CLINICAL STUDY OF CARCINOMA IN THE MAXILLARY SINUS

• Published in: JIBI INKOKA TEMBO Vol. 44; no. 3; pp. 180 - 189
• Main Authors: Yonekawa, Hiroyuki, Mitani, Hiroki, Kamata, Shin-etsu, Nigauri, Tomohiko, Hoki, Katsufumi
• Format: Journal Article
• Language: Japanese
• Published: Society of Oto-rhino-laryngology Tokyo 2001; 耳鼻咽喉科展望会
• Subjects: en bloc tumor resection; maxillary cancer; reduction surgery; survival rate; 三者併用療法; 上顎癌; 生存率
• ISSN: 0386-9687; 1883-6429
• DOI: 10.11453/orltokyo1958.44.180

With the development of reconstructive surgery and chemo-radiotherapy, the clinical results in the treatment of maxillary cancer have improved markedly. However, extension of the resection leads to a larger facial deformation, so extended resection is not necessarily the best therapy when postoperative QOL is taken into consideration. In 1960, Sato et al. performed a conservative surgery called “tumor reduction in combination with intra-arterial infusion of anti-cancer drugs and radiotherapy” to obtain satisfactory clinical results while minimizing facial deformation. We started a clinical trail using Sato's method in 151 patients from 1970 to 1998, but the results have fallen short of our expectation in T3 and T4 cases. For the purpose of avoiding facial incision as much as possible and improving the local control rate, we have studied the method of reduction surgery, propriety of localized chemotherapy and radiation doses. As a result, the local control rate improved to 82% and the cumulative 5-year-survival rate to 61%. We studied factors that improved clinical results in maxillary cancer treatment. Our conclusion is as follows. The subjects included 151 cases of squamous cell carcinoma originating from the maxillary sinus which were treated at our hospital from 1970 to 1998. They were classified into 3 groups according to therapy, namely, Group A : Radiotherapy with regional chemotherapy and reduction surgery, 78 cases ; Group B : Preoperative radiotherapy with regional chemotherapy and en bloc tumor resection, 33 cases ; Group C : Preoperative radiotherapy and en bloc tumor resection, 40 cases.The local control rate for these 3 groups was 75.6%, 93.9% and 82.5% respectively. The cumulative 5-year-survival rate according to the Kaplan-Meier method was 43.1%, 69.7% and 61.0%. The proportion of T3 cases was 33%, 33% and 45% and that of T4 was, 36%, 63% and 45% respectively, there being no significant difference between the groups. Accumulated clinical experience may be accountable largely for a 20% increase in the 5-year survival rate in groups B and C in the late stage compared with group A in the early stage. However, evaluation of tumors by CT frequently made in all the cases from 1981 on wards may have considerably contributed to it.