Postoperative radiotherapy for maxillary sinus cancer: long-term outcomes and toxicities of treatment.
OBJECTIVE
To determine the effects of three changes in radiotherapy technique on the outcomes for patients irradiated postoperatively for maxillary sinus cancer.


METHODS
The data of 146 patients treated between 1969 and 2002 were reviewed. The patients were separated into two groups according to the date of treatment. Group 1 included 90 patients treated before 1991 and Group 2 included 56 patients treated after 1991, when the three changes were implemented. The outcomes were compared between the two groups.


RESULTS
No differences were found in the 5-year overall survival, recurrence-free survival, local control, nodal control, or distant metastasis rates between the two groups (51% vs. 62%, 51% vs. 57%, 76% vs. 70%, 82% vs. 83%, and 28% vs. 17% for Groups 1 and 2, respectively). The three changes were to increase the portals to cover the base of the skull in patients with perineural invasion, reducing their risk of local recurrence; the addition of elective neck irradiation in patients with squamous or undifferentiated histologic features, improving the nodal control, distant metastasis, and recurrence-free survival rates (64% vs. 93%, 20% vs. 3%, and 45% vs. 67%, respectively; p < 0.05 for all comparisons); and improving the dose distributions within the target volume, reducing the late Grade 3-4 complication rates (34% in Group 1 vs. 8% in Group 2, p = 0.014). Multivariate analysis revealed advancing age, the need for enucleation, and positive margins as independent predictors of worse overall survival. The need for enucleation also predicted for worse local control.


CONCLUSIONS
The three changes in radiotherapy technique improved the outcomes for select patients as predicted. Despite these changes, little demonstrable overall improvement occurred in local control or survival for these patients and additional work must be done.
Bristol
Ian J
IJ
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. ijbristol@mdanderson.org
Ahamad
Anesa
A
Garden
Adam S
AS
Morrison
William H
WH
Hanna
Ehab Y
EY
Papadimitrakopoulou
Vassiliki A
VA
Rosenthal
David I
DI
Ang
K Kian
KK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control* / Q000601:surgery; D011182:Postoperative Care / Q000401:mortality*; D011832:Radiation Injuries / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome