Paranasal sinus cancer is a very rare disease. The literature contains numerous small retrospective reports describing the treatment and outcome of these patients. The comparison of patient outcome both within and between these reports is hampered by patient heterogeneity. We have outlined some of the caveats to be kept in mind when interpreting this literature and described some of the resultant controversies. The failure to achieve local control of advanced disease remains a major problem. Strategies for improvement of local control will include advanced surgical techniques with radiation dose escalation using state-of-the-art, high-precision delivery techniques accompanied by concurrent cytotoxic and/or biologic therapies. The ideal integration of surgery and radiation remains to be defined in the context of contemporary treatment approaches designed to achieve optimum local control and organ preservation.