The prognosis for sinonasal malignancies has remained poor for the past several decades despite refinements in both surgical technique and radiation therapy. Stern reviewed the M.D. Anderson experi-
ence for maxillary squamous cell carcinoma and found no significant improvement in survival when compared to a similar study there 20 years earlier.69 However, another study from M.D. Anderson has shown an improved survival with surgery and postoperative radiation therapy when reviewing all types of malignancies.47
The various chemotherapy and radiation therapy regimens described above have shown survival improvements for advanced stage disease, although some of these reports have been for small numbers of patients with relatively short follow-up periods. Surgery with postoperative radiation therapy remains the standard treatment for resectable sinonasal carcinoma. A brief review of the larger series reporting outcomes for surgery with postoperative radiation therapy is shown in Table 11-1.
Spiro reviewed 105 patients at Memorial Sloan-Kettering Cancer Center with nasal cavity, maxillary, and ethmoid squamous cell carcinoma treated with combination surgery and radiation therapy, radiation therapy alone, or surgery alone. The majority of these patients presented with extensive disease with 82 percent of newly treated patients having stage III or stage IV disease. Survival is correlated to stage at presentation (Figure 11 -17), and the overall 5-year survival was 37 percent. The survival rates for nasal, maxillary, and ethmoid tumors were 45 percent, 38 percent, and 13 percent respectively (Figure 11-18). The local control for maxillary sinus tumors was 49 percent, and local recurrence was the most common site of failure.70
Zaharia reported the outcome of 149 patients treated with surgery and postoperative radiation therapy for a variety of malignant histologies. The 5-year actuarial survival was 36.2 percent overall, while for squamous cell carcinoma alone it was 35 percent.71 Sisson reported a 49 percent 5-year survival after treating 60 patients with sinonasal malignancies with a variety of regimens.26 Jiang reviewed the M.D. Anderson experience of 73 patients with maxillary sinus malignancies of varying histologies treated with surgery and postoperative radiation therapy. Overall 5-year relapse free survival was 51 percent, with a local control rate of 78 percent.47 Lavertu treated 54 patients with squamous cell carcinoma of the sinuses: all received surgery and/or radiation therapy with an overall survival of 38.2 percent for the maxillary sinus group.72
The overall treatment of sinonasal maligancies has resulted in 5-year survival rates in the 30 to 50 percent range, with most of the larger series near the lower end of this spectrum. Local control is a particularly difficult problem, with the majority of failures occurring at the primary site. These difficulties with sinonasal cancer treatment are linked to the complex anatomy of the paranasal sinus region, and a propen
sity for late presentation due to the absence of symptoms in early stage disease. Complete surgical removal of the tumor with postoperative radiation therapy remains the standard of care for resectable lesions. Improved reconstructive techniques including microvascular free flaps and prosthetic obturators have significantly decreased the functional and cosmetic morbidity from aggressive surgical resection. The orbital contents may be preserved in cases where the orbital fat, musculature, and apex are free of disease. If the orbital floor is resected with orbital preservation, then reconstruction of the orbital floor is essential to maintaining good postoperative ocular function, particularly in the setting of additional planned radiation therapy. The use of chemotherapy and accelerated radiation therapy preliminarily appear to offer a substantial benefit for advanced stage tumors. The addition of these modalities may ultimately improve the long-prevailing poor prognosis of these challenging tumors.
1. Grant RN, Silverberg E. Cancer Statistics 1970. New York:
American Cancer Society; 1970.
2. Carrau RL, Myers EN, Johnson JT. Paranasal sinus carci noma—diagnosis, treatment, and prognosis. Oncology 1992;6:43-50.
3. Kraus DH, Roberts JK, Medendorp SV, et al. Non squamous cell malignancies of the paranasal sinuses. Ann Otol Rhi-nol Laryngol 1990;99:5-11.
4. Spiro JD, Soo KC, Spiro RH. Non squamous cell malignant neoplasms of the nasal cavities and paranasal sinuses. Head Neck 1995;17:114-8.
5. Stern SJ, Hanna E. Cancer of the nasal cavity and paranasal sinuses. In: Myers EN, Suen JY, editors. Cancer of the Head and Neck. Philadelphia (PA): W.B. Saunders Co.; 1996. p.205-33.
6. Pearson BW. Surgical anatomy of the nasal cavity and paranasal sinuses. In: Thawley SE, Panje WR, Batsakis JG, Lindberg RD, editors. Comprehensive Management of Head and Neck Tumors. Philadelphia (PA): W.B. Saunders Co.; 1999. p.540-57.
7. Öhngren LG. Malignant tumors of the maxillo-ethmoidal region. Acta Otolaryngol Suppl 1933;19:101-6.
8. American Joint Committee on Cancer. AJCC Cancer Staging
Manual. New York: Lippincott-Raven; 1997.
9. Kraus DH, Lanzieri CF, Wanamaker JR, et al. Complemen tary use of computed tomography and magnetic resonance imaging in assessing skull base lesions. Laryngoscope 1992;102:623-9.
10. Mosesson RE, Som PM. The radiographic evaluation of sinonasal tumors. Otolaryngol Clin N Am 1995;28: 1097-115.
11. Som PM, Shapiro MD, Biller HF, et al. Sinonasal tumors and inflammatory tissues: differentiation with MR imaging. Radiology 1988;167:803-8.
12. Som PM, Dillon WP, Sze G, et al. Benign and malignant sinonasal lesions with intracranial extension: differentiation with MR imaging. Radiology 1989;172:763-6.
13. Lanzieri CF, Shah M, Kraus D, Lavertu P. Use of gadolinium-
enhanced MR imaging for differentiating mucoceles from neoplasms in the paranasal sinuses. Radiology 1991;178:425-8.
14. Pedersen E, Hogetveit AC, Andersen A. Cancer of respiratory organs among workers at a nickel refinery in Norway. Int J Cancer 1973;12:32-41.
15. Batsakis JG. Pathology of tumors of the nasal cavity and paranasal sinuses. In: Thawley SE, Panje WR, Batsakis JG, Lindberg RD, editors. Comprehensive Management of Head and Neck Tumors. Philadelphia (PA): W.B. Saunders Co.; 1999. p.522-39.
Wenig BM. Atlas of Head and Neck Pathology. Philadelpia (PA): W.B. Saunders Co.; 1993.
Acheson ED. Nasal cancer in the furniture and boot and shoe manufacturing industries. Prev Med 1976;5:295-315.
Kadish S, Goodman M, Wang CC. Olfactory neuroblastoma: a clinical analysis of 17 cases. Cancer 1976;37:1571-6.
Parsons JT, Stringer SP, Mancuso AA, Million RR. Nasal vestibule, nasal cavity, and paranasal sinuses. In: Million RR, Cassisi NJ, editors. Management of Head and Neck Cancer. Philadelphia (PA): J.B. Lippincott Co.; 1994. p.551-98.
Kurohara SS, Webster JH, Ellis F, et al. Role of radiation therapy and surgery in the management of localized epi-dermoid carcinoma of the maxillary sinus. Am J Roentgenol 1972;114:35-42.
Lee F, Ogura JH. Maxillary sinus carcinoma. Laryngoscope 1981;91:133-9.
St. Pierre S, Baker SR. Squamous cell carcinoma of the maxillary sinus: analysis of 66 cases. Head Neck Surg 1983;5:508-13.
Mendenhall WM, Stringer SP, Cassisi NJ, Mendenhall NP. Squamous cell carcinoma of the nasal vestibule. Head Neck 1999;21:385-93.
Goepfert H. Editorial comment: the vex and fuss about nasal vestibular cancer. Head Neck 1999;21:383-4.
Yu-Hua H, Gui-Yi T, Yu-Qin Q, et al. Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of the maxillary sinus. Int J Radiat Oncol Biol Phys 1982;8:1045-9.
Sisson GA, Toriumi DM, Atiyah RA. Paranasal sinus malignancy: a comprehensive update. Laryngoscope 1989; 99:143-50.
Shah JP, Zelefsky MJ, O'Malley BB. Squamous cell carcinoma of the oral cavity. In: Harrison LB, editor. Head and Neck Cancer: A Multidisciplinary Approach. New York: Lippincott-Raven;1999. p.421.
Carrau RL, Segas J, Nuss DW, et al. Squamous cell carcinoma of the sinonasal tract invading the orbit. Laryngoscope 1999;109:230-5.
McCary WS, Levine PA, Cantrell RW. Preservation of the eye in the treatment of sinonasal malignant neoplasms with orbital involvement. Arch Otolaryngol Head Neck Surg 1996;122;657-9.
Perry C, Levine PA, Williamson BR, Cantrell RW. Preservation of the eye in paranasal sinus cancer surgery. Arch Otolaryngol Head Neck Surg 1988;114:632-4.
Tiwari R, van der Wal J, van der Wal I, Snow G. Studies of the anatomy and pathology of the orbit in carcinoma of the maxillary sinus and their impact on preservation of the eye in maxillectomy. Head Neck 1998;20:193-6.
Quatela VC, Futran ND, Boynton JR. Eye banking: techniques for eye preservation in selected neoplasms encroaching on the globe. Otolaryngol Head Neck Surg 1993;108:662-70.
Sato Y, Morita M, Takahashi H, et al. Combined surgery, radiotherapy, and regional chemotherapy in carcinoma of the paranasal sinuses. Cancer 1970;25:571-9.
34. Sakai S, Hohki A, Fuchihata H, Tanaka Y. Multidisciplinary treatment of maxillary sinus carcinoma. Cancer 1983;52:1360-4.
35. Knegt PP, de Jong PC, van Andel JG, et al. Carcinoma of the paranasal sinuses: results of a prospective pilot study. Cancer 1985;56:57-62.
36. Sakata K, Aoki Y, Karasawa K, et al. Analysis of the results of combined therapy for maxillary carcinoma. Cancer 1993;71:2715-22.
37. Lee Y, Dimery I, Van Tassel P, et al. Superselective intra-arte-
rial chemotherapy of advanced paranasal sinus tumors. Arch Otolaryngol Head Neck Surg 1989;115:503-11.
38. Robbins KT, Vicario D, Seagren S, et al. A targeted supra dose cisplatin chemoradiation protocol for advanced head and neck cancer. Am J Surg 1994;168:419-22.
39. Robbins KT, Storniolo AM, Kerber C, et al. Rapid superse-
lective high-dose cisplatin infusion for advanced head and neck malignancies. Head Neck 1992;14:364-71.
40. LoRusso P, Tapazoglou E, Kish JA, et al. Chemotherapy for paranasal sinus carcinoma: a 10 year experience at Wayne State University. Cancer 1988;62:1-5.
41. Bjork-Eriksson T, Mercke C, Petruson B, Ekholm S. Poten tial impact on tumor control and organ preservation with cisplatin and 5-fluorouracil for patients with advanced tumors of the paranasal sinuses and nasal fossa. Cancer 1992;70:2615-20.
42. Rosen A, Vokes EE, Scher N, et al. Locoregionally advanced paranasal sinus carcinoma: favorable survival with multi-modality therapy. Arch Otolaryngol Head Neck Surg 1993;119:743-6.
43. Choi KN, Rotman M, Aziz H, et al. Locally advanced paranasal sinus and nasopharynx tumors treated with hyperfractionated radiation and concomitant infusion cisplatin. Cancer 1991;67:2748-52.
44. Harrison LB, Raben A, Pfister DG, et al. A prospective phase
II trial of concomitant chemotherapy and radiotherapy with delayed accelerated fractionation in unresectable tumors of the head and neck. Head Neck 1998;20:497-503.
45. Harrison LB, Pfister DG, Fass DE, et al. Concomitant chemotherapy-radiation therapy followed by hyperfraction-ated radiation therapy for advanced unresectable head and neck cancer. Int J Radiat Oncol Biol Phys 1991;21:703-8.
46. Paulino AC, Fisher SG, Marks JE. Is prophylactic neck irra diation indicated in patients with squamous cell carcinoma of the maxillary sinus? Int J Radiat Oncol Biol Phys 1997;39:283-9.
47. Jiang GL, Ang KK, Peters LJ, et al. Maxillary sinus carcino mas: natural history and results of postoperative radiotherapy. Radiother Oncol 1991;21:193-200.
48. The American Society for Head and Neck Surgery and the
Society of Head and Neck Surgeons. Clinical Practice Guidelines for the Diagnosis and Management of Cancer of the Head and Neck, 1996.
49. Penzer RD, Moss WT, Tong D, et al. Cervical lymph node metastasis in patients with squamous cell carcinoma of the maxillary antrum: the role of elective irradiation of the clinically negative neck. Int J Radiat Biol 1979;5:1977-80.
50. Curran AJ, Gullane PJ, Waldron J, et al. Surgical salvage after failed radiation for paranasal sinus malignancy. Laryngoscope 1998;108:1618-22.
51. Spiro RH, Strong EW, Shah JP. Maxillectomy and its classi fication. Head Neck 1997;19:309-14.
52. Shah JP. Head and Neck Surgery. New York: Mosby-Wolfe;
53. Goepfert H, Jesse RH, Lindberg RD. Arterial infusion and radiation therapy in the treatment of advanced cancer of the nasal cavity and paranasal sinuses. Am J Surg 1973;126:464-8.
54. Shibuya H, Suzuki S, Horiuchi J, et al. Reappraisal of tri-
modal combination therapy for maxillary sinus carcinoma. Cancer 1982;50:2790-4.
55. Milas L, Peters LJ. Biology of radiation therapy. In: Thawley
SE, Panje WR, Batsakis JG, Lindberg RD, editors. Comprehensive Management of Head and Neck Tumors. Philadelphia (PA): W.B. Saunders Co.; 1999. p. 99-123.
56. Kornblith AB, Zlotolow IM, Gooen J, et al. Quality of life of maxillectomy patients using an obturator prosthesis. Head Neck 1996;18:323-34.
57. Hatoko M, Harashina T, Inoue T, et al. Reconstruction of palate with radial forearm flap: a report of 3 cases. Br J Plastic Surg 1990;43:350-4.
58. MacLeod AM, Morrison WA, McCann JJ, et al. The free radial forearm flap with and without bone for closure of large palatal fistulae. Br J Plastic Surg 1987;40:391-5.
59. Urken ML, Sullivan MJ. Scapular and parascapular fasciocu-
taneous and osteocutaneous free flaps. In: Urken ML, Cheney ML, Sullivan MJ, Biller HF, editors. Atlas of Regional and Free Flaps for Head and Neck Reconstruction. New York: Raven Press; 1995. p.217-36.
60. Aviv JE, Urken ML, Vickery C, et al. The combined latissimus dorsi-scapular free flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1991;117:1242-50.
61. McCary WS, Levine PA. Management of the eye in the treat ment of sinonasal cancers. Otolaryngol Clin N Am 1995;28:1231-8.
62. Stern SJ, Goepfert H, Clayman G, et al. Orbital preservation in maxillectomy. Otolaryngol Head Neck Surg 1993;109: 111-5.
63. Cordeiro PG, Santamaría E, Kraus DH, et al. Reconstruction of total maxillectomy defects with preservation of the orbital contents. Plast Reconstr Surg 1998;1G2:1874-84.
64. Olsen KD, Meland B, Ebersold MJ, et al. Extensive defects of the sino-orbital regions: results with microvascular reconstruction. Arch Otolaryngol Head Neck Surg 1992; 118:828-33.
65. Browne JD, Burke AJ. Benefits of routine maxillectomy and orbital reconstruction with the rectus abdominis free flap. Otolaryngol Head Neck Surg 1999;121:2G3-9.
66. Jiang GL, Tucker SL, Guttenberger R, et al. Radiation-
induced injury to the visual pathway. Radiother Oncol 1994;3G:17-25.
67. Rabin A, Pfister DG, O'Malley BB. Nonsurgical manage ment of carcinoma of the nasal vestibule, nasal cavity, and paranasal sinuses. In: Harrison LB, editor. Head and Neck Cancer: A Multidisciplinary Approach. New York: Lippincott-Raven; 1999. p.595-638.
68. Stupp R, Vokes EE. Chemotherapy of head and neck tumors.
In: Thawley SE, Panje WR, Batsakis JG, Lindberg RD, editors. Comprehensive management of Head and Neck Tumors. Philadelphia (PA): W.B. Saunders Co.; 1999. p.141-56.
69. Stern SJ, Goepfert H, Clayman G, et al. Squamous cell car cinoma of the maxillary sinus. Arch Otolaryngol Head Neck Surg 1993;119:964-9. 7G. Spiro JD, Soo KC, Spiro RH. Squamous cell carcinoma of the nasal cavity and paranasal sinuses. Am J Surg 1989;158:31G-4.
71. Zaharia, M, Salem LE, Travezan R, et al. Postoperative radiotherapy in the management of cancer of the maxillary sinus. Int J Radiat Oncol Biol Phys 1989;17:967-71.
72. Lavertu P, Roberts JK, Kraus DH, et al. Squamous cell carci noma of the paranasal sinuses: the Cleveland Clinic experience 1977-1986. Laryngoscope 1989;99:113G-6.
73. Paulino AC, Marks JE, Bricker P, et al. Results of treatment of patients with maxillary sinus carcinoma. Cancer 1998; 83:457-65.
Was this article helpful?
Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.