ETHMOID SINUS CANCER - 29 CASES MANAGED WITH PRIMARY RADIATION-THERAPY

Purpose: To describe the outcome of patients with carcinoma of the eth moid sinus managed with a policy of primary radiation therapy with sur gery for salvage of persistent or progressive disease. Methods and Mat erials: A retrospective chart review was undertaken of 29 patients wit h the diagnosis of carcinoma of the ethmoid complex who underwent trea tment in the period between January 1976 and December 1994 at the Prin cess Margaret Hospital. Analysis was confined to those patients with e pithelial invasive histology (squamous carcinoma, adenocarcinoma, or u ndifferentiated carcinoma) managed with curative intent with primary r adiation therapy. The median patient age was 62, with a median follow- up time of 4 years. Staging was assigned according to a modification o f the UICC 1997 system with 19 (66%) of patients presenting with T4 ca tegory tumors. The most common radiation dose regimes were 60 Gy in 30 daily fractions over 6 weeks, or 50 Gy in 20 daily fractions over 4 w eeks. Outcome was analyzed with respect to overall survival, cause-spe cific survival, and local progression-free survival. The influence of a variety of clinical and therapeutic factors on outcome is discussed, the patterns of disease failure are described, and the rationale for this treatment approach is outlined. Results: The 5-year rates of over all survival, cause-specific survival, and local progression-free surv ival were 39%, 58%, and 41%, respectively. A total of 18 of 29 patient s died during the period of review. Of these, 12 deaths were due to et hmoid cancer, one was due to a second primary lung cancer, and five we re attributed to nononcologic causes. No patients died due to treatmen t-related toxicity. Increasing T category predicted for worse outcome on univariate analysis. Local progression was the major cause of treat ment failure and was documented in 15 of 29 patients treated (52%). Si s patients were offered salvage surgery for local progression, of whom two remained disease free at 15 and 17 months follow-up. Conclusions: Outcome of patients with ethmoid cancer managed with primary radiatio n therapy with surgery for salvage is comparable to that achieved with planned combined modality approaches. Nevertheless, outcome remains p oor and is dependent on the local extent of tumor, with 40-50% of pati ents eventually succumbing to disease. (C) 1998 Elsevier Science Inc.