Maxillary Sinus Cancer Research Articles

A rare case of maxillary sinus cancer that involve the orbit and adjacent structures

43year old male diagnosed as case of Maxillary sinus cancer that involved the orbit. CT scan of face revealed large ill defined extensively infiltrated soft tissue mass of 7*5*4.4 cm in maxillary sinus which extended to infratemporal fossa and erosion of floor of the right orbit with infiltration of right inferior rectus muscle. The prognosis of maxillary sinus cancer with involvement adjacent structures is not very good (usually diagnosed at an advanced stage), so to attain an improved result it was essential to secure adequate resection of margins. So we followed a standard treatment protocol that was total maxillectomy with orbital exenteration, followed by postoperative radiation therapy.

Invasion of the pterygoid plates: an indicator for regional lymph node failure in maxillary sinus cancer

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.

A Case of Huge Solitary Fibrous Tumor with Maxillary Sinus Wall Destruction Masquerading as Maxillary Sinus Cancer

Solitary fibrous tumors (SFT) are rare fibroblastic mesenchymal neoplasms which are originally described as neoplasms of the pleura originating from the spindle cells. Although it can originate from extrapleural sites including the head and neck, it is exceedingly rare in the sinonasal tract. There has been no reported cases of SFT involving the paranasal sinuses in Korea; however, there was case of a 34-year-old man who presented with persistent left nasal obstruction and watering of the left eye. Imaging by CT and MRI revealed a large, highly vascular tumor occupying the maxilloethmoidal sinus cavities associated with bony wall destruction, masquerading as maxillary sinus cancer. The tumor mass occupying sinus cavities was removed through endoscopic and Caldwell-Luc approach. Histopathological examination of the tumor was consistent with SFT. We report this case to further insights regarding the diagnosis and management of this rare tumor.

Impact of Total Radiation Dose on the Treatment Outcomes in Radiotherapy and Concomitant Superselective Intra-arterial High Dose Cisplatin for Locally Advanced Maxillary Sinus Cancer

The purpose of this study is to analyze the relationship between the total radiation dose and the treatment outcomes in radiotherapy and concomitant superselective intra-arterial high dose cisplatin (RADPLAT) for locally advanced maxillary sinus cancer. We have evaluated 54 patients with locally advanced maxillary sinus cancer, who were treated with RADPLAT from March 2004 to February 2019. There were 45 males and 9 females. The median age was 68 years (range 38 to 87 years). T stage was T2 in 2 case, T3 in 10 cases, T4a in 31 cases, and T4b in 11 cases. All patients had no nodal involvement. There were 53 patients who had squamous cell carcinomas, and one with undifferentiated carcinoma. Thirty-four patients received three-dimensional conformal radiotherapy (3DCRT) until 2015, and 20 patients received intensity modulated radiotherapy (IMRT) using volumetric modulated arc therapy since 2016. Median prescribed dose to the local lesion was 66 Gy (range 50 to 66 Gy) in 3DCRT group and 66 Gy (range 60 to 70 Gy) in IMRT group. All patients were irradiated at 2 Gy/fraction. All patients did not receive either prophylactic neck irradiation or volume reduction surgery before RADPLAT. Superselective intra-arterial infusions of high-dose cisplatin (100-120 mg/m2) was performed with median 6 cycles per week (range 1 to 10 cycles) in combination with simultaneous intra-venous infusions of sodium thiosulfate to neutralize cisplatin toxicity. Superselective intra-arterial infusions were performed during or before radiotherapy in all patients. The median follow-up period was 30.3 months (range 2.9 to 193 months). The 3-year local control rate and overall survival rate in all patients were 70.7%, and 86.2%, respectively. The 3-year local control rate were 88.5% in IMRT group, which had a slightly better control rate than 3DCRT group (64.0%) (p = 0.149). However, the patients who were treated with 70 Gy of IMRT (n = 14) tended to have excellent local control rate (91.7%) than patients treated with 66 Gy of IMRT or 3DCRT (72.1%, n = 27) and 60 Gy or lower of 3DCRT (49.2%, n = 13). There was no difference in total dose of cisplatin between the three groups. The 3-year overall survival rate was 100 % in patients treated 70 Gy, 90.0% in patients with 66 Gy, and 82.0% in patients with 60 Gy or lower (p = 0.655). There were no treatment-related deaths. Acute grade 3 mucositis developed in 5 patients in IMRT group and 9 patients in 3DCRT group. No late grade 3 or higher eye disorders except for cataract developed in IMRT group, while blindness occurred in 4 patients in 3DCRT group. The patients who had received 70 Gy using IMRT showed excellent local control rate without increasing adverse events. The total dose may have an impact on local control rate and survival rate in radiotherapy with concomitant superselective intra-arterial high dose cisplatin.

A case of bleeding from maxillary carcinoma embolized from the maxillary and ophthalmic arteries

BackgroundThe majority of maxillary sinus cancers are advanced at initial detection due to anatomical limitations and lack of early symptoms. In patients with orbital invasion, the feeding arteries of the tumor are often associated with the ophthalmic artery in addition to the maxillary artery. We describe a case of tumor bleeding in a patient with recurrent maxillary carcinoma that was treated with embolization from the maxillary and ophthalmic arteries.Case presentationA 70-year-old man was treated for left maxillary carcinoma from the maxillary artery with 6 cycles of selective intra-arterial cisplatin infusion with concomitant radiation therapy. He subsequently had epistaxis and underwent arterial embolization for hemostasis. He had almost no sight by this time. Angiography of the left external carotid artery and internal carotid artery revealed blood supply from the maxillary and ophthalmic arteries. Regarding the maxillary artery, coil embolization was performed after embolization with 300-500 μm Embosphere. On the other hand, for the ophthalmic artery, the 3rd portion, supratrochlear artery and dorsal nasal artery, were selected and embolized with coils. Final angiography revealed disappearance of tumor staining and a residual choroidoretinal blush. There was no bleeding that needed treatment up to 2 months after embolization.ConclusionsIn embolization of the ophthalmic artery, it is necessary to embolize the second and subsequent parts because the arteries associated with visual function branch off from the first part. Even in patients whose visual acuity has been almost lost, like in this case, there is a risk of eye pain from embolization at the proximal end, and distal embolization is necessary.

"Point line anterograde dissection" for the safe preparation of supraclavicular flap

Objective: To investigate the application in the preparation of supraclavicular island flap by "point line anterograde dissection (PLAD) ". Methods: A retrospective analysis was performed on 45 flaps of 43 patients treated with supraclavicular artery island flap from the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2013 to June 2019. The patients were all male, aged 35-72 years old. There were 26 cases of hypopharyngeal cancer, 4 cases of recurrent laryngeal cancer, 2 cases of cervical esophageal cancer, 1 case of tonsillar cancer, 1 case of parotid gland cancer, 3 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 2 cases of esophageal fistula after trauma, 2 cases of esophageal stricture after hypopharyngeal carcinoma operation, 1 case of autoimmune laryngeal stenosis, and 1 case of cheek defect after maxillary sinus cancer operation."Point" was the origin of the supraclavicular artery in the transverse carotid artery. "Line" was an extension line made along the starting point of the supraclavicular vessel for anterograde anatomy of 1-2 cm and the direction of the blood vessel. The extension line was used as the central axis of the designed island flap. Characteristics of flap blood supply, the time of flap preparation, flap survival, donor area recovery and clinical follow-up were recorded. Results: The arterial blood supply of the flap was constant, and the venous reflux was variable. The area of the prepared flap was (4-8) cm×(10-18) cm, and the preparation time was 30-60 min, with a median of 42 min. Skin flap survival rate was 100%. Partial necrosis of skin flap occurred in 1 patient and postoperative pharyngeal fistula occurred in 5 patients, all of whom were cured by dressing change. The donor site defects were closed and sutured directly. 3 patients had partial incision dehiscence and healed after dressing change. During the follow-up, 1 patient was lost, and the remaining 42 patients were followed up for 8 to 55 months.40 patients involved swallowing function, all of them returned to regular diet or soft fluid after operation.40 patients involved malignant tumors and local tumor recurrence in 3 patients among whom, there were 2 cases of lymph node recurrence, and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis. Conclusion: PLAD is a simple, safe and efficient method for the preparation of supraclavicular island flap.

Analysis of remote results of treatment of patients with maxillary sinus cancer

Maxillary sinus cancer is one of the most complex malignancies to treat and has an unfavorable prognosis for long-term outcomes. The purpose of the study: based on the evaluation of long-term treatment outcomes (mortality, survival) to analyze the effectiveness of treatment of patients with maxillary sinus cancer and other factors which influence the outcome, including the level of expression of molecular markers. Object and methods: Long-term results of surgical treatment of 103 patients with maxillary sinus cancer stage II-IV (T2-4N0-3M0) were evaluated, which was performed in the ENT oncology department of І.І. Mechnikov Dnipropetrovsk Regional Clinical Hospital over the period of 2011-2017. Remote follow-up of patients was conducted until 2019. Results: The effectiveness of the treatment is confirmed by the analysis of survival in the studied sample: annual survival of 87.36% (95% CI 80.94-93.78); three-years’ survival – 42.75% (95% CI 33.2-52.3); five-years’ survival – 19.76% (95% CI 12.07-27.45); median survival – 32.13 (95% CI 27.0-53.0) months. Using a regression analysis of the proportional risks by Cox, it was proved that patients with recurrences of thyroid cancer die from cancer 3.13 times more often (p=0.009) than individuals in whom cancer was not accompanied by recurrence, with increasing expression of the marker TIMP-1 per unit the risk of adverse outcomes for patients is reduced by 2.56 times (p=0.034). Conclusions: Evaluation of long-term treatment outcomes (mortality, one-, three-, and five-years’ survival) of patients with maxillary sinus cancer has proven the effectiveness of treatment and approaches to their determination.

Radiotherapy with combined techniques of volumetric-modulated arc therapy (VMAT) and simultaneously intra-tumor inner escalated boost (SIEB) successfully managing a patient with locoregionally advanced maxillary sinus cancer: a case report

Radiotherapy with combined techniques of volumetric-modulated arc therapy (VMAT) and simultaneously intra-tumor inner escalated boost (SIEB) successfully managing a patient with locoregionally advanced maxillary sinus cancer: a case report

Treatment Outcome and Patterns of Failure in Patients with Maxillary Sinus Cancer: Clinical Experience from a Regional Cancer Centre in North India.

Treatment of maxillary sinus cancer poses several challenges because of its complex anatomy, close proximity to critical structures and majority of patients presenting at an advanced stage. Despite presence of several treatment approaches, the outcome in these cancers has remained dismal. This article examines its clinical behaviour and treatment outcome of these patients treated at our centre in past 7years. In this retrospective study, 67 patients with carcinoma of maxillary sinus presented from January 2011 to December 2017 were analysed. All the patients reporting during this period were included except those who did not turn up after first visit. Of all the patients, 64.2% had squamous cell carcinoma. The majority of patients presented with advanced stage (IVA and IVB, 83.58%). Nodal disease at presentation was seen in seven patients (10.4%). Treatment to the primary site comprised of surgery and radiotherapy in 24 patients, radiotherapy alone in 22 patients and surgery alone in 12 patients. Statistical program for social sciences (SPSS) version 16 was used for all statistical analyses. The mean follow-up time was 25months (range 3-72months). Overall, 17 out of 41 patients who were treated with curative intent (41.5%) developed recurrence. Patients who underwent surgery followed by adjuvant radiotherapy did fairly better in terms of recurrence. Seven patients out of 17 (41.2%) could be salvaged by surgery or radiation. Only one patient developed distant metastasis to D8 vertebra. Patients who were treated with surgery and radiotherapy (either preoperative/adjuvant setting) had better disease-free survival. The results of the current study regarding the treatment of carcinoma of the maxillary sinus show feasibility and efficacy of multimodal therapy. Radical radiotherapy appears to be a feasible alternative in cases of inoperable tumours. Loco regional relapse remains a significant pattern of failure.

Pathological evaluation of radiotherapy and concomitant intraarterial cisplatin for maxillary sinus cancer

ObjectiveSince 2010, we have mainly performed surgical treatment following radiotherapy and concomitant intraarterial cisplatin (RADPLAT) for locally advanced maxillary sinus cancer (MSC). The present study investigated treatment results and pathological evaluations following RADPLAT for MSC. MethodsPathological response to RADPLAT was evaluated using surgical specimens. Pathological response was graded in accordance with the classification method that Shimosato reported in 1964, as grade V (no tumor cells remain in any of section), grade IV, III, II, I, and 0. Five-year overall and disease-specific survival rates were estimated using Kaplan-Meier methods. Univariate analyses of correlations between recurrence of MSC and other clinicopathological parameters were evaluated using the chi-square or Fisher's exact tests. Result19 patients were enrolled in this study, 5 patients showed T3 disease and 14 had T4 disease. One patient demonstrated local recurrence and 3 patients experienced distant metastasis. The 5-year overall survival rate was 67.1% (T3, 50.0%; T4, 69.6%), and the 5-year disease-specific survival rate was 81.9% (T3, 100%; T4, 76.0%). Histological response was categorized as grade V in 9 cases. No significant risk factors for residual cancer were identified. ConclusionOur study suggested that RADPLAT not only has a low risk of side effects, but also could represent an effective procedure for locally advanced MSC by pathological evaluation. Increasing the therapeutic intensity of RADPLAT might provide an effective modality to avoid highly invasive surgery.

Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients.

Maxillary sinus cancer is a rare disease with heterogeneous biologic behavior. The pattern of neurovascular invasion is known to be an important prognosticator in head and neck cancers, but has not been studied in maxillary malignancies. Patients undergoing surgery-based treatment with curative intent for a malignancy of the maxillary sinus at the Unit of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia between November 2000 and October 2018 were included. A description of the characteristics of the patients, tumors, and treatments has been performed along with uni- and multi-variate analysis of prognostic factors. Tumors were classified based on the presence of perineural (P0/P1) and lymphovascular invasion (V0/V1) in 4 categories: P0V0, P1V0, P0V1, and P1V1. One hundred-thirty-eight patients were included. Mean age at surgery was 61.0years. Most patients (60.1%) were affected by non-salivary carcinomas, and most tumors (73.9%) were high-grade cancers. One hundred-seven (77.5%) tumors were classified as pT4. The large majority of patients received bi- or tri-modality treatment. Sixty-three (45.7%) cases were classified as P0V0, 32 (23.2%) as P1V0, 7 (5.1%) as P0V1, and 36 (26.1%) as P1V1. T category, nodal status, and neurovascular invasion were significantly associated with prognosis. Perineural and lymphovascular invasion were associated with the topographical growth of the tumor. Maxillary cancer is often diagnosed at an advanced stage and in most cases requires a multimodal approach. Perineural and lymphovascular invasion are frequent and have a different impact on prognosis and topographical extension of the tumor.

Three-Modality Therapy for Advanced Squamous Maxillary Sinus Cancer Case Report

Carcinoma of the nasal cavity and paranasal sinuses is a rare malignancy. Due to non-specific symptoms, up to 75% of patients with paranasal sinus cancer present with advanced disease, when the tumor affects different vital structures. This circumstance determines a poor prognosis and low survival rate. We report the case of the patient who presented with stage 3 maxillary sinus cancer and underwent three-modality therapy: induction chemotherapy, radiotherapy and surgery. The patient’s follow up period is 7 years and she remain disease-free.

Reconstruction of orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection

Objective: To analyze the method and effect of reconstruction of the orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection. Methods: Thirty-three patients of T3/T4 stage maxillary sinus cancer with orbital invasion who were treated in Shandong Provincial Hospital from January 2010 to October 2016 were retrospectively analyzed, including 20 males and 13 females, aged from 12 to 80 years old. Patients were treated with appropriate surgical methods according to their clinical manifestation, imaging finding, invasion range, preoperative and intraoperative pathology. Surgical approaches such as maxillectomy, expanded maxillectomy and superstructure maxillectomy were used for patients with Medpor orbit floor repairment. Patients were followed up regularly after surgery, and the surgical efficacy was discussed by descriptive statistical method. Results: Of those 33 cases, 19 were squamous cell carcinoma, 8 were adenoid cystic carcinoma, 5 were inverted papilloma malignant transformation, and 1 was myoepithelial carcinoma in our study. After tumor resection and orbital floor repair, the orbital contents and eyeball function of all patients remained intact. During follow-up time ranged from 3 to 8 years, a total of 6 patients relapsed at 3 years and died of ineffective treatment. The survival rate was 81.8% (27/33). Conclusion: Tumor resection and Medpor orbital floor repair in maxillary sinus cancer patients with orbital invasion can preserve the function of the eyeball well, greatly improve the quality of patient's life.

Oral Lesion like Mucous Membrane Pemphigoid under Carboplatin-induced Hemolytic Anemia and Pancytopenia as Hypersensitive Reactions in a case with Maxillary Sinus Cancer: A Case Report

Here we report the first case of fatal carboplatin induced immune hemolytic anemia in a patient with head and neck malignant neoplasms followed by onset of multi-organ failure. While carboplatin is an effective agent used to treat many kinds of malignant tumorigenic lesion, a number of reports about allergic side effects are present. A 64-year-old male patient diagnosed as maxillary sinus cancer was treated by radiation therapy associated with weekly intravenous infusions of carboplatin. After five times of carboplatin infusion, white blood cell and platelet counts and hemoglobin value gradually decreased, and reached to almost bottom level. Both direct and indirect coombs tests were negative. Reticulocyte count and the value of platelet-associated IgG were high level, and oral lesion-like mucous membrane pemphigoid appeared on tongue and hard plate. Recognition of the particular oral abnormality in the early stage could allow for correct diagnosis and a potentially effective therapy. Funding: This study was supported in part by JSPS KAKENHI Grant Number 18K09885.

Intra-arterial chemoradiotherapy including internal carotid arterial infusion for advanced maxillary sinus cancer with orbital invasion

Intra-arterial chemoradiotherapy including internal carotid arterial infusion for advanced maxillary sinus cancer with orbital invasion

ANALYSIS OF EXPRESSION OF P63 AND CASPASE-3 AND THEIR PREDICTIVE VALUE IN PATIENTS WITH SQUAMOUS CELL CARCINOMA OF MAXILLARY SINUS

Introduction: Maxillary sinus cancer is a malignant neoplasm with a prevalence of 3 to 5% of tumors in the head and neck and less than 1% of all malignant neoplasms. The role of p63 and caspase-3 and their predictive value in squamous cell carcinoma of maxillary sinus (SCCMS) remains an underdeveloped and controversial issue that determined the relevance of the study. The aim: To analyze the relationship between the level of expression of p63 and caspase-3 and clinical and morphological characteristics of squamous cell carcinoma of maxillary sinus and to determine their prognostic significance as immunohistochemical markers of tumor progression (relapse and metastases). Materials and methods: A comprehensive investigation with immunohistochemical study of squamous cell carcinoma of maxillary sinus of 103 patients with maxillary sinus cancer II - IV stage (T2-4 N0-3 M0) of the second clinical group was conducted. Results: The moderate and high expression rate of caspase-3 in the overall sample was 50.49% and 16.50% respectively, and one third of cases (33.01%) was characterized by a weak reaction. In the group without metastases (p <0.001), moderate expression of the marker (56.25%) prevailed; in the SCCMS group with metastases it was (60.87%). The mean level of expression of p63 in the examined patients with squamous cell carcinoma of maxillary sinus was 46.0%. The number of p63-positive specimens was statistically significantly (p = 0.034) higher in the SCCMS group with metastases. In patients with the development of squamous cell carcinoma of maxilla on the background of papilloma, a significantly higher (p <0.001) mean level of p63 expression was only moderate (90.91%) and high (9.09%). Conclusions: There was observed a relatively strong associate of the increase in the expression of caspase-3 with SCCMS metastases (p <0.001) and no correlation of immunohistochemical reaction of this marker with relapses. There was determined that the probability of metastases at high expression level of p63 is higher than in tumors with low and moderate level of the oncoprotein (p = 0.003). Based on the level of expression of p63, it is possible to predict the likelihood of development of SCCMS with papillomas (p <0.001); and the development of relapses of squamous cell carcinoma of maxillary sinus (p <0.001).

Dose distribution of intensity-modulated proton therapy with and without a multi-leaf collimator for the treatment of maxillary sinus cancer: a comparative effectiveness study

BackgroundSevere complications, such as eye damage and dysfunciton of salivary glands, have been reported after radiotherapy among patients with head and neck cancer. Complications such as visual impairment have also been reported after proton therapy with pencil beam scanning (PBS). In the case of PBS, collimation can sharpen the penumbra towards surrounding normal tissue in the low energy region of the proton beam. In the current study, we examined how much the dose to the normal tissue was reduced by when intensity-modulated proton therapy (IMPT) was performed using a multi-leaf collimator (MLC) for patients with maxillary sinus cancer.MethodsComputed tomography findings of 26 consecutive patients who received photon therapy at Okayama University Hospital were used in this study. We compared D2% of the region of interest (ROI; ROI-D2%) and the mean dose of ROI (ROI-mean) with and without the use of an MLC. The organs at risk (OARs) were the posterior retina, lacrimal gland, eyeball, and parotid gland. IMPT was performed for all patients. The spot size was approximately 5–6 mm at the isocenter. The collimator margin was calculated by enlarging the maximum outline of the target from the beam’s eye view and setting the margin to 6 mm. All plans were optimized with the same parameters.ResultsThe mean of ROI-D2% for the ipsilateral optic nerve was significantly reduced by 0.48 Gy, and the mean of ROI-mean for the ipsilateral optic nerve was significantly reduced by 1.04 Gy. The mean of ROI-mean to the optic chiasm was significantly reduced by 0.70 Gy. The dose to most OARs and the planning at risk volumes were also reduced.ConclusionsCompared with the plan involving IMPT without an MLC, in the dose plan involving IMPT using an MLC for maxillary sinus cancer, the dose to the optic nerve and optic chiasm were significantly reduced, as measured by the ROI-D2% and the ROI-mean. These findings demonstrate that the use of an MLC during IMPT for maxillary sinus cancer may be useful for preserving vision and preventing complications.

Maxillary Sinus Squamous Cell Carcinoma in a Tertiary Hospital in the Philippines

Objective: To establish preliminary demographic and clinicopathologic data on Maxillary Sinus Squamous Cell Carcinoma (SCC) in the Philippine General Hospital&#x0D; Methods: &#x0D; Design: Retrospective Case Series&#x0D; Setting: Tertiary National University Hospital&#x0D; Participants: Socio-demographic and clinical data from records of 22 patients admitted at the Department of Otorhinolaryngology of the Philippine General Hospital from 2013-2016 and histopathologically confirmed to have Maxillary Sinus SCC, were collected and described using means and proportions.&#x0D; Results: There were 15 males and 7 females with a mean age of 50-years-old (range 24 to 77-years-old). Maxillary mass/swelling was the most common chief complaint. The mean gap between initial symptoms and consult was 6.77 months. Initial biopsies were obtained from the maxillary sinus in 16 patients, with 1 patient noted to have undergone malignant transformation from a prior intranasal squamous papilloma. Staging was advanced (Stage IVA in 16, IVB in 4, and III in 2), with no patients with Stage I or II disease. Sixteen (16) patients underwent surgery and radiotherapy, while 6 patients received radiotherapy (RT) with or without chemotherapy. Regional and distant metastases were uncommon.&#x0D; Conclusion: In this series, maxillary sinus SCC occurs more in males, with a maxillary mass as the most common chief complaint. Delay in treatment is common, with a mean gap of 6 months between initial symptoms and consult. Neck node metastasis is uncommon, and most patients undergo surgery with radiotherapy as treatment.&#x0D; &#x0D; Keywords: maxillary sinus cancer; paranasal sinus cancer; squamous cell carcinoma&#x0D;

Definitive Radiation Therapy Versus Postoperative Radiation Therapy for Patients With Maxillary Sinus Cancer Invading the Upper Jaw.

Maxillectomy following radiation therapy has the strongest local control over maxillary sinus cancer. However, in the advanced stage, complete resection is difficult with adequate margin and has the risk of functional disabilities after surgeries. The objective of the study was to determine the optimal treatment strategy for patients with maxillary sinus cancer invades the upper jaw. A total of 998 histologically confirmed maxillary sinus cancer invades the upper jaw patients were subjected to simple randomization. Patients were subjected to maxillectomy and received 150 mg/m/wk intra-arterial cisplatin for 4 weeks followed by radiotherapy (PR group, n = 499) or received the same chemotherapy and definitive radiotherapy only (DR group, n = 499). Disease status, overall survival, progression-free survival, and treatment-emergent adverse effects were evaluated in the follow-up period of 5 years. At the end of 5 years of follow-up, both the treatments had the same overall survival (P = 0.066). Demographic characters were independent parameters for the overall survival (P ≥ 0.05 for all). Postoperative radiotherapy had a higher progression-free survival than definitive radiotherapy (P = 0.018). Maxillectomy was useful in the reduction of the evidence of local recurrence of cancer (P = 0.027). Dysphagia, palate fistula, incomprehensible voice, and trismus were reported as treatment-emergent effects in the PR group. Definitive radiation therapy is recommended in maxillary sinus cancer that invades the upper jaw (Level of Evidence: I; research registry 4571 dated November 14, 2012).

Salvage surgery for a locally persistent or recurrent tumour in maxillary cancer patients who have undergone radiotherapy and concomitant intra-arterial cisplatin: implications for surgical margin assessment

Limited information about salvage surgery is available for locally persistent and recurrent maxillary sinus cancers after the completion of chemoradiation therapy. Seventy-six maxillary sinus cancer patients who had undergone chemoradioselection using initial radiotherapy and concomitant intra-arterial cisplatin were screened retrospectively. Twenty-four of these patients who had a locally persistent or recurrent tumour were investigated. The 2-year overall survival rate of patients with maxillary sinus cancer of all types was 39.0% for those who underwent salvage surgery and 10.0% for those who did not. The 2-year overall survival rate of patients with maxillary sinus squamous cell carcinoma was 45.8% for those who underwent salvage surgery and 11.1% for those who did not. Furthermore, the 2-year local control and overall survival rates of patients with positive and negative surgical margins were 14.3% and 83.3% and 14.3% and 66.7%, respectively. There were significant differences in local control (P=0.004) and overall survival (P=0.005) regarding surgical margin status. Although salvage surgery for a locally persistent or recurrent maxillary sinus cancer is a feasible treatment, patients with positive surgical margins are more prone to local relapse. Therefore, surgical safety margins should be assessed thoroughly.