Treatment of maxillary sinus cancer in the modern era: one institution’s experience

Abstract

This study was conducted to report on outcomes and prognostic factors for maxillary sinus cancer treatment at Memorial Sloan-Kettering Cancer Center. Records of 125 patients treated for maxillary sinus cancer between March 1987 and April 2012 were retrieved from our head and neck database. Patients were treated with either surgery plus postoperative radiation therapy (PORT) or definitive radiotherapy (RT). Patients with prior RT, distant metastases, melanoma, lymphoma, palliative treatment, or incomplete records were excluded. Survival outcomes were determined by the Kaplan-Meier method and prognostic factors evaluated by univariate analysis and log rank test. One hundred one patients met the inclusion criteria. Median length of follow-up was 86.7 months (range 2–264 months). Histology included squamous cell (61 %) and adenoid cystic carcinoma (15 %). There were 13 T1–T2, 21 T3, and 55 T4 patients. Thirteen had positive nodes at presentation, 83 nodes negative, and 7 unknown. Seventy-three were treated with surgery plus PORT and 28 with definitive RT. The 5-year local control (LC), incidence of distant metastasis (DM), and overall survival (OS) for the entire cohort were 56, 24, and 49 %, respectively. For surgery plus PORT, 5-year LC was 66 % and OS 64 %, and for definitive RT, 5-year LC was 21 % and OS 13 % (p < 0.001). The estimated 5-year OS for squamous cell and adenoid cystic histology was 55 and 73 %, respectively (p = 0.329). Nodal status was predictive of OS and adenoid cystic histology predictive of DM. Radionecrosis (one) and blindness (one) were reported late-term effects. Treatment outcomes for maxillary sinus cancer remain poor, although a combined therapeutic approach continues to provide the best survival and local recurrence outcomes. This suggests the need for further treatment escalation.