Treatment outcome of maxillary sinus cancer

Abstract

The standard treatment in the early stage of maxillary sinus cancer is surgical resection followed by postoperative radiation therapy. However, for locally advanced maxillary sinus cancer, a multimodality treatment approach is strongly recommended to improve the survival rate and quality of life of the patient. We determined the treatment outcomes of induction chemotherapy, concurrent chemoradiation therapy, and surgical resection for locally advanced maxillary sinus cancer. Forty-four patients with locally advanced maxillary sinus cancer, who had been treated between January 1990 and April 2008 at Kangnam St. Mary's Hospital, were retrospectively analyzed. The objective response rates were 70%, 53%, and 57% in the intra-arterial induction chemotherapy, intravenous induction chemotherapy, and concurrent chemoradiation therapy groups, respectively. The orbital preservation rates were 83%, 100%, and 75% in the intra-arterial induction chemotherapy, intravenous induction chemotherapy, and surgical resection groups, respectively. In seven of nine patients in whom the orbit could be preserved after induction chemotherapy, the primary tumors were removed completely. However, although the orbits were preserved in three patients who underwent surgical resection as a primary treatment, all three cases were confirmed to be incomplete resections. We found that active induction chemotherapy for locally advanced cancer of the maxillary sinus increased the possibility of complete resection with orbital preservation as well as tumor down-staging.

Keywords: induction chemotherapy; intra-arterial chemotherapy; maxillary sinus cancer; organ preservation..

Figure 1

Orbital preservation and complete resection rate according to treatment modalities. IA-ICT: intra-arterial induction chemotherapy, IV-ICT: intravenous induction chemotherapy.

Figure 2

Overall survival curve of 44 patients with maxillary sinus malignancies by the Kaplan-Meier method.

Figure 3

A case of a T4b maxillary sinus cancer patient with: (A) magnetic resonance imaging at diagnosis; (B) magnetic resonance imaging after completion of three cycles of intra-arterial induction chemotherapy with cisplatin and intravenous 5-FU; (C) magnetic resonance imaging six months after total maxillectomy with flap reconstruction.