Adenoid cystic carcinoma of the paranasal sinuses

Adenoid cystic carcinoma of the paranasal sinuses is a rare neoplasm whose propensity for perineural spread frequently results in positive surgical ma rgins at the skull base, Radiation therapy (RT) may be used to treat unrese ctable tumors or as an adjuvant for positive surgical margins after attempt ed resection. A retrospective review of the experience at the University of Michigan Medical Center was under taken to study the factors influencing s urvival and to compare the efficacy of RT alone versus as an adjuvant treat ment to surgical resection. All patients selected for review (n = 17) had a histologically confirmed diagnosis of adenoid cystic carcinoma arising fro m the paranasal sinuses with an average follow-up of 6 years, The choice of treatment modality was based upon the resectability of the tumor by clinic al and radiologic parameters. This was therefore not a randomized study and there was a clear bias against the radiation only group, which contained t he more advanced and locally aggressive tumors. The ti-year survival for th e combined surgery + RT group was 73% compared with 50% for the radiation o nly group (p = NS). The overall local recurrence rate was 76% and the rate of distant metastases was 18%. Of the 10 patients who underwent surgical re section eight (80%) had positive surgical margins at the skull base.