Lymph node metastasis in maxillary sinus carcinoma

Purpose: To evaluate the incidence and prognostic significance of lymph nod e metastasis in maxillary sinus carcinoma. Methods and Materials: We reviewed the records of 97 patients treated for m axillary sinus carcinoma with radiotherapy at Stanford University and at th e University of California, San Francisco between 1959 and 1996, Fifty-eigh t patients had squamous cell carcinoma (SCC), 4 had adenocarcinoma (ADE), 1 6 had undifferentiated carcinoma (UC), and 19 had adenoid cystic carcinoma (AC), Eight patients had T2, 36 had T3, and 53 had T4 tumors according to t he 1997 AJCC staging system. Eleven patients had nodal involvement at diagn osis: 9 with SCC, 1 with UC, and 1 with AC, The most common sites of nodal involvement were ipsilateral level 1 and 2 lymph nodes. Thirty-six patients were treated,vith definitive radiotherapy alone, and 61 received a combina tion of surgical and radiation treatment. Thirty-six patients had neck irra diation, 25 of whom received elective neck irradiation (ENI) for NO necks. The median follow-up for alive patients was 78 months. Results: The median survival for all patients was 22 months (range: 2.4-356 months), The 5- and IO-year actuarial survivals were 34% and 31%, respecti vely, Ten patients relapsed in the neck, with a 5-year actuarial risk of no dal relapse of 12%, The 5-year risk of neck relapse was 14% for SCC, 25% fo r ADE, and 7% for both UC and ACC, The overall risk of nodal involvement at either diagnosis or on follow-up was 28% for SCC, 25% for ADE, 12% for UC, and 10% for AC, All patients with nodal involvement had T3-4, and none had T2 tumors. ENI effectively prevented nodal relapse in patients with SCC an d NO neck; the 5-year actuarial risk of nodal relapse was 20% for patients without ENI and 0% for those with elective neck therapy, There was no corre lation between neck relapse and primary tumor control or tumor extension in to areas containing a rich lymphatic network. The most common sites of noda l relapse were in the ipsilateral level 1-2 nodal regions (11/13), Patients with nodal relapse had a significantly higher risk of distant metastasis o n both univariate (p = 0.02) and multivariate analysis (hazard ratio = 4.5, p = 0.006), The 5-year actuarial risk of distant relapse was 29% for patie nts with neck control versus 81% for patients with neck failure. There was also a trend for decreased survival with nodal relapse. The 5-year actuaria l survival was 37% for patients with neck control and 0% for patients with neck relapse. Conclusion: The overall incidence of lymph node involvement at diagnosis in patients with maxillary sinus carcinoma was 9%. Following treatment, the 5 -year risk of nodal relapse was 12%. SCC histology was associated with a hi gh incidence of initial nodal involvement and nodal relapse. None of the pa tients presenting with SCC histology and NO necks had nodal relapse after e lective neck irradiation. Patients who had nodal relapse had a higher risk of distant metastasis and poorer survival. Therefore, our present policy is to consider elective neck irradiation in patients with T3-4 SCC of the max illary sinus. (C) 2000 Elsevier Science Inc.