Abstract
BackgroundThe aim of this study was to evaluate the long-term treatment results of combined superselective intraarterial chemotherapy and radiation therapy for advanced maxillary sinus cancer (MSC) and the incidence of regional lymph node failure, and to reveal the clinical and anatomical predictive factors for metastasis.MethodsWe retrospectively evaluated 55 consecutive patients with locally advanced squamous cell carcinoma of the maxillary sinus who were treated with external radiotherapy and superselective intraarterial chemotherapy. Elective nodal irradiation (ENI) was performed only in the clinical node-positive (cN+) cases and not in the clinical node-negative (cN0) cases. Results: Thirty-eight patients were cN0, and 17 were cN+ at diagnosis. Regional lymph node metastases occurred in 7 of 38 patients with cN0, and 2 of 17 with cN+ during the median follow-up period of 36 months. There were more cases of high-grade (3 or 4) late adverse events in the ENI group than in the non-ENI group (13% vs. 41%, respectively; p = 0.03). In cN0 cases without ENI, invasion of the pterygoid plates (57% vs. 90%; p < 0.01) and oral cavity (35% vs. 92%, with invasion vs without invasion, respectively; p = 0.02) was significantly correlated with a low 5-year regional recurrence-free rate.ConclusionsPatients with MCS and invasion of the pterygoid plates and oral cavity can be considered appropriate candidates for ENI.
Highlights
Maxillary sinus cancer (MSC) is a relatively rare disease, with an incidence of 1 per 100,000 person-years, accounting for 3% of all head and neck cancers [1]
In accordance with the Union for International Cancer Control (UICC, 7th edition) [8], staging was performed based on physical examination, computed tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography-CT (PET-CT) findings
The dose of elective nodal irradiation (ENI) was 46 Gy in 23 fractions by Three-dimensional conformal radiotherapy (3DCRT) or 50 Gy in 25 fractions by intensity-modulated radiation therapy (IMRT) for cN+ cases; ENI was not performed in Clinical node-negative (cN0) cases
Summary
Maxillary sinus cancer (MSC) is a relatively rare disease, with an incidence of 1 per 100,000 person-years, accounting for 3% of all head and neck cancers [1]. Network (NCCN) guidelines recommend elective nodal irradiation (ENI) for patients with T3 or T4 MSC, even in clinical node-negative (cN0) cases [2]. The long-term safety of ENI as a treatment for patients with advanced MSC is unknown because of the disease’s poor prognosis [3, 4]. The aim of this study was to evaluate the long-term treatment results of combined superselective intraarterial chemotherapy and radiation therapy for advanced maxillary sinus cancer (MSC) and the incidence of regional lymph node failure, and to reveal the clinical and anatomical predictive factors for metastasis
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