Adenoid cystic carcinoma of the maxillary antrum

Purpose: To investigate characteristic clinical features and outcome for pa tients with adenoid cystic carcinoma (ACC) of the maxillary antrum. Patients and Methods: Twenty-two patients with ACC of the maxillary antrum were initially treated with surgery alone (3 patients), radiation alone (9 patients), or a combination of surgery and radiation (10 patients). Salvage treatment for initial failure was individualized. Patterns of failure, sur vival, and prognostic factors were retrospectively analyzed. Results: The most frequent site of failure was local recurrence at the prim ary site (72.7%). All patients treated with either surgery alone or radiati on alone experienced one or more local recurrences, whereas patients who re ceived planned combined surgery and radiation had a much lower local recurr ence rate (40%). Neck node failure (4.6%) was an uncommon event, whereas di stant metastases were clinically documented in seven patients (32%). Most o f the treatment failures appeared within 5 years, but treatment failures af ter 5 years were not uncommon. The overall survival and disease-free surviv al rates at 10 years were 37.6% and 13.6%, respectively. Clinicopathologica l factors, such as location of primary tumor, tumor stage, and histological grade were of no value in predicting a favorable survival. The significant prognostic factors influencing 10-year survival were the pathological find ing of perineural invasion and the initial mode of treatment. Conclusion: ACC of the maxillary antrum represented a unique natural histor y characterized by a more aggressive tumor behavior and an unfavorable prog nosis. Combined surgery and radiotherapy is recommended for optimal local c ontrol and survival. (Am J Otolaryngol 1999;20:77-85. Copyright (C) 1999 by W.B. Saunders Company).