title: Surgical salvage after failed radiation for paranasal sinus malignancy.
abstract: OBJECTIVE
  To comment on the role of surgical salvage following failed initial treatment for paranasal sinus malignancy.
  
  
  METHODS
  A retrospective analysis of one hundred eighty patients treated at The Princess Margaret Hospital, Toronto, from 1976 to 1993.
  
  
  METHODS
  Thirty-four of 95 patients (36%) who failed initial treatment underwent surgical salvage. Initial therapy in this group was radiation only (n = 27) and combined therapy (n = 7). Patient, tumor, and surgical data were recorded. There were 23 T4, three T3, six T2, and two T1 carcinomas. Survival, recurrence rates, and the influence of a variety of variables on outcome were analyzed.
  
  
  RESULTS
  Two- and 5-year overall actuarial survival calculated from the date of diagnosis was 54% and 35%, respectively. Two- and 5-year overall actuarial survival calculated from the date of salvage surgery was 44% and 22%, respectively. Advanced age (P < .004), patients with T4 category disease (P < .04), and squamous cell carcinomas (P < .049) correlated with poorer outcome on univariate analysis. Local failure was the most common cause of death (n = 13; 65%).
  
  
  CONCLUSIONS
  Salvage surgery has a limited role in the management of persistent or progressive disease following failure of initial treatment. Careful postradiation surveillance with endoscopic biopsy under general anesthesia and immediate surgical resection when appropriate may improve the salvage rate.
authors.affiliation: University of Toronto, Department of Otolaryngology, Toronto General Hospital, Ontario, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Curran
authors.forename: P J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: J
authors.initials: J
authors.lastname: Waldron
authors.forename: J
authors.initials: J
authors.lastname: Irish
authors.forename: D
authors.initials: D
authors.lastname: Brown
authors.forename: B
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: B
authors.initials: B
authors.lastname: Cummings
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery*; D002423:Cause of Death; D018450:Disease Progression; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000528:radiation effects / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010255:Paranasal Sinus Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome