Search

Several characteristics of maxillary sinus and oral maxillary squamous cell carcinoma have been discussed, After trimodal combination therapy have been introduced to both cancers, improved local control have been obtained. In addition to elevation of survival rate, neck metastases and double cancers have become the problems to be solved.

This study is a retrospective analysis of 216 cases of malignant tumours of the nasal cavity and paranasal sinuses, treated from 1965 to 1980. The mean age at diagnosis was 59 years, 70 per cent were men and 30 per cent women. There were 121 (56%) epidermoid carcinomas, and 31 (14%) adenocarcinomas. Three-year and five-year actuarial survival rate was 40 and 33 per cent respectively for epidermoid carcinomas, 72 and 50 per cent respectively for adenocarcinomas. Recurrences occurred in 46 per cent of epidermoid carcinomas and 42 per cent of adenocarcinomas. Early diagnosis is important to improve the survival rate, and radical primary treatment should be carried out to reduce the rate of recurrence.

A 50-year-old severely immunodeficient woman with malignant non-Hodgkin lymphoma died from graft-versus-host disease due to transfusion of a single unit of packed red cells. Three days after this transfusion a maculo-papular rash appeared, followed by generalized erythroderma refractory to therapy and eventually progressing into generalized ulcero-squamous dermatitis. This case, and a review of other similar cases published elsewhere, prompt the authors to recommend prophylactic irradiation of blood products prior to their administration to patients with cellular immunodeficiency, particularly in cases of acute leukaemia or malignant lymphoma where patients receive intensive radio- and/or chemotherapy regimens. To appreciate the degree of cellular immunodeficiency in such risk patients, simple criteria should be developed to assess the efficiency of the cellular immune system.

A retrospective analysis of 33 cases of maxillary sinus cancer seen at R.P.M.I. between 1970 and 1979 was performed. The age of the patients ranged from 18-88 years, with a median age of 60.3. The male to female ratio was 2:1.3. Twenty-seven (81.8%) of the cases were squamous cell carcinomas. Of the 33 cases, there were no cases in Stage 1, 2 cases in Stage 2, 8 and 23 in Stages 3 and 4, respectively. The 5-year survival among the patients who were available for a long-term follow-up was 36.4% (8 of 22). The 5-year survival was best for Stage 3 disease (75%) and Stage 4, without local and/or distant metastasis (57.14%). No patient with metastasis lived for more than 3 years. While poorer diagnosis could be related to the degree of local involvement and presence of metastasis, it could not be related to site of involvement, previous treatment, histological findings or delay in diagnosis. Correlation of treatment with prognosis is difficult because selection of treatment is based on a variety of factors, including stage of disease and patient acceptance of treatment. Of the 4 patients treated with surgery alone, all 4 survived for 5 years. Of the 8 patients treated with combined surgery and radiation, 4 survived for 5 years and 2 died without evidence of tumor before 2 years. Other treatments were far less successful.

Between 1974 and 1986, 54 cases of squamous cell carcinoma of the maxillary sinus were treated combining surgery, radiotherapy and regional chemotherapy simultaneously. Using UICC (1987) system, these 54 cases were classified into one T1, four T2, thirty-three T3 and sixteen T4. The combined therapy consisted of 1) reduction operation followed by daily cleaning of the necrotic tumor mass; 2) external irradiation with less than 30Gy; 3) intra-arterial infusion of 5-fluorouracil (5-FU) and broxuridine (BUdR); and 4) final tumor resection under general anesthesia. As several modifications were made for the treatment procedure in 1979, the 54 cases were divided into two groups: Group A with 29 cases, which were treated before 1979 and Group B with 25 cases, which were treated after 1979. In this paper, the operative procedure, which we use for T4 cases is described. The first operation is performed after radiotherapy with about 10Gy and in this operation only the necrotic portion of the tumor mass is removed. The maxillary cavity is opened through the sublabial incision. This window is kept open and daily cleaning of the necrotic tumor mass is continued through the window. Three weeks after the simultaneous administration of radiation with 20Gy and 5 intra-arterial infusions of 5-FU and BUdR, the residual tumor is curetted thoroughly under general anesthesia. Surgery is performed through the sublabial window which has been kept open after the reduction surgery. Removal of the residual tumor mass which extends to the pterygomaxillary fossa, nasopharynx, anterior and medial skull base can be performed without difficulty, provided that the tumor mass is removed in pieces.(ABSTRACT TRUNCATED AT 250 WORDS)

Eleven patients with solitary plasmacytoma of bone (SPB) and six patients with extramedullary plasmacytoma (EMP) were treated at the UCLA Center for the Health Sciences. Primary treatment in 14 of 17 patients was with radiation, while three patients were irradiated for recurrent disease. Eleven patients with SPB were irradiated with dose of 32-55 Gy, with 10 of 11 patients receiving doses of 40-55 Gy. Local control was achieved in 10 of 11 patients with SPB. One patient died with metastatic disease with unknown local status. Six patients with EMP were irradiated with doses of 38-56 Gy. Of these patients, two were locally controlled; one patient failed locally; one patient died during treatment; one patient died with local disease at 85 months after multiple resections, chemotherapy, and two courses of irradiation; and one patient was lost to follow-up. Progression to multiple myeloma was seen in 5 of 11 patients with SPB and in none of six patients with EMP. For patients with SPB, we recommend treating the entire bone to 40 Gy, with a boost when feasible. Patients with EMP receive the same dose, including the lymph nodes in tumors at high risk for spread. Radical surgical resections appear to be unwarranted.

Sixty patients with paranasal sinus cancer were treated from January 1976 until July 1981 according to a standard protocol in which surgery is combined with a low dose of irradiation and a topically applied cytostatic drug. The local control rate was 65%. Mutilation was clearly reduced. The actuarial 2-year and 5-year survival rate was 76% and 65%, respectively. The actuarial 5-year survival rate for squamous cell carcinoma and undifferentiated carcinoma of the maxillary sinus was 52%. For adenocarcinoma of the ethmoid sinus the actuarial 5-year survival rate was 100%. The results of this prospective pilot study suggest that it may be possible to achieve better results with less aggressive treatment.

Our reconstructive method utilizing the free latissimus dorsi myocutaneous flap by microneurovascular anastomosis is a rewarding method for the patient with total cheek defect after cancer surgery of the maxillary sinus from the standpoint of morphology, function, and psychology.

Eight cases of a highly aggressive undifferentiated carcinoma of the nasal cavity and paranasal sinuses are described. The patients, who ranged in age from 30-77 years, had multiple sinonasal symptoms, and each had involvement of the nasal cavity, maxillary antrum, and ethmoid sinus. Six tumors extended into the orbital bones, and five penetrated the cranial cavity. Five patients died of disease from 1 to 41 months after diagnosis (median: 4 months), and three are alive with tumor less than 1 year following diagnosis. Microscopically, the neoplasms formed nests, trabeculae, and sheets containing medium-sized cells with small to moderate amounts of eosinophilic cytoplasm. A high mitotic rate, tumor necrosis, and prominent vascular permeation were characteristic. Seven neoplasms were immunoreactive for cytokeratin, five for epithelial membrane antigen, and four for neuron-specific enolase. Ultrastructurally, occasional small desmosomes and rare membrane-bound, dense-core granules were observed. Sinonasal undifferentiated carcinoma is a distinctive clinicopathologic entity that must be distinguished from other, less aggressive sinonasal neoplasms.

A 2-year-old boy developed proptosis of the right eye in May 1982. He was admitted to Isawa Hospital on June 9. Physical examination revealed a well developed child with slight proptosis of the right eye and swelling of the right temple. Routine serologic and blood examination revealed no abnormality except LDH, ALP and LAP. CT scan showed high density area in the anterior part of the right temporal lobe and lateral wall of the right orbit. He underwent open-biopsy of this tumor on July 15. Eosinophilic granuloma was suspected, but definite diagnosis was not made. Second biopsy was performed at right upper gingiva on August 2. Follow-up CT scan revealed tumor invaded sphenoidal and maxillary sinus. The patient was transferred to Tohoku University Hospital on August 13. On admission myeloblasts appeared in peripheral blood, and bone marrow examination revealed acute myelo-monocytic leukemia. We discussed its difficulty of differential diagnosis in literature.

The technique of therapeutic arterial embolisation involves the introduction of a thrombus-inducing material into the lumen of a blood vessel to occlude the vessel and reduce the blood supply to a lesion or to a specific part of the body. It is particularly useful in the maxillofacial region in the management of vascular lesions where marked diminution in blood flow can be achieved. This paper reviews the procedure and the materials for embolisation, and describes four patients for whom it was of considerable assistance.

Procedural control during therapeutic neuroradiologic procedures is generally based on repeated angiograms to assess the degree to which embolization has reduced abnormal blood flow. Due to the complex craniofacial skeletal anatomy that is superimposed over lesions in this area, subtraction studies are usually required to see the vessels and visualize a tumor stain satisfactorily. We have used a device incorporating continuous recursive digital video filtration, which allows the operator to view a subtracted fluoroscopic image of each control angiographic sequence in real time. The advantages of this technique for therapeutic procedures are described.

Thirty one cases of malignant tumours of the maxillary sinus presenting to the Department of Otolaryngology, Universiti Kebangsaan Malaysia over a four year period from 1982 to 1986 are reviewed. 18 cases (58.1%) were squamous cell carcinoma while seven cases (22.5%) were Non-Hodgkin's lymphoma. There were four cases (12.0%) of adenoid cystic carcinoma while in two cases (6.5%) the tumours were undifferentiated. Presentation was generally late. Nasal obstruction, facial swelling and epistaxis were the main presenting symptoms. Nasal involvement was found in 61.3% of cases, while 51.6% had involvement of the palate as well. Metastasis to the cervical lymph node were uncommon (6.5%). Surgery and radiotherapy with or without chemotherapy were the main modes of treatment in the management of malignant tumours of the maxillary sinus.

Twenty-four cases of squamous cell carcinomas of the larynx and maxillary sinus were irradiated with or without cisplatin during a period from April 1973 through March 1984. Both bleomycin in oil and tegafur were administered irrespective of cisplatin. Therapeutic effectiveness was critically evaluated by means of serial biopsy and/or surgery. Radiotherapy alone could not bring about negative conversion of the biopsies, but ultimate negative conversion was observed in 18 out of the 24 cases when chemotherapeutics were appropriately combined. The five positives underwent surgery. In the cases of maxillary cancer, mixed infections appeared to interfere with the curative effectiveness of the radiochemotherapy. A resulting dosage reduction of 15Gy was observed in radiotherapy for negative conversion and one of 10mg for bleomycin as a result of incorporation of cisplatin.

A rare case of angiosarcoma of the maxilla is presented. It was treated with embolisation, radiotherapy, chemotherapy and surgery but resulted in death 14 months after initial presentation. Review of the literature shows three other cases of primary angiosarcoma of the maxilla and six of the maxillary sinus treated with poor results.

In 247 patients with squamous cell carcinoma of the maxillary sinus, the logistic multiple regression analyses were employed to identify prognostic factors. Among various factors evaluated, use of CT scans in treatment planning (p less than .004), age (p less than .009), location of the tumor (p less than .011), T-stage (p less than .017), and free set-up in radiotherapy (p less than .052) proved to be significant factors independently predictive of survival. The most significant factor in improving survival rate was the use of CT scans in treatment planning which was initiated in 1980. Against our prediction, intra-arterial 5-Fu infusion combined with surgery and radiation did not yield favorable result when compared with combined surgery and radiation. Radiation was combined with surgery, high dose radiation of 50 to 55 Gy delivered in 16 fractions over 4 weeks seemed to show better local control than other dose-fractionations.

Four patients with head and neck tumors were observed by serial computed tomography (CT) during treatment. Osseous regeneration was demonstrated at sites of initial osteolytic destruction in two patients who responded to therapy. This regeneration was observed at 4 and 7 months, respectively, after the start of therapy. No such regeneration could be seen in the other two patients who did not respond to treatment. CT may be useful not only in demonstrating initial osseous invasion, but also in monitoring treatment response.

In 72 patients with maxillary squamous cell carcinoma, computed tomography (CT) alone was used for T-staging according to the AJC classification. Five, 31, and 36 tumors were diagnosed as T2, T3, T4, respectively. In N0 patients with a minimum follow-up of 2 years, local control rates for T2, T3, and T4 tumors were 33% (1/3), 64% (16/25) and 38% (9/24), respectively. Addition of maxillectomy to treatment seemed to have improved the local prognoses in T3 and T4 tumors. High radiation doses of 60 Gy or more seemed to be beneficial for patients with T3 tumors and without maxillectomy. CT will be of great help in classifying tumors objectively. But more importantly, it will reveal resectability and dictate treatment of choice by delineating the tumor extent precisely.