
will become minimal disease - sub-clinical disease treated by new technologies.
The resection was considered complete if all gross disease
was resected or ablated.
Since there was no postoperative evidence of gross disease
in the nose or paranasal sinuses, we believe that a more radical and aggressive surgical intervention was not warranted in this case.
Also, preoperative and intraoperative identification of the bleeding site is difficult, as multiple segments of gross disease
may obscure the precise source of bleeding at surgery.
The challenge has been that although 55-60 Gy is needed to effectively treat postsurgical residual gross disease
, the safe limit of exposure is lower (for example, just 45 Gy to the spinal cord).
In a case like this, where extension of disease was great, the morbidity of surgery was weighed against its benefit and the decision was made to remove all gross disease
surgically, followed by adjuvant radiation therapy.