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Liu Q, Qu Y, Wang K, Wu R, Zhang Y, Huang X, Zhang J, Chen X, Wang J, Xiao J, Yi J, Xu G, Luo J. Lymph Node Metastasis Spread Patterns and the Effectiveness of Prophylactic Neck Irradiation in Sinonasal Squamous Cell Carcinoma (SNSCC). Front Oncol 2022; 12:793351. [PMID: 35707357 PMCID: PMC9190260 DOI: 10.3389/fonc.2022.793351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To analyze the incidence and spread of lymph node metastasis (LNM) and the effectiveness of prophylactic neck irradiation in patients with SNSCC. Methods A total of 255 patients with SNSCC were retrospectively reviewed. The LNM spread pattern was revealed. The clinical parameters related to LNM, and the prognostic value of elective neck irradiation (ENI) were assessed. A 1:1 matching with propensity scores was performed between ENI group and observation (OBS) group. Results The initial LNM rate was 20.8%, and the regional recurrence (RR) rate was 7.5%. Lymphatic spreading in SNSCC followed the common trajectories: a. level Ib ➔ level II ➔ level Va/level III/IV lymph nodes (LNs); b. retropharyngeal lymph nodes (RPLNs) ➔ level II LNs. The most frequently involved site was level II LNs (16.1%), followed by level Ib LNs (10.2%), RPLNs (4.7%), level III LNs (3.2%), level Va LNs (1.6%), level IVa LNs (1.4%) and level VIII LNs (0.8%). The median follow-up time was 105 months. The 5-year overall survival (OS) was 55.7% for N0 patients and 38.5% for patients with initial N+ or N- relapse (p = 0.009). After PSM, the 5-year regional recurrence-free survival was 71.6% and 94.7% (p = 0.046) in OBS and ENI group, respectively. The multivariate analysis showed that ENI (p = 0.013) and absence of nasopharynx involvement (p = 0.026) were associated with a significantly lower RR rate. Conclusions Patients with LNM had poorer survival than those who never experienced LNM. Lymphatic spread in SNSCC followed predictable patterns. ENI effectively reduced the RR rate in patients at high risk.
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Affiliation(s)
- Qian Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kosugi Y, Kawamoto T, Oshima M, Fujimaki M, Ohba S, Matsumoto F, Shikama N, Sasai K. Invasion of the pterygoid plates: an indicator for regional lymph node failure in maxillary sinus cancer. Radiat Oncol 2021; 16:2. [PMID: 33407616 PMCID: PMC7789512 DOI: 10.1186/s13014-020-01726-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND 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. METHODS We 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. CONCLUSIONS Patients with MCS and invasion of the pterygoid plates and oral cavity can be considered appropriate candidates for ENI.
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Affiliation(s)
- Yasuo Kosugi
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masaki Oshima
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mitsuhisa Fujimaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Shinichi Ohba
- Department of Otorhinolaryngology-Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Treatment Outcome and Patterns of Failure in Patients with Maxillary Sinus Cancer: Clinical Experience from a Regional Cancer Centre in North India. Indian J Surg Oncol 2020; 11:401-405. [PMID: 33013118 DOI: 10.1007/s13193-020-01062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022] Open
Abstract
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 7 years. 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 25 months (range 3-72 months). 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.
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Kanno C, Masubuchi T, Fushimi C, Kitani Y, Niwa K, Takeishi E, Kaneko T, Yamazaki M, Hasegawa H, Kamata SE, Miura K, Tada Y. A novel technique of arterial blood flow modification in intra-arterial chemoradiotherapy of maxillary sinus squamous cell carcinoma. Oral Oncol 2020; 109:104873. [PMID: 32604059 DOI: 10.1016/j.oraloncology.2020.104873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Intra-arterial chemoradiotherapy via a superficial temporal artery is reportedly a useful organ-preserving treatment for maxillary sinus squamous cell carcinoma. This study aimed to determine whether blood flow modification facilitates sufficient drug delivery to the entire carcinoma via the maxillary artery alone, even for advanced tumors. MATERIALS AND METHODS A retrospective study of 10 patients who were diagnosed with locally advanced carcinoma (4 [40%] at stage T3, 5 [50%] at T4a, and 1 [10%] at T4b) from August 2016 to July 2018, with tumor blood flow from both the maxillary and facial arteries, was conducted. Patients underwent intra-arterial chemoradiotherapy, which involved chemotherapy with weekly cisplatin administration (40 mg/m2) and radiotherapy (70 Gy/35 fr), with facial artery ligation. The success rate of blood flow modification, as well as its therapeutic effects and safety, were evaluated, with a median follow-up period of 14.4 months (range: 12.3-35 months). RESULTS The blood flow surrounding the tumor was changed from both the maxillary and facial arteries to the maxillary artery alone in all patients. A median of 9 chemotherapy courses (range: 8-10) were administered; the median total cisplatin dose was 350 mg/m2 (range: 320-360 mg/m2). Radiotherapy of 70 Gy/35 fr was used to treat all patients. Grade 3 oral mucositis (80%) and irradiation field dermatitis (40%) were observed. In all patients, complete response was achieved, and local recurrence was not observed for at least 1 year. CONCLUSION Simplifying the blood flow around the tumor facilitates more standardized intra-arterial chemoradiotherapy via a superficial temporal artery procedure.
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Affiliation(s)
- Chihiro Kanno
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Tatsuo Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Chihiro Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yosuke Kitani
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Kazutomo Niwa
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Etsuro Takeishi
- Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Tetsuharu Kaneko
- Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Morio Yamazaki
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Hiroshi Hasegawa
- Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Shin-Etsu Kamata
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.
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Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients. Oral Oncol 2020; 106:104672. [PMID: 32298995 DOI: 10.1016/j.oraloncology.2020.104672] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND 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. MATERIALS AND METHODS 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. RESULTS One hundred-thirty-eight patients were included. Mean age at surgery was 61.0 years. 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. CONCLUSIONS 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.
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Ophthalmic Changes Following Maxillectomy With or Without Postoperative Radiation Therapy. J Craniofac Surg 2019; 30:1448-1451. [PMID: 31299741 DOI: 10.1097/scs.0000000000005437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate ophthalmic complications and quantitatively assess anatomic changes following maxillectomy with or without adjuvant radiotherapy in patients with midface malignancy. METHODS Twenty-four patients who underwent maxillectomy for sinus and/or paranasal cancer were included for retrospective review. Patients with complete ophthalmic examinations were evaluated for postoperative findings corresponding to sequelae of treatment. When available, anatomical changes including eyelid position were quantified from preoperative and postoperative full-face photos using computer software. RESULTS The most common complications identified in patients after maxillectomy were retraction/ectropion (50%), epiphora (29%), and exposure keratopathy/dry eye syndrome (25%). Patients treated with maxillectomy with adjuvant radiation therapy were more frequently found to have ophthalmic complications following treatment. In patients with available postoperative photos (n = 10), the mean ipsilateral margin reflex distance (MRD)2 and inferior scleral show were 8.4 mm and 2.4 mm, respectively. In patients with available preoperative photos (n = 5), the mean change in MRD2 and inferior scleral show following maxillectomy was 3.4 mm and 2.8 mm, respectively. CONCLUSION Patients undergoing maxillectomy for the treatment of head and neck malignancy may be at significant risk for development of specific periocular complications. Lower eyelid malposition was the most significant postoperative quantitative eyelid change following maxillectomy, which may be exacerbated by adjuvant radiotherapy and inferior orbital rim removal.
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Garcia de de Jesus K, Gupta S, Hwang RR, Vigoda I, Cisneros O. An Aggressive Case of Sinonasal Squamous Cell Carcinoma, Invasive to Bone, Arising Within Inverted Papilloma with Intracranial Extension: A Case Report. Cureus 2019; 11:e4508. [PMID: 31259117 PMCID: PMC6590862 DOI: 10.7759/cureus.4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Sinonasal squamous cell carcinoma represents a rare and aggressive disease. Clinical presentation usually mimics other benign entities and consequently this malignancy is seldom diagnosed in early stages. Surgical management, although is standard of care, is rarely amenable due to the structures involved, usually intracranially. This article encompasses a case report of squamous cell carcinoma involving the ethmoidal, maxillary, and sphenoid sinuses invasive to bone and extending intracranially.
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Affiliation(s)
| | - Sorab Gupta
- Oncology, St. Barnabas Hospital Health System / Albert Einstein College of Medicine, Bronx, USA
| | - Richard R Hwang
- Pathology, St. Barnabas Hospital Health System / Albert Einstein College of Medicine, Bronx, USA
| | - Ivette Vigoda
- Oncology, St. Barnabas Hospital Health System / Albert Einstein College of Medicine, Bronx, USA
| | - Oscar Cisneros
- Internal Medicine, St. Barnabas Hospital Health System / Albert Einstein College of Medicine, Bronx, USA
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Gabriele AM, Airoldi M, Garzaro M, Zeverino M, Amerio S, Condello C, Trotti AB. Stage III-IV Sinonasal and Nasal Cavity Carcinoma Treated with Three-Dimensional Conformal Radiotherapy. TUMORI JOURNAL 2018; 94:320-6. [DOI: 10.1177/030089160809400306] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To report the dosimetric data and clinical outcomes of patients with advanced neoplasm of the paranasal sinuses and nasal cavity, treated by three-dimensional conformal radiotherapy. Methods Between 2000 and 2005, 31 consecutive patients were treated for locally advanced tumors of paranasal sinuses and nasal cavity. The primary tumor was located as follows: maxillary sinus 15 (48.4%); ethmoid sinus 10 (32.3%); nasal cavity 6 (19.3%). The patients were separated in two groups according to the modality of treatment: group Aincluded 21 patients treated with postoperative three-dimensional conformal radiotherapy with or without chemotherapy; group B included 10 patients treated with radical three-dimensional conformal radiotherapy with or without chemotherapy. The median radiation dose to the planning target volume was 60 Gy (range, 56–63) for patients who underwent complete surgical resection and 68 Gy (range, 64–70) for those who did not have tumor resection or patients with residual disease. Results The median follow-up was 42 months. Five-year local tumor control and overall survival actuarial rates were 74% and 72%, respectively, in the postoperative setting, 20% and 25%, respectively, with the primary radiotherapy. Local recurrence was the most common site of failure. No patient developed radio-induced blindness; 4 patients underwent enucleation as part of radical surgery. Dosimetric data are reported. Conclusions The local control rate for these tumors remains low. The prognosis depends on localization, tumor stage and treatment modality. Three-dimensional conformal radiotherapy reduces the risk on optical pathways but does not modify outcome.
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Affiliation(s)
| | - Mario Airoldi
- Departments of Medical Oncology, San Giovanni Antica Sede Hospital, Turin
| | | | - Michele Zeverino
- Departments of Medical Physics, San Giovanni Antica Sede Hospital, Turin
| | - Simonetta Amerio
- Departments of Medical Physics, San Giovanni Antica Sede Hospital, Turin
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Park JH, Nam W, Kim HJ, Cha IH. Is elective neck dissection needed in squamous cell carcinoma of maxilla? J Korean Assoc Oral Maxillofac Surg 2017; 43:166-170. [PMID: 28770157 PMCID: PMC5529190 DOI: 10.5125/jkaoms.2017.43.3.166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/19/2017] [Accepted: 02/05/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives To define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients. Materials and Methods Sixty-seven patients with maxillary SCC and cN0 neck were analyzed retrospectively, including 35 patients with maxillary gingiva and 32 patients with maxillary sinus. Results Of 67 patients, 10 patients (14.9%) had occult cervical metastasis. The incidence of occult cervical metastasis of maxillary gingival SCC was higher than that of maxillary sinus SCC (17.1% and 12.5%, respectively). The 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. The success rate of treatment for regional recurrence was high at 71.4%, whereas that for local or locoregional recurrence was low (33.3% and 0%, respectively). Conclusion The incidence of occult cervical metastasis of maxillary SCC was not high enough to recommend END. For survival of cN0 patients, local control of the primary tumor is more important than modality of neck management. Observation of cN0 neck is recommended when early detection of regional recurrence is possible irrespective of the site or T stage. The key enabler of early detection is patient education with periodic follow-up.
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Affiliation(s)
- Jung-Hyun Park
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
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Implication of Tumor Location for Lymph Node Metastasis in Maxillary Sinus Carcinoma: Indications for Elective Neck Treatment. J Oral Maxillofac Surg 2017; 75:858-866. [DOI: 10.1016/j.joms.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/25/2016] [Accepted: 10/02/2016] [Indexed: 02/03/2023]
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11
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Suh YG, Lee CG, Kim H, Choi EC, Kim SH, Kim CH, Keum KC. Treatment outcomes of intensity-modulated radiotherapy versus 3D conformal radiotherapy for patients with maxillary sinus cancer in the postoperative setting. Head Neck 2015; 38 Suppl 1:E207-13. [PMID: 25538027 DOI: 10.1002/hed.23971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 10/15/2014] [Accepted: 12/17/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In this study, we compared the treatment outcomes of postoperative 3D conformal radiotherapy (RT) and intensity-modulated radiotherapy (IMRT) for patients with maxillary sinus carcinoma. METHODS Fifty-four patients underwent surgery and postoperative RT, of whom 27 (50%) had squamous cell carcinoma and 14 (26%) had adenoid cystic carcinoma. Nineteen patients (35%) were treated with IMRT and 35 patients (65%) received 3D conformal RT. The median radiation dose for 3D conformal RT and IMRT were 62.1 and 63 Gy, respectively. RESULTS IMRT produced significantly superior radiation dose distribution to planning target volumes (PTVs) than 3D conformal RT. Over a median follow-up of 60 months, IMRT provided better 3-year locoregional recurrence-free survival (89.2% vs 59.5%; p = .035) and distant metastasis-free survival (94.7% vs 55.3%; p = .042) rates than 3D conformal RT. CONCLUSION Postoperative IMRT for patients with maxillary sinus carcinoma resulted in excellent disease control, and should be considered as the first treatment option in these cases. © 2015 Wiley Periodicals, Inc. Head Neck 38: E207-E213, 2016.
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Affiliation(s)
- Yang-Gun Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunju Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hun Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kaneko T, Tada Y, Maruya S, Takeishi E, Miura K, Masubuchi T, Fushimi C, Hasegawa H, Kamata S. Intra-arterial chemoradiation therapy with weekly low-dose cisplatin for squamous cell carcinoma of the maxillary sinus. Int J Oral Maxillofac Surg 2015; 44:697-704. [PMID: 25843537 DOI: 10.1016/j.ijom.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/28/2014] [Accepted: 03/06/2015] [Indexed: 02/03/2023]
Abstract
A new intra-arterial chemoradiation regimen that involves infusing low-dose cisplatin in combination with definitive irradiation was used in 36 patients diagnosed with squamous cell carcinoma of the maxillary sinus. The safety and therapeutic efficacy of this regimen were reviewed retrospectively. An intra-arterial catheter was inserted in a retrograde manner into the target artery via the superficial temporal artery or occipital artery. Intra-arterial infusion was performed using cisplatin at a dose of 20-50mg/m(2) per week for 6-8 weeks. At the same time, sodium thiosulphate was infused as a neutralizing agent. Irradiation was performed at 60Gy in 30 fractions. All 36 patients completed treatment. Grade 3 adverse events occurred in only seven patients (19.4%) and no grade 4 events were noted. As a primary therapy, the complete response rate was 83.3%, the partial response rate was 16.7%, and the overall response rate was 100%. The 2-year local control rate was 63.0%, and the 2-year overall survival rate was 75.5%. The 2-year preservation rate of the hard palate was 97.1%, that of the eyeball was 97.2%, and that of visual function was 94.4%. This treatment regimen can contribute to improving the quality of life of patients without reducing the curability of the therapy.
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Affiliation(s)
- T Kaneko
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
| | - Y Tada
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - S Maruya
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - E Takeishi
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - K Miura
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - T Masubuchi
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - C Fushimi
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - H Hasegawa
- Department of Dentistry and Oral Surgery, Fukushima Medical University, School of Medicine, Fukushima, Japan
| | - S Kamata
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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13
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Abstract
PURPOSE OF REVIEW To discuss and review the role for elective treatment of the neck in maxillary squamous cell carcinoma. Improvements in survival have been seen because of improved local therapies and control; therefore, the treatment of the neck has become a topic of debate. RECENT FINDINGS The risk of occult metastases in neck nodes is higher for T3-4 tumors. The rate of nodal relapse in the N0 neck without elective treatment is 8-15%. With elective irradiation the nodal relapse rate decreases. However, most nodal relapses are accompanied by local failure or distant disease. Local failure remains the most common site of failure and cause of death in this patient population. SUMMARY Treatment failure occurs overall in 62% of all patients, with local recurrence by far the most common site of treatment failure, which is rarely amenable to salvage therapy. Therefore, elective neck irradiation is not routinely indicated in the clinically N0 neck; those that recur only in the neck can be surgically salvaged more than 50% of the time.
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Affiliation(s)
- Laura Dooley
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New, York NY 10065
| | - Jatin Shah
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New, York NY 10065
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14
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Abu-Ghanem S, Horowitz G, Abergel A, Yehuda M, Gutfeld O, Carmel NN, Fliss DM. Elective neck irradiation versus observation in squamous cell carcinoma of the maxillary sinus with N0 neck: A meta-analysis and review of the literature. Head Neck 2014; 37:1823-8. [PMID: 24913744 DOI: 10.1002/hed.23791] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/05/2014] [Accepted: 06/04/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Elective neck irradiation of a clinical node-negative (N0) neck in squamous cell carcinoma (SCC) of the maxillary sinus is a controversial issue. METHODS A systematic review of electronic databases and a meta-analysis were conducted to clarify the role of elective neck irradiation in patients with SCC of the maxillary sinus and clinical N0 neck. Regional (neck) nodal recurrence was chosen as the primary endpoint. RESULTS Four retrospective studies with a total of 129 patients met the inclusion criteria. The results of the meta-analysis showed that elective neck irradiation reduced the risk of regional nodal recurrence (fixed effects model: odds ratio [OR] = 0.16; 95% confidence interval [CI] = 0.04-0.67; p = .01; random-effects model: OR = 0.17; 95% CI = 0.04-0.76; p = .02) compared to observation. CONCLUSION This systemic review and first meta-analysis confirmed that elective neck irradiation can significantly reduce the rate of nodal recurrence in patients with N0 SCC of the maxillary sinus.
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Affiliation(s)
- Sara Abu-Ghanem
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Yehuda
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Gutfeld
- Department of Radiation Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin-Nard Carmel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Sakashita T, Homma A, Hatakeyama H, Kano S, Mizumachi T, Furusawa J, Yoshida D, Fujima N, Onimaru R, Tsuchiya K, Yasuda K, Shirato H, Fukuda S. The incidence of late neck recurrence in N0 maxillary sinus squamous cell carcinomas after superselective intra-arterial chemoradiotherapy without prophylactic neck irradiation. Eur Arch Otorhinolaryngol 2013; 271:2767-70. [PMID: 24213278 DOI: 10.1007/s00405-013-2806-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/30/2013] [Indexed: 11/28/2022]
Abstract
The efficacy of elective neck irradiation (ENI) for patients with N0 carcinoma of the maxillary sinus has been controversial. The purpose of our study was to investigate the incidence of late neck recurrence and the mortality rate from regional disease in patients with N0 maxillary sinus cancer after superselective cisplatin infusion and concomitant radiotherapy (RADPLAT) without ENI. We retrospectively analyzed 48 patients with N0 maxillary sinus cancer who underwent RADPLAT. Chemotherapy consisted of 100-120 mg/m(2) superselective intra-arterial cisplatin administered at a median rate of four times weekly. Concurrent radiation therapy was administered at a median dose of 65 Gy without ENI. Late neck recurrence was observed in 8.3% (4/48). Three patients underwent salvage neck dissection and survived without any evidence of disease. The remaining patient did not undergo neck dissection due to coexistence with distant metastasis, and he died of regional disease. The mortality rate from regional disease was calculated to be 2% (1/48). The incidence of late neck recurrence was not frequent, and the mortality rate from regional disease was low. Salvage neck dissection was considered to be feasible for patients with late neck recurrence. When definitive radiotherapy and concomitant chemotherapy are applied, it is considered that ENI is not required for cases of N0 maxillary sinus cancer.
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Affiliation(s)
- Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan,
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16
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Sanghvi S, Khan MN, Patel NR, Yeldandi S, Baredes S, Eloy JA. Epidemiology of sinonasal squamous cell carcinoma: A comprehensive analysis of 4994 patients. Laryngoscope 2013; 124:76-83. [DOI: 10.1002/lary.24264] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/17/2013] [Accepted: 05/30/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Saurin Sanghvi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Neal R. Patel
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Swetha Yeldandi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
- Department of Neurological SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
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17
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The controversy in the management of the N0 neck for squamous cell carcinoma of the maxillary sinus. Eur Arch Otorhinolaryngol 2013; 271:899-904. [PMID: 23784492 DOI: 10.1007/s00405-013-2591-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
Squamous cell carcinoma (SCC) of the maxillary sinus is a relatively rare disease. As the reported incidence of regional metastasis varies widely, controversy exists as to whether or not the N0 classified neck should be treated electively. In this review, the data from published series are analyzed to decide on a recommendation of elective treatment of the neck in maxillary SCC. The published series consist of heterogeneous populations of different subsites of the paranasal sinuses, different histological types, different staging and treatment modalities used and different ways of reporting the results. These factors do not allow for recommendations based on high levels of evidence. Given this fact, the relatively high incidence rate of regional metastasis at presentation or in follow-up in the untreated N0 neck, and the relatively low toxicity of elective neck irradiation, such irradiation in SCC of the maxillary sinus should be considered.
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18
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Arora S, Korn RL, Lenkiewicz E, Cherni I, Beach TG, Hostetter G, Barrett MT, Weiss GJ. Clonal evolution of a case of treatment refractory maxillary sinus carcinoma. PLoS One 2012; 7:e45614. [PMID: 23029135 PMCID: PMC3460998 DOI: 10.1371/journal.pone.0045614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/23/2012] [Indexed: 01/16/2023] Open
Abstract
Background Maxillary sinus carcinoma (MSC) is a rare cancer of the head and neck region. Patients are treated with surgery, radiation therapy, and chemotherapy and the treatment regimen is based on patient’s age, general health condition, disease stage, and its extent of spread. There is very little information available on the genetics of this disease. DNA content based flow sorting of tumor cells followed by array comparative genomic hybridization allows for high definition global assessment of distinct clonal changes within tumor populations. Methods We applied this technique to primary and metastatic samples collected from a patient with radio- and chemotherapy refractory maxillary sinus carcinoma to gauge the progression of this disease. Results A clonal KIT amplicon was present in aneuploid populations sorted from the primary tumor and in divergent subclones arising in metastatic foci found in the brain, lung, and jejunum. The evolution of these subclones was associated with distinct genetic aberrations and DNA ploidies. Conclusion The information presented here paves the path to understanding the development and progression of this disease.
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Affiliation(s)
- Shilpi Arora
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Ronald L. Korn
- Scottsdale Medical Imaging, LLC, Scottsdale, Arizona, United States of America
| | - Elizabeth Lenkiewicz
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Irene Cherni
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Thomas G. Beach
- Sun Health Research Institute at Banner Healthcare, Phoenix, Arizona, United States of America
| | - Galen Hostetter
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Michael T. Barrett
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Glen J. Weiss
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona, United States of America
- * E-mail:
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19
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Brown JS, Bekiroglu F, Shaw RJ, Woolgar JA, Triantafyllou A, Rogers SN. First report of elective selective neck dissection in the management of squamous cell carcinoma of the maxillary sinus. Br J Oral Maxillofac Surg 2012; 51:103-7. [PMID: 22578881 DOI: 10.1016/j.bjoms.2012.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/09/2012] [Indexed: 11/30/2022]
Abstract
Controversy remains about management of the neck in squamous cell carcinoma (SCC) of the maxillary sinus and we know of no reports of the use of elective selective neck dissection for management in this site. We retrospectively reviewed 18 consecutive patients with SCC of the maxillary sinus who were managed by primary operation with curative intent. A total of 13 patients had an elective selective neck dissection, which was invaded in one case 8%. Four patients had regional metastases, two with positive nodal disease confirmed after elective selective neck dissection, and two who developed regional recurrence (both after elective selective neck dissections which were negative (pN0)). A review of other published articles in the English language showed no cases of elective selective neck dissections reported. The mean regional recurrence rate was 12% (range 0-26%) and total mean regional metastases rate 21% (range 5-36%). Elective selective neck dissection did not contribute to an improved rate of neck control with regional recurrence of 11% (2/18) compared with 12% in the review. There is no evidence in this report to indicate that elective selective neck dissections for maxillary sinus SCC will result in better disease control. Future research may indicate fewer radiotherapy fields for necks with pathologically clear nodes after elective selective neck dissection.
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Affiliation(s)
- James S Brown
- Regional Head and Neck Unit, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, United Kingdom.
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20
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Abstract
The sinonasal tract (SNT) includes the nasal cavity and paranasal sinuses (maxillary, ethmoid, frontal, and sphenoid) and may give rise to a variety of nonneoplastic and neoplastic proliferations, including benign and malignant neoplasms. The benign neoplasms of the SNT include epithelial neoplasms of surface epithelial origin, minor salivary gland origin, and mesenchymal origin. The spectrum of malignant neoplasms of the SNT includes epithelial malignancies, sinonasal undifferentiated carcinoma, malignant salivary gland neoplasms, neuroectodermal neoplasms, neuroendocrine neoplasms, melanocytic neoplasm, and sarcomas. This article concentrates on some of the more common types of benign and malignant neoplasms.
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Affiliation(s)
- Joaquín J García
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Bruce M Wenig
- Department of Diagnostic Pathology and Laboratory Medicine, Beth Israel Medical Center, St. Luke's-Roosevelt Hospitals, Room 34, Silver Building 11th Floor, First Avenue at 16th Street, New York, NY 10003, USA
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21
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Poeschl PW, Russmueller G, Seemann R, Klug C, Poeschl E, Sulzbacher I, Ewers R. Staging and Grading as Prognostic Factors in Maxillary Squamous Cell Carcinoma. J Oral Maxillofac Surg 2011; 69:3038-44. [DOI: 10.1016/j.joms.2011.02.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 01/13/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
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22
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Radiotherapy with or without surgery for maxillary sinus squamous cell carcinoma: should the clinical N0 neck be treated? Am J Clin Oncol 2011; 34:483-7. [PMID: 21150568 DOI: 10.1097/coc.0b013e3181f942c7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Maxillary sinus squamous cell carcinoma is commonly diagnosed at an advanced stage and treated using radiotherapy, with or without surgical resection. METHODS Fifty-four patients with maxillary sinus squamous cell carcinoma were treated from 1969 to 2006, using radiotherapy, with or without surgical resection. Fifty-two (96%) patients had American Joint Committee on Cancer stages III to IV disease, and 45 (83%) patients had N0 neck disease. RESULTS Five-year local control (LC) rates by T-stage were 63% for T2/T3; and 43% for T4. Five-year LC rates for patients treated with radiotherapy preoperatively, postoperatively, and definitively were 61%, 65%, and 37%, respectively. Initially, overall 5-year LC, neck control, and local-regional control were 49%, 82%, and 45%, respectively. The ultimate 5-year LC, neck control, and local regional control after salvage of failures were 51%, 87%, and 50%, respectively. The overall 5-year cause-specific survival was 41%. Thirty-three percent of patients had a severe complication. CONCLUSIONS Radiotherapy, with or without surgical resection, remains an effective tool in treating patients with this disease. LC, cause-specific survival, and complication rates need significant improvement. Treatment details and recommendations are discussed herein.
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23
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Kang JH, Cho SH, Kim JP, Kang KM, Cho KS, Kim W, Seol YM, Lee S, Park HS, Hur WJ, Choi YJ, Oh SY. Treatment outcomes between concurrent chemoradiotherapy and combination of surgery, radiotherapy, and/or chemotherapy in stage III and IV maxillary sinus cancer: multi-institutional retrospective analysis. J Oral Maxillofac Surg 2011; 70:1717-23. [PMID: 21945430 DOI: 10.1016/j.joms.2011.06.221] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/20/2011] [Accepted: 06/22/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The incidence of maxillary sinus cancer (MSC) is extremely rare, representing less than 1% of all cancers. Because of its rarity, the management of locally advanced MSC is a challenging issue. The objective of the present study was to retrospectively compare the efficacy of 2 traditional treatment strategies, concurrent chemoradiotherapy (CCRT) versus combination of surgery and radiotherapy and/or chemotherapy (SRCT) in MSC. PATIENTS AND METHODS From 1989 to 2010, 65 patients with histologically confirmed stage III or IVA/IVB were retrospectively analyzed. RESULTS The median age of our subjects was 60 years (range 36 to 81). The present study involved 18 women (27.7%) and 47 men (72.3%). Of the 65 patients, 52 (80.0%) had squamous cell carcinoma. The TNM stage was stage III, as determined by the American Joint Committee on Cancer, 6th edition, in 27 patients (41.5%). Stage IVA or IVB was observed in 38 patients (58.5%). Of the 65 patients, 41 underwent treatment. Of these 41 patients, 26 and 15 patients underwent SRCT and CCRT, respectively. During the 75.6 months (range 6.4 to 249.4) of median follow-up, the median progression-free survival duration was 45.1 months (95% confidence interval 0.0 to 142.7). The 5-year overall survival rate was 64.8%. However, the patients who had undergone surgery had better progression-free survival (hazard ratio 2.363, 95% confidence interval 1.098 to 5.085, P = .028) and overall survival (hazard ratio 4.989, 95% confidence interval 1.646 to 15.118, P = .004). The SRCT group had a better progression-free survival (P = .043) and overall survival (P = .029) duration than did the CCRT group. CONCLUSION SRCT might be superior to CCRT for locally advanced MSC. Additional studies comparing the treatment outcomes of CCRT with SRCT are warranted.
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Affiliation(s)
- Jung Hun Kang
- Department of Internal Medicine, Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
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Vieillot S, Boisselier P, Aillères N, Hay MH, Dubois JB, Azria D, Fenoglietto P. [Paranasal sinus carcinoma]. Cancer Radiother 2011; 14 Suppl 1:S52-60. [PMID: 21129670 DOI: 10.1016/s1278-3218(10)70008-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cancers of the paranasal sinuses are rare tumors, with treatment based on a multidisciplinary approach. Surgery and radiation therapy, possibly associated with chemotherapy are used to obtain 5 years specific survival rate of 60-70 %. Advances in radiotherapy, including the use of imaging for 3D conformal approach require precise knowledge of the radioanatomy for this type of tumor to determine the different volumes of interest. Purpose of this study was to specify radioanatomy and conformal radiation modalities for cancers of the sinuses, and is illustrated by a case report.
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Affiliation(s)
- S Vieillot
- Département de cancérologie radiothérapie, Université Montpellier I, CRLC Val d'Aurelle - Paul-Lamarque, Rue Croix-Verte, 34298 Montpellier, cedex 5, France. sabinevieillot@yahoo
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26
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Abstract
OBJECTIVE To characterize the clinical behavior of rare sinonasal malignancies. METHODS Clinical data from the cases of rare sinonasal malignancies at Gujarat Cancer and Research Institute during 2001-2007 were extracted. Data for histologic type of tumor, tumor stage and survival were analyzed. RESULTS Eighty-nine cases of the non-squamous cell malignancy were identified. The mean patient age was 54 years. In this study, we found minor salivary gland tumor in 31 patients, sarcoma in 19 patients, spindle cell carcinoma (SpCC) in 19 patients, undifferentiated carcinoma in 9 patients, lymphoma in 6 patients and melanoma in 3 patients. Adenoid cystic carcinoma exhibited the best survival rate (3 years survival rate was 77%), whereas melanoma and undifferentiated carcinoma exhibited poor survivals (1 year survival was 25% and 33%, respectively and 3 years survival rate is 0%). CONCLUSIONS Adenoid cystic carcinoma is the most common squamous cell carcinoma (SCC) of the sinonasal track. Survival for the patients with undifferentiated carcinoma and melanoma involving the sinonasal track is poor.
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Jang NY, Wu HG, Park CI, Heo DS, Kim DW, Lee SH, Rhee CS. Definitive Radiotherapy With or Without Chemotherapy for T3-4N0 Squamous Cell Carcinoma of the Maxillary Sinus and Nasal Cavity. Jpn J Clin Oncol 2010; 40:542-548. [DOI: 10.1093/jjco/hyq009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Varan O, Ozen G, Sarikaya D, Dogan E, Altundag K. Malignant Hypercalcemia in a Patient with Maxillary Sinus Squamous Cell Carcinoma without Skeletal Metastases. Am Surg 2010. [DOI: 10.1177/000313481007600405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ozkan Varan
- Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Gülsen Ozen
- Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Derya Sarikaya
- Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Erkan Dogan
- Department of Medical Oncology Hacettepe University Institute of Oncology Ankara, Turkey
| | - Kadri Altundag
- Department of Medical Oncology Hacettepe University Institute of Oncology Ankara, Turkey
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Ashraf M, Biswas J, Dam A, Bhowmick A, Jha, Sing V, Nayak S. Results of Treatment of Squamous Cell Carcinoma of Maxillary Sinus: A 26-Year Experience. World J Oncol 2010; 1:28-34. [PMID: 29147176 PMCID: PMC5649731 DOI: 10.4021/wjon2010.02.191w] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2010] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years. METHODS From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients. RESULTS There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group. CONCLUSIONS The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option.
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Affiliation(s)
- M. Ashraf
- Department of Surgical Oncology, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
| | - J. Biswas
- Department of Surgical Oncology, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
| | - A. Dam
- Department of Head and Neck Surgery, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
| | - A. Bhowmick
- Department of Head and Neck Surgery, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
| | - Jha
- Department of Surgical Oncology, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
| | - V. Sing
- Department of Head and Neck Surgery, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
| | - S. Nayak
- Department of Surgical Oncology, Chittaranjan National Cancer Institute (CNCI), 37, S P Mukherjee Road, Kolkata-26, India
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Detection and prediction of local recurrence of maxillary sinus cancer using F-18 FDG PET/CT. Eur J Surg Oncol 2009; 36:214-20. [PMID: 19883988 DOI: 10.1016/j.ejso.2009.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 09/27/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of the current study was to investigate the role of F-18 FDG PET/CT in the detection and prediction of local recurrence of maxillary sinus cancer. METHODS Retrospectively, we analyzed F-18 FDG PET/CT images of maxillary sinus cancer patients for the surveillance after treatment. Twenty-two consecutive patients with maxillary sinus cancer, who underwent maxillectomy followed by adjuvant radiation treatment, were included in the study. F-18 FDG PET/CT images were analyzed visually and quantitatively. RESULTS The median age of the patients included in the current study population was 54.5 years (range, 35-78). Seven patients (29.1%) had local recurrent diseases. Recurrent diseases show statistically significant higher values in SUV(max) (recurrent: 5.09 +/- 3.3, non-recurrent; 3.05 +/- 0.7, p < 0.05), L/NL (recurrent: 2.95 +/- 0.9, non-recurrent; 1.86 +/- 0.5, p < 0.05), L/Ao (recurrent: 3.37 +/- 2.1: non-recurrent; 1.88 +/- 0.4, p < 0.05), and L/Cbr (recurrent: 1.06 +/- 0.7: non-recurrent; 0.46 +/- 0.1, p < 0.05) than those of non-recurrent disease of maxillary sinus cancer. There were no statistical differences between visual assessment and quantitative indices for the detection of local recurrence. The visual assessment was the potent predictor by logistic regression analysis for prediction of local recurrence. CONCLUSION The visual assessment of F-18 FDG uptake pattern was potential predictor for local recurrence of maxillary sinus cancer. However, the diagnostic performances were similar between visual assessment and quantitative indices. Further studies are needed to confirm these results and improve statistical accuracy.
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Kim S, Lee IJ, Kim YB, Koom WS, Jeon BC, Lee CG, Kim GE, Keum KC. A comparison of treatment plans using linac-based intensity-modulated radiation therapy and helical tomotherapy for maxillary sinus carcinoma. Technol Cancer Res Treat 2009; 8:257-63. [PMID: 19645518 DOI: 10.1177/153303460900800402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated whether helical tomotherapy (TOMO) planning could achieve better isodose distribution for the maxillary sinus while concomitantly sparing the adjacent _critical normal organs than linac-based step-and-shoot IMRT (s-IMRT) planning. TOMO and s-IMRT were established for 10 patients with maxillary sinus cancer. The prescription (66 Gy, 30 fractions) was used to cover the planning target volume (PTV) with a 95% isodose line. Each plan was independently optimized using the CORVUS planning system and Tomotherapy Hi-Art system. The treatment plans were compared using dose volume histogram (DVH), a dose homogeneity index (DHI) of the PTV, and equivalent uniform dose (EUD) and DVH of organs at risk (OARs). The TOMO plans demonstrated better dose homogeneity compared to the s-IMRT plans. The average V95% of the TOMO plans was similar to that of the s-IMRT (92.92% vs. 95.07%, respectively), but the average V107% was 0% for TOMO compared with 18.74% for s-IMRT. The average maximum dose reduction was 7 Gy, and DHI increased by 8% for PTV1 in TOMO compared with s-IMRT (79 Gy vs. 71 Gy and, 89% vs. 97%, respectively). The average EUD reduction for the optic nerve was 17%. In summary, planning with TOMO was superior to s-IMRT planning with respect to dose homogeneity within the PTV and sparing of the optic nerve.
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Affiliation(s)
- Songyih Kim
- Department of Radiation Oncology, Yonsei University Health System, Seoul, Korea
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Chargari C, Bauduceau O, Védrine L, Haen P, Fayolle M, Ceccaldi B, Conessa C, Magné N. Radiothérapie des carcinomes des sinus maxillaires : l’état de l’art. Cancer Radiother 2009; 13:195-204. [DOI: 10.1016/j.canrad.2008.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 11/09/2008] [Indexed: 10/21/2022]
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Wang JH, Lee BJ, Lee JH, Kim IJ, Jang YJ. Development of mucosal thickening after radiotherapy in contralateral sinuses of patients with nasal cavity and/or paranasal sinus carcinoma. Ann Otol Rhinol Laryngol 2009; 117:844-8. [PMID: 19102131 DOI: 10.1177/000348940811701109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the development of radiotherapy (RT)-induced mucosal thickening (MT) of the contralateral sinuses in patients with nasal cavity and/or paranasal sinus carcinoma. METHODS We retrospectively reviewed the medical records and the initial and follow-up computed tomography (CT) scans of 37 patients with RT and 10 controls without RT. The CT scans were scored on the Lund-Mackay (LM) staging system. RESULTS Fifteen of the 37 patients had MT before RT, and the mean LM score was 0.68. The MT incidence significantly increased, to 72.9% (p = 0.009), and the LM score significantly increased, to 2.84 (p < 0.001), by 3 months after RT, after which the LM score decreased gradually to 1.73 at 36 months after RT. Four of the 10 controls had MT before treatment, and their mean LM score was 0.7. Their MT incidence and LM score had not changed significantly at 3 months after treatment. The pretreatment LM scores of the patient group and the control group were not significantly different, but their posttreatment LM scores were significantly different at the 3-month follow-up (p = 0.033). CONCLUSIONS Use of RT in patients with nasal cavity and/or paranasal sinus carcinoma may cause a significant increase in the incidence of MT and in the LM scores in all sites of the paranasal sinuses by 3 months after RT, after which the LM score decreases gradually.
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Affiliation(s)
- Jong Hwan Wang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Maeda A, Chijiwa H, Sakamoto K, Miyajima Y, Umeno H, Nakashima T. [Clinical study of cervical lymph node metastasis in maxillary cancer patients]. ACTA ACUST UNITED AC 2008; 111:486-9. [PMID: 18634455 DOI: 10.3950/jibiinkoka.111.486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The clinical characteristics of lymph node metastasis in maxillary cancer patients were analyzed. Thirty-eight (23%) of the 166 patients who received intial treatment at Kurume University Hospital between 1978 and 2003 had cervical lymph node metastasis at the time of diagnosis. The disease-specific 5-year survival rate was 63% in the lymph node metastasis negative group and 18% in the lymph node metastasis positive group (p<0.01). There was a statistically significant correlation between bone invasion and lymph node metastasis in the case of the group with bone invasion of the posterior wall of the maxillary sinus. Cervical neck lymph node metastasis developed in 38 (28%) of 135 posterior-wall-invasion-positive group and in none (0%) of the 31 patients in the negative group (p<0.01). Because distant metastasis is common in patients with lymph node metastasis, postoperative adjuvant chemotherapy is highly recommended.
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Affiliation(s)
- Akiteru Maeda
- Department of Otolaryngology and Head and Neck Surgery, Kurume University School of Medicine, Kurume
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Hoppe BS, Nelson CJ, Gomez DR, Stegman LD, Wu AJ, Wolden SL, Pfister DG, Zelefsky MJ, Shah JP, Kraus DH, Lee NY. Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys 2008; 72:763-9. [PMID: 18395361 DOI: 10.1016/j.ijrobp.2008.01.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/02/2008] [Accepted: 01/03/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate long-term outcomes and toxicity in patients with unresectable paranasal sinus carcinoma treated with radiotherapy, with or without chemotherapy. METHODS AND MATERIALS Between January 1990 and December 2006, 39 patients with unresectable Stage IVB paranasal sinus carcinoma were treated definitively with chemotherapy plus radiotherapy (n = 35, 90%) or with radiotherapy alone (n = 4, 10%). Patients were treated with three-dimensional conformal radiotherapy (n = 18, 46%), intensity-modulated radiotherapy (n = 12, 31%), or conventional radiotherapy (n = 9, 23%) to a median treatment dose of 70 Gy. Most patients received concurrent platinum-based chemotherapy (n = 32, 82%) and/or concomitant boost radiotherapy (n = 29, 74%). RESULTS With a median follow-up of 90 months, the 5-year local progression-free survival, regional progression-free survival, distant metastasis-free survival, disease-free survival, and overall survival were 21%, 61%, 51%, 14%, and 15%, respectively. Patients primarily experienced local relapse (n = 25, 64%), mostly within the irradiated field (n = 22). Nine patients developed neck relapses; however none of the 4 patients receiving elective neck irradiation had a nodal relapse. In 13 patients acute Grade 3 mucositis developed. Severe late toxicities occurred in 2 patients with radionecrosis and 1 patient with unilateral blindness 7 years after intensity-modulated radiation therapy (77 Gy to the optic nerve). The only significant factor for improved local progression-free survival and overall survival was a biologically equivalent dose of radiation >/=65 Gy. CONCLUSIONS Treatment outcomes for unresectable paranasal sinus carcinoma are poor, and combined-modality treatment is needed that is both more effective and associated with less morbidity. The addition of elective neck irradiation may improve regional control.
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Affiliation(s)
- Bradford S Hoppe
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Maxillary Sinus Cancer Review in 23 Patients Treated With Postoperative Radiotherapy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70179-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Manrique RD, Deive LG, Uehara MA, Manrique RK, Rodríguez JL, Santidrian C. Revisión del cáncer de seno maxilar en 23 pacientes tratados con radioterapia postoperatoria. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73250-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen AM, Daly ME, Bucci MK, Xia P, Akazawa C, Quivey JM, Weinberg V, Garcia J, Lee NY, Kaplan MJ, El-Sayed I, Eisele DW, Fu KK, Phillips TL. Carcinomas of the Paranasal Sinuses and Nasal Cavity Treated With Radiotherapy at a Single Institution Over Five Decades: Are We Making Improvement? Int J Radiat Oncol Biol Phys 2007; 69:141-7. [PMID: 17459609 DOI: 10.1016/j.ijrobp.2007.02.031] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 01/31/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare clinical outcomes of patients with carcinomas of the paranasal sinuses and nasal cavity according to decade of radiation treatment. METHODS AND MATERIALS Between 1960 and 2005, 127 patients with sinonasal carcinoma underwent radiotherapy with planning and delivery techniques available at the time of treatment. Fifty-nine patients were treated by conventional radiotherapy; 45 patients by three-dimensional conformal radiotherapy; and 23 patients by intensity-modulated radiotherapy. Eighty-two patients (65%) were treated with radiotherapy after gross total tumor resection. Nineteen patients (15%) received chemotherapy. The most common histology was squamous cell carcinoma (83 patients). RESULTS The 5-year estimates of overall survival, local control, and disease-free survival for the entire patient population were 52%, 62%, and 54%, respectively. There were no significant differences in any of these endpoints with respect to decade of treatment or radiotherapy technique (p > 0.05, for all). The 5-year overall survival rate for patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s was 46%, 56%, 51%, 53%, and 49%, respectively (p = 0.23). The observed incidence of severe (Grade 3 or 4) late toxicity was 53%, 45%, 39%, 28%, and 16% among patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s, respectively (p = 0.01). CONCLUSION Although we did not detect improvements in disease control or overall survival for patients treated over time, the incidence of complications has significantly declined, thereby resulting in an improved therapeutic ratio for patients with carcinomas of the paranasal sinuses and nasal cavity.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Adenoid Cystic/mortality
- Carcinoma, Adenoid Cystic/radiotherapy
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Disease-Free Survival
- Female
- Humans
- Male
- Middle Aged
- Nasal Cavity
- Neoplasm Recurrence, Local
- Nose Neoplasms/mortality
- Nose Neoplasms/radiotherapy
- Nose Neoplasms/surgery
- Paranasal Sinus Neoplasms/mortality
- Paranasal Sinus Neoplasms/radiotherapy
- Paranasal Sinus Neoplasms/surgery
- Radiation Injuries/prevention & control
- Radiotherapy/adverse effects
- Radiotherapy/trends
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Intensity-Modulated/adverse effects
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, San Francisco (UCSF) Comprehensive Cancer Center, San Francisco, CA, USA.
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Bristol IJ, Ahamad A, Garden AS, Morrison WH, Hanna EY, Papadimitrakopoulou VA, Rosenthal DI, Ang KK. Postoperative radiotherapy for maxillary sinus cancer: long-term outcomes and toxicities of treatment. Int J Radiat Oncol Biol Phys 2007; 68:719-30. [PMID: 17543999 DOI: 10.1016/j.ijrobp.2007.01.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 07/21/2006] [Accepted: 01/03/2007] [Indexed: 01/29/2023]
Abstract
PURPOSE To determine the effects of three changes in radiotherapy technique on the outcomes for patients irradiated postoperatively for maxillary sinus cancer. METHODS AND MATERIALS The data of 146 patients treated between 1969 and 2002 were reviewed. The patients were separated into two groups according to the date of treatment. Group 1 included 90 patients treated before 1991 and Group 2 included 56 patients treated after 1991, when the three changes were implemented. The outcomes were compared between the two groups. RESULTS No differences were found in the 5-year overall survival, recurrence-free survival, local control, nodal control, or distant metastasis rates between the two groups (51% vs. 62%, 51% vs. 57%, 76% vs. 70%, 82% vs. 83%, and 28% vs. 17% for Groups 1 and 2, respectively). The three changes were to increase the portals to cover the base of the skull in patients with perineural invasion, reducing their risk of local recurrence; the addition of elective neck irradiation in patients with squamous or undifferentiated histologic features, improving the nodal control, distant metastasis, and recurrence-free survival rates (64% vs. 93%, 20% vs. 3%, and 45% vs. 67%, respectively; p < 0.05 for all comparisons); and improving the dose distributions within the target volume, reducing the late Grade 3-4 complication rates (34% in Group 1 vs. 8% in Group 2, p = 0.014). Multivariate analysis revealed advancing age, the need for enucleation, and positive margins as independent predictors of worse overall survival. The need for enucleation also predicted for worse local control. CONCLUSION The three changes in radiotherapy technique improved the outcomes for select patients as predicted. Despite these changes, little demonstrable overall improvement occurred in local control or survival for these patients and additional work must be done.
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Affiliation(s)
- Ian J Bristol
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Gras Cabrerizo JR, García AS, Montserrat i Gili JR, Dotú CO. Revision of Carcinomas in Paranasal Sinus. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Weber DC, Chan AW, Lessell S, McIntyre JF, Goldberg SI, Bussiere MR, Fitzek MM, Thornton AF, Delaney TF. Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons. Radiother Oncol 2006; 81:243-9. [PMID: 17050017 DOI: 10.1016/j.radonc.2006.09.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 09/04/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the visual outcomes of patients with advanced sinonasal malignancies treated with proton/photon accelerated fractionated radiation (AFR). PATIENTS AND METHODS Between 1991 and 2001, AFR was used to treat 36 patients with advanced stage primary (n=33) or recurrent (n=3) nasal or paranasal malignant tumors. Full ophthalmologic follow-up was documented. The median dose to the gross tumor volume (GTV) was 69.6 CGE (range 60.8-77). Visual complications were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) and the late effects of normal tissue (LENT) scoring systems. The median follow-up was 52.4 months (range 17-122.8). RESULTS Thirteen patients developed late visual/ocular toxicity. Cataracts were LENT grade 1 and 3 in 2 patients and 1 patient, respectively. One LENT grade 1 vascular retinopathy and 1 optic neuropathy were also observed. Three and five patients presented with nasolacrimal duct stenosis (CTC grade 2, 2 patients; CTC grade 3, 1 patient) and dry-eye syndrome (CTC grade 1, 1 patient; CTC grade 2, 4 patients), respectively. The 3- and 5-year probability of LENT/CTC grade > or =2 visual toxicity were 15.8+/-6.7% and 20.7+/-7.8%, respectively. CONCLUSIONS AFR for locally advanced nasal cavity and paranasal sinus tumors enables delivery of 70 CGE to the tumor with acceptable ophthalmologic complications.
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Affiliation(s)
- Damien C Weber
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ahmed RS, Ove R, Duan J, Popple R, Cobb GB. Intensity-modulated radiotherapy (IMRT) for carcinoma of the maxillary sinus: A comparison of IMRT planning systems. Med Dosim 2006; 31:224-32. [PMID: 16905454 DOI: 10.1016/j.meddos.2005.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 08/08/2005] [Accepted: 08/16/2005] [Indexed: 10/24/2022]
Abstract
The treatment of maxillary sinus carcinoma with forward planning can be technically difficult when the neck also requires radiotherapy. This difficulty arises because of the need to spare the contralateral face while treating the bilateral neck. There is considerable potential for error in clinical setup and treatment delivery. We evaluated intensity-modulated radiotherapy (IMRT) as an improvement on forward planning, and compared several inverse planning IMRT platforms. A composite dose-volume histogram (DVH) was generated from a complex forward planned case. We compared the results with those generated by sliding window fixed field dynamic multileaf collimator (MLC) IMRT, using sets of coplanar beams. All setups included an anterior posterior (AP) beam, and 3-, 5-, 7-, and 9-field configurations were evaluated. The dose prescription and objective function priorities were invariant. We also evaluated 2 commercial tomotherapy IMRT delivery platforms. DVH results from all of the IMRT approaches compared favorably with the forward plan. Results for the various inverse planning approaches varied considerably across platforms, despite an attempt to prescribe the therapy similarly. The improvement seen with the addition of beams in the fixed beam sliding window case was modest. IMRT is an effective means of delivering radiotherapy reliably in the complex setting of maxillary sinus carcinoma with neck irradiation. Differences in objective function definition and optimization algorithms can lead to unexpected differences in the final dose distribution, and our evaluation suggests that these factors are more significant than the beam arrangement or number of beams.
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Affiliation(s)
- Raef S Ahmed
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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Qureshi SS, Chaukar DA, Talole SD, Dcruz AK. Clinical characteristics and outcome of non-squamous cell malignancies of the maxillary sinus. J Surg Oncol 2006; 93:362-7. [PMID: 16550558 DOI: 10.1002/jso.20500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES A significant paucity of data exists on non-squamous cancers of the maxillary sinus. The purpose of this study was to assess the clinical characteristics and outcomes of these tumors. METHODS Retrospective review of 42 patients with complete available data and a diagnosis of non-squamous cancer of the maxillary sinus treated with curative intent between 1994 and 1999 were performed. Information recorded included demography, clinical characteristics, histopathological findings, treatment methods, and outcome. Survival was also compared with that of squamous cancers of the maxillary sinus. RESULTS The majority of patients presented with locally advanced disease (83%). Malignancies were 14 sarcomas, 8 adenoid cystic carcinoma, 8 mucoepidermoid carcinoma, 2 adenocarcinoma, and 10 miscellaneous tumors. Fifteen (35.7%) patients developed recurrent disease and six developed distant metastases. The most common site of recurrence was local (32.5%). The overall mean survival was 71.7 months and 5-year overall and disease-free survival was 51% and 48%, respectively. In contrast, the mean survival in the selected 62 patients with squamous cancers was 40 months and 5-year survival was 29% (P = 0.01). Tumor stage, histological, and treatment type was not associated with significant survival advantage. CONCLUSIONS Patients with non-squamous cancers of the maxillary sinus present with locally advanced disease. Local tumor progression remains a significant pattern of failure; however, unlike squamous cancers they have a better prognosis.
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Affiliation(s)
- Sajid S Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
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Muneuchi G, Miyabe K, Hoshikawa H, Hata Y, Suzuki S, Igawa HH, Mori N. Postoperative complications and long-term prognosis of microsurgical reconstruction after total maxillectomy. Microsurgery 2006; 26:171-6. [PMID: 16482590 DOI: 10.1002/micr.20194] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Between 1986-2004, 13 patients (11 males and 2 females; mean age, 63.9 years) underwent microsurgical reconstruction after total maxillectomy in our hospital. Reconstructions using a rectus abdominis musculocutaneous flap were primarily carried out in our hospital by emphasizing soft-tissue filling. No postoperative complication related to a vascular anastomosis (such as thrombosis) was noted (success rate, 100%). In 3 cases, fistula formation was observed postoperatively (23.0%). In one case reconstructed with a scapular flap with a vascularized scapula, atelectasis followed by serious pneumonia was observed, and the patient temporarily fell into a life-threatening condition. Five patients died after 1-2 years due to recurrence of maxillary sinus carcinoma, and 2 died after 3-4 years due to another tumor (lung and esophageal). The disease-specific 5-year survival rate of all 40 patients with maxillary sinus carcinoma treated in our hospital by the Kaplan-Meier method was 54.6%, and the overall survival rate was 45.8%. As the prognosis of maxillary sinus carcinoma is poor, we consider that priority should be given to filling of defects with soft tissues, and we also consider that this study is significant to reevaluate strategies for maxillary reconstruction.
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Affiliation(s)
- Gan Muneuchi
- Department of Plastic and Reconstructive Surgery, Kagawa University, Kagawa, Japan.
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Day TA, Beas RA, Schlosser RJ, Woodworth BA, Barredo J, Sharma AK, Gillespie MB. Management of paranasal sinus malignancy. Curr Treat Options Oncol 2005; 6:3-18. [PMID: 15610711 DOI: 10.1007/s11864-005-0009-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malignancies of the nasal cavity and paranasal sinuses represent a wide spectrum of histologies, tissues of origin, and anatomic primary sites. The inherent difficulty in generalizing treatment approaches is obvious, given the numerous variables associated with the broadly-based term, paranasal sinus malignancy (PNSCa). Nevertheless, the majority of epithelial and salivary malignancies of this region (ie, squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, sinonasal undifferentiated carcinoma, and esthesioneuroblastoma) require surgical intervention as part of any treatment regimen. Recent trends have broadened the indications for chemotherapeutic and radiotherapeutic options in the management of advanced PNSCa. Nonepithelial malignancies, including the wide variety of sarcomas arising in this region, most commonly require multimodality treatment including chemotherapy, radiation, and/or surgery for definitive treatment. Moreover, the proximity of the nasal cavity and paranasal sinuses to structures including the orbit, dura, brain, cranial nerves, and carotid arteries mandates careful radiologic and neurologic evaluations throughout the course of the disease. Surgical advances now permit complex tumor removal and reconstruction surrounding these structures resulting in functional and cosmetic improvements when compared to earlier techniques. However, additional clinical trials are necessary to systematically evaluate the locoregional control, organ-preservation strategies, and survival related to the variety of treatments currently available.
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Affiliation(s)
- Terry A Day
- Head and Neck Tumor Program, Hollings Cancer Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Blanch JL, Ruiz AM, Alos L, Traserra-Coderch J, Bernal-Sprekelsen M. Treatment of 125 sinonasal tumors: prognostic factors, outcome, and follow-up. Otolaryngol Head Neck Surg 2005; 131:973-6. [PMID: 15577800 DOI: 10.1016/j.otohns.2004.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We reviewed our experience with sinonasal cancer patients to assess the prognostic factors. Between 1974 and 1995, we enrolled 125 patients (58 + 16 years [mean age + SD]; 94 males and 31 females). Tumor stage distribution was: T1, 64 patients; T2, 36 patients; and T3, 25 patients. Surgery as a primary treatment was selected for 106 patients (55 cases of surgery alone, 40 cases of surgery plus radiotherapy, and 11 cases of surgery plus chemotherapy with/without radiotherapy). The 1-, 5-, and 10-year overall survival was 75.0%, 37.2%, and 24.7%, respectively. The parameters with statistical prognostic significance were nodal stage, locoregional failure, and tumor stage. Histological type and primary site had no prognostic value. There were no significant survival differences between surgery alone and surgery plus radiotherapy. Sinonasal tumors have a poor survival, despite early diagnosis, radical surgical resection, and strict follow-up. Radiotherapy seems not to be clearly necessary in stage T1.
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Affiliation(s)
- José L Blanch
- Department of Otorhinolaryngology, Hospital Clínic, Universidad de Barcelona, Spain.
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Abstract
PURPOSE The study goal was to determine survival parameters and clinical factors influencing survival for maxillary sinus malignancies. METHODS Cases of maxillary sinus malignancy for the time period 1988 to 1998 were extracted from the Surveillance, Epidemiology and End Results database. Cases with distant metastatic disease at presentation were excluded. Clinical information, including tumor histology, grade and stage, and extent of surgery and radiation therapy, were determined. Kaplan-Meier survival and Cox proportional hazards analyses were conducted to determine the influence of these factors on overall survival. RESULTS The study sample was composed of 650 patients with maxillary sinus cancer (mean age, 64 years; male-to-female ratio, 3:2). The most common histology was squamous cell carcinoma (61.7%), followed by adenoid cystic carcinoma (9.8%). The overall mean (median) survival was 52 months (25 months), and 77.5% and 7.4% of patients presented with advanced (T3/T4) disease or cervical metastasis, respectively. Radiation therapy was administered in 441 patients (67.9%) and significantly improved survival mainly for those with T4 lesions. On multivariate analysis, increasing age, T stage, N stage, and tumor grade independently predicted poorer survival, whereas gender did not. Adenoid cystic carcinoma exhibited a significantly improved overall survival (P <.001). CONCLUSIONS Survival for patients with maxillary sinus cancer is determined not only by TNM staging but also by tumor histology and grade. TNM staging effectively stratifies patients according to survival. Radiation therapy significantly improves survival for those with T4 lesions.
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Affiliation(s)
- Neil Bhattacharyya
- Diovision of Otolaryngology, Brigham and Women's Hospital, 333 Longwood Avenue, Boston, MA 02215, USA.
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49
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Huang D, Xia P, Akazawa P, Akazawa C, Quivey JM, Verhey LJ, Kaplan M, Lee N. Comparison of treatment plans using intensity-modulated radiotherapy and three-dimensional conformal radiotherapy for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys 2003; 56:158-68. [PMID: 12694834 DOI: 10.1016/s0360-3016(03)00080-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To compare intensity-modulated radiotherapy (IMRT) treatment planning with three-dimensional conformal radiotherapy (3D-CRT) planning for paranasal sinus carcinoma. MATERIALS AND METHODS Treatment plans using traditional 3-field technique, 3D-CRT planning, and inverse planning IMRT were developed for a case of paranasal sinus cancer requiring adjuvant radiotherapy. Plans were compared with respect to dose conformality, dose-volume histograms, doses to critical normal tissues, and ease of treatment delivery. RESULTS The inverse-planned IMRT technique was more conformal around the tumor target volume than conventional techniques. The dose-volume histograms demonstrated significantly better critical normal-tissue sparing with the IMRT plans, while able to deliver a minimum dose of 60 Gy to the clinical tumor volume and 70 Gy to the gross tumor volume. Acute toxicities in our analysis were minimal. CONCLUSIONS IMRT planning provided improved tumor target coverage when compared to 3D-CRT treatment planning. There was significant sparing of optic structures and other normal tissues, including the brainstem. Inverse planning IMRT provided the best treatment for all paranasal sinus carcinomas, but required stringent immobilization criteria. Further studies are needed to establish the true clinical advantage of this modality.
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Affiliation(s)
- David Huang
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
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50
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Padovani L, Pommier P, Clippe S S, Martel-Lafay I, Malet C, Poupart M, Zrounba P, Ceruse P, Desmes S, Carrie C, Montbarbon X, Ginestet C. Three-dimensional conformal radiotherapy for paranasal sinus carcinoma: clinical results for 25 patients. Int J Radiat Oncol Biol Phys 2003; 56:169-76. [PMID: 12694835 DOI: 10.1016/s0360-3016(03)00078-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess local control, survival, and clinical and dosimetric prognostic factors in 25 patients with locally advanced maxillary or ethmoid sinus carcinoma treated by three-dimensional conformal radiotherapy (RT). MATERIALS AND METHODS Surgery was performed in 22 patients and was macroscopically complete in 16. Seven patients received chemotherapy (concomitant with RT in four). The following quality indexes were defined for the 95% and 90% isodoses: tumor conformity index, normal tissue conformity index, and global conformity index. RESULTS The median radiation dose to the planned treatment volume was 63 Gy, with a minimal dose of 60 Gy, except in 2 patients whose cancer progressed during RT. The maximal doses tolerated by the structures involved in vision were respected, except for tumors that involved the optic nerve. After a median follow-up of 25 months, 14 local tumor recurrences developed. The major prognostic factors were central nervous system involvement by disease and the presence of nonresectable tumors. The radiation dose and tumor conformity index value were not significant prognostic indicators. Two patients died of acute infectious toxicity, and two developed late ipsilateral ocular toxicity. CONCLUSIONS Improving local control remains the main challenge in RT for paranasal tumors.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/mortality
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/drug therapy
- Carcinoma/radiotherapy
- Carcinoma/surgery
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Disease Progression
- Disease-Free Survival
- Dose-Response Relationship, Radiation
- Ethmoid Sinus
- Eye Injuries/etiology
- Eye Injuries/prevention & control
- Female
- Follow-Up Studies
- Humans
- Imaging, Three-Dimensional
- Life Tables
- Male
- Maxillary Sinus Neoplasms/drug therapy
- Maxillary Sinus Neoplasms/mortality
- Maxillary Sinus Neoplasms/radiotherapy
- Maxillary Sinus Neoplasms/surgery
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Optic Nerve Injuries/etiology
- Optic Nerve Injuries/prevention & control
- Paranasal Sinus Neoplasms/drug therapy
- Paranasal Sinus Neoplasms/mortality
- Paranasal Sinus Neoplasms/radiotherapy
- Paranasal Sinus Neoplasms/surgery
- Radiation Injuries/etiology
- Radiation Injuries/prevention & control
- Radiotherapy Dosage
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Survival Analysis
- Treatment Outcome
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