External Beam Irradiation for Squamous Cell Carcinoma of the Maxillary Sinus

Kim, Tae Hyun; Yoon, Won Sub; Yang, Dae Sik; Kim, Chul Yong; Choi, Myung Sun

Abstract

PURPOSE: Maxillary sinus cancers are usually locally advanced, and involve the structures around sinus, but the regional lymphatic spread is uncommon. Therefore, the local control of these cancers is important for their cure. We reviewed our experience of 55 patients with squamous cell carcinomas of the maxillary sinus, treated with radiation therapy, and looked for the role of radiation therapy in maxillary sinus cancers.
MATERIALS AND METHODS
Between November 1982 and October 1999, 55 patients with squamous cell carcinomas of the maxillary sinus underwent either radiation therapy only, or combined with surgery or with concurrent chemoradiation therapy. All patients were restaged according to the 1997 AJCC staging systems. The T classifications of the tumors of the patients were as follows:1.8% (1/55) for T2, 81.8% (45/55) for T3 and 16.4% (9/55) for T4. Thirteen patients were diagnosed with lymph node involvement. With the surgical procedures, 12 patients were managed by biopsy only, 21 were resected by FESS (functional endoscopic sinus surgery) and 22 by partial/medial/total maxillectomies. The details of the treatments were as follows:8 patients were treated with radiation therapy only, 17 with a combination of FESS and radiation therapy, 22 with a combination of a maxillectomy and radiation therapy, 4 with a combination of preoperative radiation therapy and surgery, and 4 with concurrent chemoradiation therapy. The mean follow-up for all patients was 25 months, ranging from 2.8 to 125 months.
RESULTS
The 4-year local control and survival rates for all patients were 45.5 and 33.3%, respectively. The 4-year local control and survival rates, due to the extent of surgery, were as follows:32.1, and 21.4 % for biopsy; 41.9, and 31.7% for FESS; and 56.8, and 52.7% for maxillectomy, respectively. Twenty-nine (52.7%) patients were not cured, and of these 29 patients, 23 (79.3%) patients had a local recurrence following treatment.
CONCLUSION
This study has shown that the major failure sites following treatment to be the local regions, and that the completeness of surgery was important for improving the local control and survival of patients with squamous cell carcinoma of the maxillary sinus.