Maxillary Sinus Cancer Research Articles

The utility and outcomes of the temporalis muscle flap for palate reconstruction after maxillectomy for malignancy

Back groundA common pedicled facial technique in head and neck reconstruction is the TMF It can be utilised to replace missing tissues in a variety of conditions, including oral deformities of the hard and soft palate.Aim of the study was to document the utility and outcomes with the reconstruction of the palate using TM flaps following Maxillectomy For maxillary sinus malignancies MethodologyThe study included 24 patients who were operated on for cancer maxilla and eligible for maxillectomy and reconstruction of the Palate using temporalis flap. Follow-up was planned for at least 12 months postoperative. Postoperative physical and speech therapy are initiated to help improve speech and swallow outcomes and to prevent trismus ResultsThe current study included 24 cases with Maxillary sinus cancer with a mean age of 42.34±4.67. The mean operative time was 5.4±1.22 hours with no reported intraoperative bleeding or injury of important structures .No cases of facial palsy or trismus were reported while partial flap loss was reported in one case where oronasal fistula was evident. The donor site complications were minimal where seroma occurred in two patients and alopecia , wound infection and dehiscence were reported in one case each. The donor site depression was evident in 25% of cases ConclusionTMF is an excellent option for the reconstruction of many craniofacial defects, it is easy to be harvested with good blood supply with minimal postoperative complications

Optimal timing of postoperative radiotherapy initiation in maxillary sinus cancer patients

Optimal timing of postoperative radiotherapy initiation in maxillary sinus cancer patients

Activity of Matrix Metalloproteinase-7 (MMP-7) Related to Heparin-Binding Epidermal Growth Factor (HB-EGF) Activation in Squamous Cell as Diagnostic Biomarker for Early Detection And Treatment of Maxilarian Cancer: Review Article

Background: Squamous cell carcinoma (SCC) has a higher chance of occurance and progression in maxillary sinus cancer than other paranasal sinus cancers (80%). Matrix metalloproteinase-7 (MMP-7) is a protease specified in collagen type IV degradation and Heparin Binding Epidermal Growth Factor activation, which causes an increase in squamous cell carcinoma proliferation and metastasis Methods: This review aims to identify the potential role of MMP-7 as a target for prevention and therapeutic modality to manage SCC sinus maxillary cancer. We did literature searching in several databases to elucidate the importance of the MMP-7 pathway in SCC sinus maxillary cancer progression. Results: : Increasing expression and activity of MMP-7 are associated with maxillary sinus cancer progression. Squamous cells, the most impacted in maxillary sinus cancer, sustain dysplasia due to heparin-binding epidermal growth factor (HB-EGF) activation into EGF by MMP-7 and Cluster of Differentiation 44 (CD44) binding complexes that trigger high proliferation and mitogenic activity. The therapeutic function of MMP-7 occurs by affecting the protein 53 (p53) in cancer cell apoptosis initiation by specific interaction with CD44. Conclusion: MMP-7 could be an alternative therapeutic target and potential treatment option for maxillary sinus cancer. Furthermore, more trials should be done to test the relevancy of MMP-7 uses as an SCC sinus maxillary cancer modality

Effect of radiotherapy on head and neck cancer tissues in patients receiving radiotherapy: a bioinformatics analysis-based study

Radiotherapy is pivotal in treating head and neck cancers including nasopharyngeal, tongue, hypopharyngeal, larynx, maxillary sinus, parotid gland, and oral cancers. It holds the potential for curative effects and finds application in conjunction with chemotherapy, either as a radical method to preserve organ function or as an adjuvant postoperative treatment. We used bioinformatics analysis to investigate the effects of radiotherapy on head and neck cancer tissues in patients who had received radiotherapy. In this study, the expression and mutation profiles of The Cancer Genome Atlas–Head-Neck Squamous Cell Carcinoma were downloaded from the UCSC-Xena database, categorizing patients into two groups—those receiving radiotherapy and those not receiving radiotherapy. Subsequently, differential expression analysis and gene set enrichment analysis (GSEA) were performed. Following this, single-sample GSEA (ssGSEA) scores related to glucose and lipid metabolism were compared between the two groups. Additionally, immune cell infiltration analysis and single-cell verification were performed. Finally, the mutation profiles of the two groups were compared. The analyses revealed that patients receiving radiotherapy exhibited prolonged survival, enhanced apoptosis in head and neck cancer tissue, and diminished keratinocyte proliferation and migration. A comparison of ssGSEA scores related to glucose and lipid metabolism between the two groups indicated a reduction in glycolysis, tricarboxylic acid cycle activity, and fat synthesis in tissues treated with radiotherapy, suggesting that radiotherapy can effectively inhibit tumour cell energy metabolism. Analyses of immune cell infiltration and single-cell verification suggested decreased infiltration of immune cells post-radiotherapy in head and neck cancer tissues. A comparison of mutation profiles revealed a higher frequency of TP53, TTN, and CDKN2A mutations in patients receiving radiotherapy for head and neck cancer. In conclusion, the bioinformatics analyses delved into the effect of radiotherapy on patients with head and neck carcinoma. This study provides a theoretical framework elucidating the molecular mechanisms underlying radiotherapy's efficacy in treating head and neck cancer and presents scientific recommendations for drug therapy following radiotherapy.

Detection of Rare Gallbladder Microperforation by 18F-FDG PET/CT in a Patient with Maxillary Sinus Cancer.

Gallbladder perforation is one of the most serious complications of cholecystitis and is rarely seen in 2-11% of cases. Pericholecystic abscesses secondary to gallbladder perforation are rare. Rapid diagnosis is important because of high morbidity and mortalityrates. A subcapsular abscess secondary to gallbladder microperforation is presented on 18F-fluorodeoxyglucose positron emission tomography/computed tomography performed for restaging in a patient with maxillary sinus cancer.

Pembrolizumab-associated Neuronopathy with Improved Lower Limb Somatosensory Evoked Potential After Intravenous Methylprednisolone Treatment: A Case Report.

Cases of neuronopathy associated with immune checkpoint inhibitors (ICIs) have rarely been reported. We herein report a case of ICI-associated neuronopathy. A 54-year-old man underwent chemotherapy for right maxillary sinus cancer. Two months after pembrolizumab treatment, diarrhea, worsening of abnormal sensations, and severe ataxia of the lower limbs were observed. Somatosensory evoked potentials (SEPs) with tibial nerve stimulation showed disappearance of the N21 waveform. A colonic biopsy suggested ICI-associated colitis. Based on these findings, the patient was diagnosed with ICI-associated neuronopathy. Clinical symptoms and SEP findings improved markedly after two courses of intravenous methylprednisolone.

Dose-Finding and Efficacy Confirmation Trial of the Superselective Intra-arterial Infusion of Cisplatin and Concomitant Radiation Therapy for Locally Advanced Maxillary Sinus Cancer (JCOG1212): Results of the Efficacy Confirmation Phase in Patients with T4aN0M0

Background: Locally advanced maxillary sinus cancers require radical surgery as a standard treatment. But this often results in significant disfigurement and impairment of function. JCOG1212 seeks to evaluate the safety and efficacy of the superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT) for T4aN0M0 and T4bN0M0 maxillary sinus squamous cell carcinomas (MS-SCC). We herein report the results of the efficacy confirmation phase in the T4a cohort.Patients and methods: Patients received cisplatin 100 mg/m2 intra-arterially weekly for 7 weeks with concomitant radiotherapy (total 70 Gy) as determined by the results of the preceding dose-finding phase. The trial aimed to evaluate the primary endpoint of 3-year overall survival (3yr OS), comparing RADPLAT with the historical control for 3yr OS in surgery (80%).Results: From April 2014 to August 2018, 65 patients were registered in the T4a cohort from 18 institutions, consisting of 54 males and 11 females with a median age of 64 years (range, 40-78 years) and ECOG PS 0/1 (58/7). After excluding one ineligible patient, 64 patients were included in the primary analysis of efficacy and safety. The median follow-up was 4.5 years in all eligible patients, and the primary endpoint for 3yr-OS was 82.8% (90% CI, 73.4%-89.2%). With regard to acute adverse events, mucositis (≥ grade 3), neutropenia (≥ grade 3), increased creatinine (≥ grade 2), hearing impairment (≥ grade 2), and stroke (≥ grade 2) were observed in 20.3%, 14.1%, 3.1%, 3.1%, and 1.6% of patients, respectively. One treatment-related death due to a thromboembolic event was reported.Conclusion: We demonstrated that RADPLAT showed favorable results for patients with T4aN0M0 MS-SCCs compared with the historical control for 3yr OS in surgery, which was from an earlier period, and showed some specific toxicities. Therefore, RADPLAT, as well as surgery, can be regarded as a possible treatment option for these patients.

Ligation of the ethmoid arteries in superselective intra‐arterial infusion of cisplatin for advanced maxillary sinus cancer fed by the ophthalmic artery

Superselective cisplatin (CDDP) infusion via the external carotid artery system and concomitant radiotherapy (RADPLAT) provides favorable oncological and functional outcomes in patients with maxillary sinus cancer. However, targeted lesions are occasionally fed by the branch of the internal carotid artery. In RADPLAT for maxillary sinus cancer partly fed by the ophthalmic artery, the ethmoid arteries were ligated in two patients without medial orbital wall involvement. In four patients with that, CDDP was administered via the ophthalmic artery. A complete response was obtained in all six patients. Locoregional recurrence was not observed in any cases. However, visual acuity was lost in four patients who received the ophthalmic artery infusion. Ligation of the ethmoid arteries is recommended in RADPLAT for maxillary sinus cancer with lesions fed by the ophthalmic artery. CDDP administered via the ophthalmic artery may be considered if a patient accepts the possibility of visual loss.

A case of amebiasis during induction chemotherapy for maxillary sinus cancer

A case of amebiasis during induction chemotherapy for maxillary sinus cancer

Case of Lower Eyelid Reconstruction with the Reverse Facial Artery Flap for Incomplete Eyelid Closure After Maxillectomy and Radiotherapy

Different methods have been used to reconstruct the lower eyelids. Herein, we report a case of lower eyelid reconstruction using a reverse facial artery flap. A 66-year-old woman underwent a partial maxillectomy that included the orbital floor and received radiotherapy for maxillary sinus cancer. The lower eyelid gradually atrophied, resulting in incomplete closure. Thus, lower eyelid reconstruction was performed using a reverse facial artery flap, which was applied for nose and lip reconstruction. However, to date, there have been no reports on lower eyelid reconstruction in Japan. The reverse facial artery flap was a good match for the lower eyelid in terms of color and texture. A relatively large flap was harvested, and the lower eyelid was reconstructed as a unit. The flap was thick, which was favorable for correcting the eyelid depression. Cheek contracture was observed after maxillectomy; therefore, cutting the mimetic muscles to elevate the flap was not considered a newly identified complication. Thus, the application of the reverse facial artery flap may be limited. However, this can be an option for lower eyelid reconstructions.

CLINICOPATHOLOGICAL PROFILE OF MALIGNANT MAXILLARY SINUS TUMORS: A CASE SERIES

Maxillary sinus cancer is a rare entity and is commonly related to late diagnosis and poor prognosis. In this case series, we analyzed the clinicopathologic profile of 17 patients with malignant maxillary sinus tumors (MMSTs) treated at our center. Eleven tumors were diagnosed as squamous cell carcinoma (SCC, 64.7%) and 6 were non-SCC (35.3%). Ten patients were men (58.8%) and 7 were women (41.2%), and the average age was 65.7 years. All tumors were diagnosed at an advanced stage. The main signs and/or symptoms of MMSTs are maxillary swelling, pain, nasal obstruction, intraoral ulcer or nodule, dental mobility, and exophthalmos. Six patients had the first sign and/or symptom in the intraoral region (35.3%). Four patients were initially misdiagnosed as odontogenic infection (23.5%) and 3 as sinusitis (17.6%). This case series reveal that the oral cavity may be the first region of clinical presentation of maxillary sinus malignant tumors.

Palatal mucoperiosteal flap for oro-nasal fistula following maxillectomy for maxillary sinus cancer

ObjectivesThis study aimed to describe the technique and clinical outcomes of using a palatal mucoperiosteal flap for oro-nasal fistula closure following resection of maxillary sinus cancer. MethodsThe study was conducted with the permission of the internal review board of the Japanese Red Cross Wakayama Medical Center. Five consecutive cases from 2016 to 2020 of surgically treated maxillary sinus cancer in which the oro-nasal fistulas were closed using a palatal mucoperiosteal flap were retrospectively reviewed. ResultsFollowing tumor resection, the oro-nasal fistula was closed using a palatal mucoperiosteal flap. Complete separation of the oral and nasal cavities was achieved in four patients. Oral intake was resumed within two weeks in four patients. All the patients were able to eat foods similar to those in the preoperative period. Their postoperative speech function was excellent, with no difficulty in communicating with others. ConclusionIn the selected cases of maxillary sinus cancer, preservation of the palatal mucosa and closure of an oro-nasal fistula using a palatal mucoperiosteal flap was possible with reasonable outcomes for swallowing and speech functions. The use of this local flap is recommended as a minimally invasive procedure that can be performed especially in patients with limited physiological reserves which preclude free flap reconstruction.

Dose-finding and efficacy confirmation trial of the superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for locally advanced maxillary sinus cancer (JCOG1212): Results of the efficacy confirmation phase in the T4a cohort.

6014 Background: The JCOG1212 trial seeks to evaluate the safety and efficacy of the superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (RADPLAT) for patients (pts) with T4aN0M0 or T4bN0M0 maxillary sinus squamous cell carcinomas (MS-SCC). T4aN0M0 MS-SCC requires radical surgery with or without complete resection of the orbital contents as a standard treatment, which results in disfigurement and functional impairment. We herein report the results of the efficacy confirmation phase in the T4a cohort. Methods: Eligible pts with T4aN0M0 MS-SCC were registered and received cisplatin 100 mg/m 2 intra-arterially weekly for 7 weeks with concomitant radiotherapy (total 70 Gy) as determined by the results of the previous dose-finding phase. The trial investigated the 3-year overall survival (3yr OS) of RADPLAT to demonstrate its non-inferiority to surgery, the current standard of care, and its superiority to IV-CRT, which is used for pts refusing surgery. From the results of observational study undertaken by our group, the historical control for the 3yr OS was set at 80% for surgery and 65% for IV-CRT. A margin of 15% was set to demonstrate its non-inferiority to surgery and superiority to IV-CRT. Thus, when the lower boundary of the two-sided 90% confidence interval (CI) exceeds the threshold of 65% for 3yr OS, RADPLAT will be confirmed as the new standard. A sample size of 62 was required to achieve 80% power with a one-sided 5% significance level. Results: From April 2014 to August 2018, 65 pts were registered in the T4a cohort from 18 institutions, consisting of 54 males and 11 females with a median age of 64 years (range, 40-78 years) and ECOG PS 0/1 (58/7). After the exclusion of one ineligible patient, 64 pts were included in the primary analysis of efficacy and safety. The complete clinical remission rate was 73.4% (47/64, 95% CI, 60.9%-83.7%), with 15 showing CR and 32 showing good PR. The median follow-up was 4.5 years in all eligible pts and the primary endpoint for 3yr-OS was 82.8% (90% CI, 73.4%-89.2%), which met the prespecified hypothesis. The 3yr event-free survival and 3yr local event-free survival were 60.9% (95% CI, 47.9%-71.7%) and 65.6 % (95% CI, 52.5%-75.8%), respectively. With regard to acute adverse events, neutropenia (≥ grade 3), increased creatinine (≥ grade 2), hearing impairment (≥ grade 2), mucositis (≥ grade 3), and stroke (≥ grade 2) were observed in 14.1%, 3.1%, 3.1%, 20.3%, and 1.6% of pts, respectively. One treatment-related death due to a thromboembolic event was reported. Conclusions: RADPLAT is non-inferior to surgery and superior to IV-CRT for pts with T4aN0M0 MS-SCCs and showed manageable toxicities. Therefore, RADPLAT, as well as surgery, should be considered the new standard treatment option for these pts. Clinical trial information: UMIN000013706.

Organized Hematoma after Intra-Arterial Chemoradiotherapy for Maxillary Sinus Cancer: A Case Report.

An organized hematoma (OH) is a relatively rare benign lesion of the paranasal sinuses. Traditionally, it has been reported to occur following trauma, surgery, and sinus hemorrhagic lesions and in various bleeding predispositions. OHs are sometimes difficult to differentiate from malignancy because of the similar clinical symptoms and bone destruction. It is especially difficult when OHs occur in the same location as the primary tumor after treatment of a malignant tumor. In this paper, we report two cases of OH that occurred after intra-arterial chemoradiotherapy (IACRT) for maxillary sinus cancer. In one case, FDG accumulation was found in PET/CT and suspected to be a cancer recurrence. However, the postoperative pathology showed no malignant findings. This suggests that OH may show accumulation on 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET). In both cases, bleeding from the maxillary sinus continued after surgery. In one case, recurrence was observed, and in the other, nasal irrigation prevented the pooling of blood in the maxillary sinus, and no recurrence was observed. These cases suggest that OH after IACRT may easily recur because the bleeding continues even after surgery. In such cases, nasal irrigation or preoperative embolization may be helpful to avoid recurrence.

Treatment of electroplating industry wastewater: a review on the various techniques.

Water pollution by recalcitrant compounds is an increasingly important problem due to the continuous introduction of new chemicals into the environment. Choosing appropriate measures and developing successful strategies for eliminating hazardous wastewater contaminants from industrial processes is currently a primary goal. Electroplating industry wastewater involves highly toxic cyanide (CN), heavy metal ions, oils and greases, organic solvents, and the complicated composition of effluents and may also contain biological oxygen demand (BOD), chemical oxygen demand (COD), SS, DS, TS, and turbidity. The availability of these metal ions in electroplating industry wastewater makes the water so toxic and corrosive. Because these heavy metals are harmful to living things, they must be removed to prevent them from being absorbed by plants, animals, and humans. As a result, exposure to electroplating wastewater can induce necrosis and nephritis in humans and lung cancer, digestive system cancer, anemia, hepatitis, and maxillary sinus cancer with prolonged exposure. For the safe discharge of electroplating industry effluents, appropriate wastewater treatment has to be provided. This article examines and assesses new approaches such as coagulation and flocculation, chemical precipitation, ion exchange, membrane filtration, adsorption, electrochemical treatment, and advanced oxidation process (AOP) for treating the electroplating industry wastewater. On the other hand, these physicochemical approaches have significant drawbacks, including a high initial investment and operating cost due to costly chemical reagents, the production of metal complexes sludge that needs additional treatment, and a long recovery process. At the same time, advanced techniques such as electrochemical treatment can remove various kinds of organic and inorganic contaminants such as BOD, COD, and heavy metals. The electrochemical treatment process has several advantages over traditional technologies, including complete removal of persistent organic pollutants, environmental friendliness, ease of integration with other conventional technologies, less sludge production, high separation, and shorter residence time. The effectiveness of the electrochemical treatment process depends on various parameters, including pH, electrode material, operation time, electrode gap, and current density. This review mainly emphasizes the removal of heavy metals and another pollutant such as CN from electroplating discharge. This paper will be helpful in the selection of efficient techniques for treatment based on the quantity and characteristics of the effluent produced.

Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study.

BackgroundThe resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology.Material and MethodFour maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared.Results3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001).ConclusionsThis preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.

Radiologic criteria of retropharyngeal lymph node metastasis in maxillary sinus cancer

ObjectiveTo determine the most appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with maxillary sinus cancer (MSC).Materials and methodsWe retrospectively evaluated 16 consecutive patients who underwent magnetic resonance imaging (MRI) before and after the treatment of locally advanced squamous cell carcinoma of the maxillary sinus. The minimal and maximal diameters of all RLNS were recorded. RLNs were classified as metastatic on the basis of the MRI follow-up (f/u). RLNs were considered non-metastatic if stable disease continued until the final MRI f/u and metastatic in cases with different evaluations (complete response, partial response, progressive disease) determined using Response Evaluation Criteria in Solid Tumours (RECIST) ver. 1.1. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the accuracy of various criteria in the diagnosis of metastatic RLNs.ResultsOf the 34 RLNs in 16 cases observed on pretreatment MRI, 7 were classified as metastatic RLNs and 27 as non-metastatic RLNs. Using the radiologic criteria, metastatic RLNs tended to be diagnosed more accurately with the minimal axial diameter than with the maximal axial diameter (AUC; 0.97 vs. 0.73, p = 0.06). The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 5 mm or larger, with an accuracy of 94.1% (32 of 34).ConclusionsThe most appropriate radiologic criterion of metastatic RLNs in MSC is a minimal axial diameter of 5 mm or longer.

Imaging predictor of ophthalmic involvement in maxillary sinus cancer during super selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT)

ObjectiveTo investigate the predictability of ophthalmic artery involvement in maxillary sinus cancer using preprocedural contrast enhanced CT and MRI.MethodsWe analyzed advanced (T3, T4a, and T4b) primary maxillary sinus squamous cell carcinoma treated with super-selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) from Oct 2016 to Mar 2020. Two diagnostic radiologists evaluated the tumor invasion site around the maxillary sinus using preprocedural imaging. These results were compared with the angiographic involvement of the ophthalmic artery using statistical analyses. We also evaluated our RADPLAT quality using complication rate, response to treatment, local progressive free survival (LPFS), and overall survival (OS).ResultsTwenty patients were included in this study. There were ten cases of ophthalmic artery tumor stain and there was a correlation between ophthalmic artery involvement and invasion for ethmoid sinus with statistically significant differences. Other imaging findings were not associated with ophthalmic artery involvement.ConclusionsEthmoid sinus invasion on preprocedural imaging could suggest ophthalmic artery involvement in maxillary sinus cancer. It may be useful in predicting prognosis and treatment selection.

Maxillary Sinus Floor Infiltration: Results From a Series of 118 Maxillary Sinus Cancers

Maxillary cancers are rare and aggressive tumors, which can spread beyond the sinus bony walls. Preoperative assessment of infiltration of maxillary sinus floor (MSF) is paramount for surgical planning, as palatomaxillary demolition significantly impacts patients' quality of life. This study investigates the challenges involved in the preoperative and intraoperative evaluation of MSF infiltration and analyzes its prognostic relevance. Retrospective case series. A retrospective review of patients treated for sinonasal malignancies at a single Institution was performed. Patients receiving surgical-based treatment with curative intent for primary maxillary sinus cancers, between January 2000 and November 2019, were included. A cohort of 118 patients was analyzed. By comparing intraoperative findings (endoscopic assessment and frozen sections) with preoperative radiological assessment, diagnostic changes with regard to MSF infiltration were found in 27.1% (32/118 cases). MSF infiltration negatively affected the prognosis in both univariate and multivariate analyses in the overall population. In the subgroup ofpT1-T3 tumors, MSF infiltration was significantly associated with reduced overall (P=.012), disease-free (P=.011), and distant recurrence-free (P=.002) survival rates. Conversely, pT classification was not able to stratify patients according to prognosis, mainly because early-staged cancers (pT1-T2) with MSF infiltration showed reduced survival rates, similar to those observed in pT3 cancers. Preoperative imaging should be integrated with intraoperative findings based on endoscopic inspection and frozen sections. Future studies are required to investigate the opportunity to incorporate MSF infiltration in the TNM staging system, considering its crucial role in defining the extent of surgery and its potential as prognosticator. 4 Laryngoscope, 132:26-35, 2022.

Salvage surgery improves the treatment outcome of patients with residual/recurrent maxillary sinus cancer after superselective intra-arterial cisplatin infusion with concomitant radiation therapy.

We have performed superselective intra-arterial cisplatin infusion with concomitant radiotherapy (RADPLAT) for patients with maxillary sinus cancer. The promising treatment outcomes of this non-surgical treatment were reported in past studies. However, few clinical studies have been conducted to evaluate the outcome of salvage surgery following RADPLAT. The purpose of this study was to analyze the treatment outcomes of salvage surgery for patients with recurrent maxillary sinus cancer after RADPLAT. We assessed 45 patients who had recurrence following RADPLAT between 1999 and 2017, and conducted a retrospective analysis. We excluded patients who did not complete RADPLAT. Patients were not considered to have completed RADPLAT if they underwent intra-arterial cisplatin less than three times or received a total radiation dose of less than 60Gy. The primary endpoint was overall survival. The median follow-up period for surviving patients after recurrence was 5.1years. Twenty-five of the 45 (56%) patients underwent salvage surgery. The 5-year overall survival rate was 68% in patients who underwent salvage surgery, while all patients who did not undergo salvage surgery died during the observation period. Fifteen of 24 (63%) patients with local recurrence underwent salvage surgery. Eight patients did not undergo salvage surgery because of unresectable disease; five of the eight patients had unresectable posterior extension. All nine patients with nodal recurrence underwent neck dissection. Treatment outcomes of salvage surgery following RADPLAT were favorable enough for it to be generally recommended. To reduce unresectable recurrence, the posterior section should be eradicated by RADPLAT.