Organ preservation treatment using TPF-a pilot study in patients with advanced primary and recurrent cancer of the oral cavity and the maxillary sinus

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

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.

Endoscopic-assisted maxillectomy: Operative technique and control of surgical margins

BACKGROUND

When amenable to radical excision, cancer involving the maxilla is typically treated with maxillectomy followed by adjuvant therapy. Posterior tumor extension beyond the maxillary box leads to the invasion of complex areas, where achieving clear margins may be challenging.

METHODS

Patients undergoing endoscopic-assisted maxillectomy for nasoethmoidal, maxillary, or hard palate cancer between 2007 and 2017 were included in the study. Surgical technique, margin status, and recurrences were analyzed. Extension of posterior resection was classified in 3 types (type 1: resection of the pterygopalatine fossa; type 2: resection of the pterygoid plates and related muscles; type 3: resection of the upper parapharyngeal space). The analysis of putative risk factors for involvement of margins and local recurrence was performed with special focus on the posterior and medial margin.

RESULTS

The study included 79 patients (75 with available follow-up; mean: 20.6 months, range: 6-101 months), 37 (46.8%) of whom underwent type 1 resection, 34 (43.0%) type 2, and 8 (10.1%) type 3. According to pT category, 57 (72.2%) tumors were classified as T4a/T4b. Posterior and medial clear margins were achieved in 76/79 (96.2%) and 75/79 (94.9%) patients, respectively. T4b category, extension to the ethmoid, sphenoid sinus, pterygoid process, orbital cavity, and premaxillary tissues were significantly associated with a higher rate of margin involvement. None of the factors was significantly associated with medial margin involvement.

CONCLUSION

Endoscopic-assisted maxillectomy combines several refinements including the facilitated detachment of the maxilla from the skull base and precise delineation of the posterior and medial margins of resection.

Organ preservation with neoadjuvant chemoradiation in patients with orbit invasive sinonasal cancer otherwise requiring exenteration

Purpose

We sought to determine if organ preservation (OP) with neoadjuvant chemoradiation (CRT) was feasible in patients with sinonasal cancer determined to require exenteration.

Materials and Methods

Twenty patients were determined to require exenteration for definitive treatment from 2005 to 2014. Fourteen patients underwent OP and 6 patients received exenteration with adjuvant CRT. Exenteration free survival (EFS), locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) were estimated.

Results

Five patients (36%) receiving OP had complete disease response at time of surgery. With a median follow-up of 18.8 months, EFS was 62% at 2 years for patients undergoing OP. At 2 years, there were no significant differences in LRC, PFS or OS (all all p > 0.050) between the groups. Less grade 3 or greater toxicity was seen in patients undergoing OP (p = 0.003). Visual function was preserved in all patients undergoing OP.

Conclusion

For patients with sinonasal cancer, OP may avoid exenteration, offering similar disease control and improved toxicity.