SURGICAL SALVAGE AFTER FAILED RADIATION FOR PARANASAL SINUS MALIGNANCY

Objective: To comment on the role of surgical salvage following failed initial treatment for paranasal sinus malignancy. Design: A retrospec tive analysis of one hundred eighty patients treated at The Princess M argaret Hospital, Toronto, from 1976 to 1993. Materials and Methods: T hirty-four of 95 patients (36%) who failed initial treatment underwent surgical salvage. Initial therapy in this group was radiation only (n = 27) and combined therapy (n = 7). Patient, tumor, and surgical data were recorded. There were 23 T4, three T3, six T2, and two T1 carcino mas. Survival, recurrence rates, and the influence of a variety of var iables on outcome were analyzed. Results: Two- and 5-year overall actu arial survival calculated from the date of diagnosis was 54% and 35%, respectively. Two- and 5-year salvage surgery was 44% and 22%, respect ively. Advanced age (P < .004), patients with T4 category disease (P < .04), and squamous cell carcinomas (P < .049) correlated with poorer outcome on univariate analysis. Local failure was the most common caus e of death (n = 13; 65%). Conclusion: Salvage surgery has a limited ro le in the management of persistent or progressive disease following fa ilure of initial treatment. Careful postradiation surveillance with en doscopic biopsy under general surveillance with endoscopic biopsy unde r general anesthesia and immediate the salvage rate.