Advanced Maxillary Sinus Carcinoma Research Articles

P-63 Inoperable locally advanced Carcinoma of Maxillary Sinus: Three different multimodality treatment approaches

P-63 Inoperable locally advanced Carcinoma of Maxillary Sinus: Three different multimodality treatment approaches

Locally Advanced Carcinoma of Maxillary Sinus with Orbital Involvement

Maxillary sinus carcinoma is a rare neoplasm, with incidence of 0.2 to 0.8% of all systemic malignancies. Patients are diagnosed in the advanced stage when there is orbital invasion with abnormal ocular signs and symptoms. The standard treatment of maxillary sinus carcinoma is en bloc radical maxillectomy along with orbital exenteration, followed by postoperative adjuvant therapy. Orbital exenteration is used when the malignancy extends to the orbit in case of squamous/basal cell carcinoma. The aim of the current review is to provide an insight into the management of advanced maxillary carcinoma with orbital involvement in a 42-year-old male.

Relationship between BMI and Postoperative Complications with Free Flap in Anterolateral Craniofacial Reconstruction

Background:Although we have seen tremendous advancement in microsurgery over the last 2 decades and free tissue transfer has become standard for head and neck reconstruction, surgeons still struggle to prevent postoperative complications. We examined the relationship between body mass index (BMI) and postoperative complications in patients undergoing rectus abdominis free flap transfer after anterolateral craniofacial resection.Methods:This was a retrospective review of reconstructive surgery using rectus abdominis musculocutaneous free flap in patients with locally advanced maxillary sinus carcinoma from 2003 to 2014 (n = 35, 27 men and 8 women; average age, 60.9 ± 7.8 years). All patients underwent craniofacial reconstruction after anterior and middle cranial fossa skull base resection and maxillectomy (class IV, subtype a) with palatal resection. Patients were categorized based on sex, BMI, and other parameters.Results:Recipient-site infection occurred in 11 patients (31.4%), cerebrospinal fluid leakage in 6 (17.1%), partial flap necrosis in 2 (5.7%), total flap necrosis in 1 (2.9%), and facial fistula in 4 (11.4%). Women showed partial flap necrosis significantly more frequently (P = 0.047), probably owing to poor vascular supply of the subcutaneous fat layer. Patients with low BMI (<20 kg/m2) showed recipient-site infection (P = 0.02) and facial fistula (P = 0.01) significantly more frequently owing to insufficient tissue volume and poor vascular supply.Conclusion:Postoperative recipient-site infection and facial fistula occurred mainly in low-BMI patients. Surgeons should take care to achieve sufficient donor tissue on low-BMI patients. Using a prosthetic obturator in low-BMI patients for craniofacial reconstruction can be a good alternative option to reduce postoperative complications due to insufficient donor tissue volume.

A Clinical Study of Maxillary Sinus Squamous Cell Carcinoma.

We report a retrospective study of 26 patients with maxillary sinus squamous cell carcinoma who were treated at the Sapporo Medical University between January 2002 and December 2008. The 5-year local control rate was 85.7% in patients with stage T2-3 disease and 61.0% in patients with stage T4a disease. The overall 5-year survival rate was 71.3% and the 5-year disease-specific survival rate was 79.9%. The 5-year disease-specific survival rate was 100% in patients with T2-3 disease and 44.4% in patients with T4 disease. The 5-year disease-specific survival rate was 76.3% in patients with N0 disease and 87.5% in patients with N+ disease. Five patients died of stage T4a disease. Two died of uncontrolled tumors at the primary site and 3 patients died of lung metastasis. We should consider another approach for the treatment of patients with advanced maxillary sinus carcinoma in the future.

Craniofacial Resection for T4 Maxillary Sinus Carcinoma: Managing Cases with Involvement of the Skull Base.

The objective of this study was to clarify the outcomes of craniofacial resection for locally advanced maxillary sinus carcinoma classified as T4 and to present methods for managing cases involving the skull base. Case series with chart review. Tertiary university hospital. We performed anterolateral craniofacial resection in en bloc fashion for locally advanced maxillary sinus carcinoma at stage T4. Participants comprised 40 patients with T4 maxillary sinus carcinoma treated between 1992 and 2011. Surgical outcomes were analyzed retrospectively. Forty patients with stage T4a (n = 26) or stage T4b (n = 14) were included in this study. Five-year overall and disease-free survival rates for the 40 patients with T4 maxillary sinus carcinoma were 62.7% and 52.6%, respectively. Cavernous sinus involvement correlated significantly with worse prognosis (P = .012). In 35 cases without cavernous sinus involvement, previous treatment (P = .017) and positive margins (P = .019) correlated significantly with worse prognosis, and 5-year overall and disease-free survival rates were 72.4% and 55.3%, respectively. This study only included cases of locally advanced maxillary sinus carcinoma classified as T4. Considering the advanced stage, our study suggests relatively favorable outcomes and the importance of managing the cavernous sinus in en bloc resections of malignant skull base tumors. Craniofacial resection in en bloc fashion achieved good survival rates.

Induction chemotherapy in technically unresectable locally advanced carcinoma of maxillary sinus.

Background. Locally advanced carcinoma of maxillary sinus has been historically reported to have poor prognosis. We evaluated the role of NACT in improving the outcome in these patients. Methods. 41 patients with locally advanced technically unresectable (stage IVa) or unresectable maxillary carcinoma (stage IVb) were treated with induction chemotherapy between 2008 and 2011. The demographic profile, response and toxicity of chemotherapy, definitive treatment received, progression free survival (PFS), and overall survival (OS) were analyzed. Univariate and multivariate analysis were performed to determine factors associated with PFS and OS. Results. The chemotherapy included two drugs (platinum and taxane) in 34 patients (82.9%) and three drugs (platinum, taxane, and 5 FU) in 7 (17.1%). There was no complete response seen in any of the patients, stable disease in 18 (43.9%), partial response in 16 (39%), and progression in 7 (17.1%) patients. After induction, the treatment planned included surgery in 12 (29.3%), CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%), and palliative chemotherapy in 3 (7.3%) patients. Overall, the median PFS was 10.0 months. The OS at 24 months and 36 months was 41% and 35%, respectively. Conclusion. In unresectable maxillary carcinoma, induction chemotherapy has clinically significant benefit with acceptable toxicity.

Treatment Outcome of Combined Radiation Therapy and Intra-arterial (IA) Chemotherapy for Advanced Maxillary Sinus Carcinoma

Treatment Outcome of Combined Radiation Therapy and Intra-arterial (IA) Chemotherapy for Advanced Maxillary Sinus Carcinoma

Neoadjuvant chemotherapy followed by definitive local treatment in locally advanced carcinoma maxillary sinus.

5585 Background: Locally advanced carcinoma of maxillary sinus has been historically reported to have poor prognosis. We evaluated the role of neoadjuvant chemotherapy in improving the outcome in these patients. Methods: 41 patients with locally advanced borderline resectable (stage IVa) or unresectable maxillary carcinoma (stage IVb) were treated with induction chemotherapy between 2008 and 2011. The protocol included 2 cycles of chemotherapy, response assessment and multidisciplinary clinic review for definitive local treatment. The demographic profile, response to induction therapy, toxicity of chemotherapy, definitive treatment received, time to treatment failure (TTF) and overall survival (OS) were analysed. Univariate and multivariate analysis was performed to determine factors associated with response, TTF and OS. Results: The cohort of 41 patients had a median age of 48 years (22-71) with male preponderance (80.5%). The chemotherapy included two drugs (platinum and taxane) in 34 patients (82.9%) and three drugs (platinum, taxane and 5 FU) in 7(17.1%) The taxane utilized was docetaxel in 22 patients (53.7%) and paclitaxel in 19 patients (46.3%). There was no complete response, stable disease in 18 (43.9%), partial response in 16 (39%), and progression in 7 (17.1%) patients. All patients competed two cycles of chemotherapy, adequate dose intensity was maintained in 33 patients (78%) and there were no deaths. Post-induction, the treatment planned included surgery in 12 (29.3%), CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%) and palliative chemotherapy in 3 ( 7.3%) patients. Overall, the median TTF was 10.2 months. With 16 deaths, the median OS was not reached. Only response post-induction was significantly associated with better TTF (p=0.02). Grade 3 tumor (p=0.04) and baseline serum albumin more than 4 mg/dl (p=0.02) were associated with better OS. Grade 3-4 neutropenia, febrile neutropenia and loose motions were seen in 21.1%, 23.8% and 15.8% respectively. Conclusions: In unresectable maxillary carcinoma, induction chemotherapy has clinically significant benefit with acceptable toxicity. Response to induction was the only significant factor for improved TTF.

Water-filled balloon in the postoperative resection cavity improves dose distribution to target volumes in radiotherapy of maxillary sinus carcinoma

Postoperative radiotherapy is a major treatment for patients with maxillary sinus carcinoma. However, the irregular resection cavity poses a technical difficulty for this treatment, causing uneven dose distribution to target volumes. In this study, we evaluated the dose distribution to target volumes and normal tissues in postoperative intensity-modulated radiotherapy (IMRT) after placing a water-filled balloon into the resection cavity. Three postoperative patients with advanced maxillary sinus carcinoma were selected in this trial. Water-filled balloons and supporting dental stents were fabricated according to the size of the maxillary resection cavity. Simulation CT scans were performed with or without water-filled balloons, IMRT treatment plans were established, and dose distribution to target volumes and organs at risk were evaluated. Compared to those in the treatment plan without balloons, the dose (D98) delivered to 98% of the gross tumor volume (GTV) increased by 2.1 Gy (P = 0.009), homogeneity index (HI) improved by 2.3% (P = 0.001), and target volume conformity index (TCI) of 68 Gy increased by 18.5% (P = 0.011) in the plan with balloons. Dosimetry endpoints of normal tissues around target regions in both plans were not significantly different (P > 0.05) except for the optic chiasm. In the plan without balloons, 68 Gy high-dose regions did not entirely cover target volumes in the ethmoid sinus, posteromedial wall of the maxillary sinus, or surgical margin of the hard palate. In contrast, 68 Gy high-dose regions entirely covered the GTV in the plan with balloons. These results suggest that placing a water-filled balloon in the resection cavity for postoperative IMRT of maxillary sinus carcinoma can reduce low-dose regions and markedly and simultaneously increase dose homogeneity and conformity of target volumes.

Selection of the optimal radiotherapy technique for locally advanced maxillary carcinoma using a three-dimensional treatment planning system

To compare the isodose distribution of three radiotherapy techniques for locally advanced maxillary sinus carcinoma and analyze the potential of three-dimensional (3D) conformal radiotherapy planning in order to determine the optimal technique for target dose delivery, and spare uninvolved healthy tissue structures. Computed tomography (CT) scans of fourteen patients with T3-T4, N0, M0 maxillary sinus carcinoma were acquired and transferred to 3D treatment planning system (3D-TPS). The target volume and uninvolved dose limiting structures were contoured on axial CT slices throughout the volume of interest combining three variants of treatment plans (techniques) for each patient: 1. A conventional two-dimensional (2D) treatment plan with classically shaped one anterior + two lateral opposite fields and two types of 3D conformal radiotherapy plans were compared for each patient. 2. Three-dimensional standard (3D-S) plan: one anterior + two lateral opposite coplanar fields, which outlines were shaped with multileaf collimator (MLC) according to geometric information based on 3D reconstruction of target volume and organs at risk as seen in the beam eye's view (BEV) projection. 3. Three-dimensional non-standard (3D-NS) plan: one anterior + two lateral noncoplanar fields, which outlines were shaped in the same manner as in 3D-S plans. The planning parameters for target volumes and the degree of neurooptic structures and parotid glands protection were evaluated for all three techniques. Comparison of plans and treatment techniques was assessed by isodose distribution, dose statistics, and dose-volume histograms. The most enhanced conformity of the dose delivered to the target volume was achieved with 3D-NS technique, and significant differences were found comparing 3D-NS vs. 2D (Dmax: p<0.05; Daver: p<0.01; Dmin: p<0.05; V90: p<0.05, and V95: p<0.01), as well as 3D-NS vs. 3D-S technique (Dmin: p<0.05; V90: p<0.05, and V95: p<0.01), while there were no differences between 2D vs. 3D-S technique. 3D-S conformal plans were significantly superior to 2D plans regarding the protection of parotid glands, and the additional improvement of dose conformity was achieved with 3D-NS technique. 3D-NS technique resulted in the decrease of Dmax for ipsilateral retina compared with 3D-S technique, while the level of Dmax for optic nerve was increased (within an acceptable range) with 3D-NS technique. In this study, 3D planning of radiotherapy for locally advanced maxillary sinus carcinoma with noncoplanar fields, which number did not exceed the number of fields for conventional arrangement enabled conformal delivering of the adequate dose to the target volume with the improved sparing of adjacent uninvolved healthy tissue structures.

Elective ipsilateral neck irradiation of patients with locally advanced maxillary sinus carcinoma

Elective ipsilateral neck irradiation of patients with locally advanced maxillary sinus carcinoma

Elective ipsilateral neck irradiation of patients with locally advanced maxillary sinus carcinoma

The current study was conducted to investigate retrospectively whether elective ipsilateral neck irradiation (EINI) is effective in controlling subclinical neck disease in patients with locally advanced (T3 and T4) nonmetastatic (N0, M0) squamous cell carcinoma (SCC) of the maxilla. Between 1987 and 1993 a total of 44 patients were treated with EINI. The primary tumor bed was treated with 60 grays (Gy) in patients undergoing radical maxillectomy or with 66 Gy in patients undergoing partial maxillectomy. The ipsilateral upper and lower neck (down to the clavicle) was treated with either opposing anteroposterior-posteroanterior fields or appositional electron fields. The dose of elective neck radiotherapy was 50 Gy in 25 daily fractions. The 5-year and 10-year survival rates (with standard error [SE]) were 66% (SE 7%) and 60% (SE 8%), respectively, whereas the 5-year and 10-year recurrence free survival rates both were 64% (SE 7%). The 10-year local recurrence free survival rate was 69% (SE 7%), whereas the 10-year regional recurrence free survival rate was 94% (SE 4%). Of the 2 patients who developed a recurrence in the neck, 1 was salvaged successfully by surgery, producing an ultimate 10-year regional recurrence free survival rate of 97%. The 10-year distant metastasis free survival rate was 91% (SE 4%). The findings of the current study appear to suggest the potential efficacy of EINI in patients with locally advanced, nonmetastatic SCC of the maxilla and that the high rate of control of cervical lymph nodes may lead to better overall survival than that reported in the majority of the recent series.

Extended surgery for advanced maxillary sinus carcinoma.

Maxillary sinus carcinoma is a relatively uncommon head and neck tumor. It makes up 3% of head and neck malignancies. The commonest histology is squamous cell carcinoma, although adenoid cystic carcinoma, acinic cell tumor, and adenocarcinoma are not uncommon. These are primarily epithelial neoplasms arising in the mucosal lining of the sinus. Primary tumors of bone such as osteogenic sarcoma, ameloblastoma, and chondrosarcoma arise in the skeletal elements of the sinus. Consideration must also be given to those malignancies that arise from adjacent tissue and invade the maxilla and the maxillary sinus by direct extension. Examples of these are aggressive and neurotropic skin tumors such as basal cell carcinoma, squamous cell carcinoma, and malignant melanoma, which may invade the maxilla by extending along the vascular and neural foramina of the orbit and maxillary face. Direct extension of oral cavity tumors, such as carcinoma of the alveolar ridge, and nasal cavity tumors, such as esthesioneuroblastoma, and inferior extension of ethmoidal malignancies further exemplify spread from contiguous sites.

5-FU持続動注と照射による上顎洞癌治療の遠隔成績

Therapeutic results of 33 primary cases of maxillary sinus carcinoma treated with irradiation and intraarterial infusion of 5-FU between 1972 and 1984 were analyzed. The 5year crude survival rate for the group with stage T2 carcinoma (n =10) was 50.0%, and for those with T3 (n=15) and T4 (n=8) it was 46.7% and 25.0%, respectively. The overall 5year crude survival rate was 42.4%. Eight patients who did not undergo maxillectomy survived for 5 years after irradiation and intraarterial infusion. Recurrence of the tumor after the irradiation and intraarterial infusion occurred in 63.6%, and was frequently observed at the ethmoidal region and the orbita. In the areas in which the tumor extended to regions such as the ethmoid sinus and orbita, which are nourished by arteries other than the maxillary artery, conventional intraarterial infusion was ineffective for complete tumor eradication. Therefore, in most of the patients with advanced maxillary sinus carcinoma, partial or total maxillectomy following combined therapy of intraarterial infusion and irradiation is necessary to improve a prognosis.

レンチナン持続動注療法が奏効を示した高齢者進展上顎洞癌の１例

A 80-year-old male patient, diagnosed advanced maxillary sinus carcinoma was treated by multidisciplinary methods which included continous intra-arterial infusion immunochemotherapy with Lentinan, oral administration of 5'-DFUR, radiation and partial maxillary resection.He had a good course clinically, histopathologically and immunologically. Seven months after treatment he was free from local recurrence and distant metastasis. However he is still followed up. So, we think that a view of the regional immunocondition will be necessary for the prospective cancer treatment.