IS PROPHYLACTIC NECK IRRADIATION INDICATED IN PATIENTS WITH SQUAMOUS-CELL CARCINOMA OF THE MAXILLARY SINUS

Purpose: To determine the proportion of patients with squamous cell ca rcinoma of the maxillary sinus who will fail in regional nodes without elective neck treatment and to identify any prognostic factors that m ay influence neck control. Methods and Materials: From 1971-1995, 42 c onsecutive patients with squamous cell carcinoma of the maxillary sinu s were seen at our department for curative treatment. There were 35 ma les and 7 females, with a median age at diagnosis of 63.5 years (range , 42-77 years). One tumor was classified as T1, 5 had T2, 15 had T3, a nd 21 had T4 disease. Four of 42 patients (9.5%) had cervical lymphade nopathy at initial presentation. Thirty-three patients had surgical re section and radiotherapy and nine had radiotherapy alone. None of the 38 patients with clinical N0 necks received elective treatment to the cervical nodes. Results: Median overall survival was 30 months for all patients. Of the 38 patients with N0 disease, 11 (28.9%) had neck rec urrence. Of the 11 neck failures, 9 were ipsilateral only, 1 was contr alateral, and 1 had bilateral neck recurrence. The most common site of neck failure was in the upper neck (suhmandibular and jugulodigastric lymph nodes). Four of the 38 patients (10.5%) had isolated neck failu re. Only tumor stage was found to be significant for neck relapse, wit h T1 and T2 doing worse compared to T3 and T4 tumors. Location of tumo r (infrastructure vs. suprastructure), involvement of the oral cavity/ oropharynx, nasal cavity, nasopharynx or orbit did not predict for cer vical node relapse. Local control at the primary site was likewise not prognostic. The median overall survival for patients who remained N0 was 80 months and for those with initial cervical involvement or recur red in the neck without elective neck irradiation was 25 months (p = 0 .05). Conclusion: Based on the 28.9 % rate of neck recurrence and the poor median survival of patients who recur in the neck, we recommend p rophylactic ipsilateral neck irradiation in patients with T1-T4 squamo us cell carcinoma of the maxillary sinus. (C) 1997 Elsevier Science In c.