ADENOCARCINOMA OF THE ETHMOID SINUSES IN WOODWORKERS - A REVIEW OF 25CASES

A retrospective oncological study was performed in 25 woodworkers, in whom an adenocarcinoma of the ethmoid sinuses was discovered between M arch 1985 and December 1993. All patients were males with a mean age o f 57 years, and a mean duration of wood dust exposure of 24 years. Sig ns of nasal obstruction, drainage, and discomfort were present in all cases. Ophthalmological findings were a poor prognosis indicator. It w as possible to precisely evaluate treatment and outcome in 23 cases. T he majority of tumors were classified as T3 or T4 (72 %), with extensi on beyond the ethmoid sinuses; all were in contact with the roof of th e ethmoidal sinuses. Extension was pre dominantly into the orbital and intracranial cavities as compared with extension posteriorly or into the maxillary sinuses. Treatment was identical in the 25 patients: a) combined surgery including a paranasal and a neurosurgical approach, b ) postoperative radiotherapy. Results were expressed in terms of morbi dity related to surgery and the oncologic outcome. Operative morbidity and mortality were substantially reduced with reconstruction of the r oof of the ethmoidal sinuses. Meticulous excision, in addition to post operative radiotherapy, resulted in a decreased rate of local recurren ce (26 %). On the other hand, metastasis were encountered more frequen tly (30 %). Radiotherapy was insufficient when macroscopic excision wa s incomplete. Chemotherapy was used as palliative treatment in the eve nt of a recurrence and/or metastases. Survival rate was 68 % at 3 year s, and 48 % at 5 years. Most complications and recurrences arose withi n the first two years. Exophthalmos, intracranial extension, incomplet eremoval, and extensive class T4 tumors were associated with a poor pr ognosis. Optimal therapy for malignant tumors of the ethmoid sinuses r equires combined transfacial and neurosurgical approaches that allow p recise assessment of tumor extension and adequate excision, yielding a n improved oncologic outcome. Followed by radiotherapy, this associati on can result in a remission. Patient prognosis depends essentially on management of the initial lesion.