Craniofacial resection for sinunasal tumors.
BACKGROUND
Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial.


OBJECTIVE
We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors.


METHODS
A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10).


RESULTS
Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months.


CONCLUSIONS
Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.
Granados-García
M
M
Department of Head and Neck Surgery, Instituto Nacional de Cancerología, México, Tlalpan. martingranadosmx@yahoo.com.mx
Celis-López
M A
MA
Aguilar-Ponce
J L
JL
Villavicencio-Valencia
V
V
Luna-Ortiz
K
K
Poitevin-Chachón
A
A
Carrillo-Hernández
F
F
Herrera-Gómez
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery; D003131:Combined Modality Therapy; D004388:Dura Mater / Q000601:surgery; D005005:Ethmoid Sinus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000601:surgery; D008577:Meningeal Neoplasms / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009669:Nose Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D009918:Orbital Neoplasms / Q000556:secondary / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy; D013101:Sphenoid Sinus / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome