Chemoradiation in Locally Advanced Maxillary Sinus Squamous Cell Carcinoma-A Retrospective Study and Review Of Literature

 

Introduction: Sinonasal malignancies are relatively rare. They comprise less than 1% of all cancers. It has been reported that 55% to 83% of the paranasal sinus cancer originate in the maxillary sinus, 35% to 40% in the nasal cavity, 9% to 35% in the ethmoid sinuses and 1% in the frontal and sphenoid sinuses. Due to the unique anatomy and relatively long asymptomatic growth patients present with advanced stage disease.

Aims: To study the outcomes following chemo-radiation in cases of locally advanced maxillary sinus squamous cell carcinoma (SCC)

Methods: Patients treated for locally advanced maxillary sinus SCC with chemoradiation therapy as primary treatment from 1997 – 2012. Demographics and outcomes including time to recurrence, disease free survival (DFS) and overall survival (OS) were evaluated. Results were compared with published data.

Results: A total of 65 charts with locally advanced maxillary cancer were reviewed. 12 patients were treated with chemo-radiation, at their initial presentation of which 9 patients were T4a and 3 patients were T4b The median age at diagnosis was 57.5 years. Male to female ratio was 3:1 and racial distribution was 1.5:1 for Caucasian and African Americans. 6 patients were smokers and 1 patient chewed tobacco. The recurrence rate was 50% and all were local recurrences. 3 patients had persistence of disease. DFS was 54% and 40% at 2 years and 5 years respectively. Overall survival was 41% and 25% at 2 years and 5 years respectively.

Conclusion: Outcomes from this small dataset are similar to the limited studies published. Radiation therapy with chemotherapy remains a viable modality in treatment of patients with locally advanced maxillary sinus SCC who may not be suitable for surgery especially in cases where the pterygomaxillary fissure is involved or there is superior orbital fissure involvement or when the patient refuses surgery. Further studies with larger dataset to compare outcomes especially for unresectable disease treated with chemo-radiation therapy are warranted.