title: Long-term results of ethmoid squamous cell or undifferentiated carcinoma treated with radiotherapy with or without surgery.
abstract: OBJECTIVE
  Ethmoidal malignant tumors, for which intensity-modulated radiotherapy is expected to improve outcome, consist of heterogeneous pathological types. Reports about their outcome are influenced by the inclusion of favorable histology, such as adenocarcinoma and adenoid cystic carcinoma. We investigated the long-term treatment outcome of squamous cell carcinoma and undifferentiated carcinoma of the ethmoid sinus.
  
  
  METHODS
  Between August 1976 and April 2002, 25 patients (20 squamous cell carcinomas and five undifferentiated carcinomas) received radical radiotherapy or preoperative radiotherapy in our institution. One (4%) had stage T2 disease, seven (28%) had stage T3, three (12%) had stage T4a, and 14 (56%) had stage T4b. Surgery was performed in 13 patients. Radiation dose varied from 50.4 Gy in 16 fractions (50.4 Gy/16 Fr) to 65 Gy in 26 fractions with or without stereotactic boost irradiation. Eleven patients received chemotherapy consisting mainly of platinum-based compounds.
  
  
  RESULTS
  The 3- and 5-year overall survival rates for all 25 patients were 34% (95% confidence interval [CI]: 14%-54%) and 24% (CI: 6%-42%), respectively. The 3- or 5-year local progression-free rates for all patients were 48.9% and 36.7%, respectively. Visual acuity of a single eye was impaired in three patients and was lost in five patients as a result of tumor progression, but no patient had visual impairment or loss due to radiotherapy.
  
  
  CONCLUSIONS
  Ethmoid squamous cell carcinoma or undifferentiated carcinoma was diagnosed at advanced T stages and was treated with radiotherapy; these patients had a poorer outcome than patients with adenocarcinoma or adenoid cystic carcinoma. Prospective trials using advanced technology should be carefully compared with historical controls because pathological types can considerably influence the treatment results.
authors.affiliation: Department of Radiology, Department of Otorhinolaryngology, Hokkaido University School of Medicine, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Uchida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shirato
authors.forename: Rikiya
authors.initials: R
authors.lastname: Onimaru
authors.forename: Hideho
authors.initials: H
authors.lastname: Endou
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Aoyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishioka
authors.forename: Akihiro
authors.initials: A
authors.lastname: Homma
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Furuta
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukuda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Miyasaka
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005005:Ethmoid Sinus / Q000473:pathology* / Q000528:radiation effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome