Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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External Beam Irradiation for Squamous Cell Carcinoma of the Maxillary Sinus

상악동 편평세포암종에서의 방사선치료

  • Kim Tae-Hyun (Department of Radiation Oncology. College of Medicine, University of Korea) ;
  • Yoon Won-Sub (Department of Radiation Oncology. College of Medicine, University of Korea) ;
  • Yang Dae-Sik (Department of Radiation Oncology. College of Medicine, University of Korea) ;
  • Kim Chul-Yong (Department of Radiation Oncology. College of Medicine, University of Korea) ;
  • Choi Myung-Sun (Department of Radiation Oncology. College of Medicine, University of Korea)
  • 김태현 (고려대학교 의과대학 방사선종양학교실) ;
  • 윤원섭 (고려대학교 의과대학 방사선종양학교실) ;
  • 양대식 (고려대학교 의과대학 방사선종양학교실) ;
  • 김철용 (고려대학교 의과대학 방사선종양학교실) ;
  • 최명선 (고려대학교 의과대학 방사선종양학교실)
  • Published : 2003.03.01
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Abstract

Purpose : Maxillary sinus cancers are usually locally advanced, and involve the structures around sinus, but the regional lymphatic spread is uncommon. Therefore, the local control of these cancers is important for their cure. We reviewed our experience of 55 patients with squamous cell carcinomas of the maxillary sinus, treated with radiation therapy, and looked for the role of radiation therapy in maxillary sinus cancers. Materials and Methods : Between November 1982 and October 1999, 55 patients with squamous cell carcinomas of the maxillary sinus underwent either radiation therapy only, or combined with surgery or with concurrent chemoradlation therapy. All patients were restaged according to the 1997 AJCC staging systems. The T classifications of the tumors of the patients were as follows 1.8$\%$ (1/55) for 72, 81.8$\%$ (45/55) for 73 and 16.4$\%$ (9/55) for 74. Thirteen patients were diagnosed with lymph node involvement. With the surgical procedures, 12 patients were managed by biopsy only, 21 were resected by FESS (funclienal endoscopic sinus surgery) and 22 by partial/medical/total rnaxillectomies. The details of the treatments were as follows 8 patients were treated with radiation therapy only, 17 with a combination of FESS and radiation therapy, 22 with a combination of a maxillectomy and radiation therapy, 4 with a combination of preoperative radiation therapy and surgery, and 4 with concurrent chemoradiation therapy. The mean follow-up for all patients was 25 months, ranging from 2.8 to 125 months. Results : The 4-year local control and survival rates for all Patients were 45.5 and 33.3$\%$, respectively. The 4-year local control and suHival rates, due to the extent of surgery, were as follows 32.1, and 21.4$\%$ for biopsy; 41.9, and 31.7$\%$ for FESS; and 56.8, and 52.7$\%$ for maxillectomy, respectively. Twenty-nine (52.7$\%$) patients were not cured, and of these 29 patients, 23 (79.3$\%$) patients had a iocal recurrence following treatment. Conclusions :This study has shown that the major failure sites following treatment to be the local regions, and that the completeness of surgery was important for improving the local control and survival of patients with squamous cell carcinoma of the maxillary sinus.

목적 : 상악동 편평세포암종 환자에서 방사선치료의 성적을 분석하여, 예후인자와 방사선치료의 역할을 알아보고자 하였다. 대상 및 방법 : 본 연구는 1982년 11월부터 1999년 10월까지 상악동암 중 조직학적으로 편평세포암종으로 진단 후 방사선치료를 시행한 55명을 대상으로 하였다. 임상병기별로 보면, III기가 44명, IV기가 11명이었다. 원발종양병기분류를 보면, 72가 1명, 73가 45명, 74가 9명이었으며, 림프절 전이는 13명에서 있었다. 수술은 12명은 조직검사만, 21명에서는 기능적 내시경 부비동수술을, 22명에서는 전상악동 절제술 또는 아상악동 절제술을 시행하였다. 방사선치료 단독으로 시행한 경우가 8명, 기능적 내시경 부비동수술 후 방사선치료를 시행한 군이 17명, 근치적수술 후 방사선치료를 시행한 경우가 22명, 수술 전 방사선치료를 시행한 경우가 4명, 동시항암방사선치료를 시행한 경우가 4명이었다. 전체환자의 평균 추적관찰기간은 25개월(2.8$\~$125개월)이었다. 결과 : 전체환자의 2년과 4년 국소제어율은 각각 49.0$\%$, 45.5$\%$였고, 2년과 4년 생존율은 각각 42.1$\%$, 33.3$\%$였다. 방사선치료 전의 수술적 절제 정도에 따라 보면 조직검사 군은 4년 국소제어율과 생존율이 각각 32.1$\%$, 21.4$\%$였고, 기능적 내시경 부비동 수술을 시행한 군은 각각 41.9$\%$ 31.7$\%$였고, 근치적 절제술을 시행한 환자군은 각각 56.8$\%$ ,38.5$\%$로 차이를 보였다(p<0.05). 전체환자 중 26명의 환자는 추적관찰 기간 중 무병상태를 보였고, 19명은 국소재발만을, 2명은 림프절 전이와 국소재발을 함께 보였고, 1명은 림프절전이를, 2명은 전신전이와 국소재발을 동시에, 5명은 전신전이를 보였다 결론 : 상악동 편평세포암종 환자에서 방사선치료시 국소제어율과 생존율의 향상을 위해서는 수술시 절제정도가 중요한 예후인자임을 확인하였고, 치료 실패의 부위가 국소인 경우가 높아 효과적인 국소치료방법에 대한 연구가 필요할 것을 보인다.

Keywords

References

  1. Ayiomamitis A, Parker L, Havas T. The epidemiology of malignant neoplasms of the nasal cavities, the paranasal sinuses and the middle ear in Canada. Arch Otorhinolaryngol 1988;244:367-371 https://doi.org/10.1007/BF00497467
  2. Paulino AC, Fisher SG, Marks J. Is prophylactic neck irradiation indicated in patients with squamous cell carcinoma of the maxillary sinus? Int J Radiat Oncol Bioi Phys 1997;39: 283-289
  3. Batini JP, Ennuyer A. Advanced carcinoma of the maxillary antrum treated by cobalt teletherapy and electron beam irradiation. Br J Radiol 1971;44:590-598 https://doi.org/10.1259/0007-1285-44-524-590
  4. Cheng VST, Wang CC. Carcinomas of the paranasal sinuses : A study of sixty-six cases. Cancer 1977;40:3038-3041 https://doi.org/10.1002/1097-0142(197712)40:6<3038::AID-CNCR2820400641>3.0.CO;2-9
  5. Paulino AC, Fisher SG, Marks JE. Is prophylactic neck irradiation indicated in patients with squamous cell carcinoma of the maxillary sinus? Int J Radiat Oncol Bioi Phys 1997;39: 283-289
  6. Shidnia H, Hornback NB, Saghafi N, et al. The role of radiation therapy in treatment of malignant tumors of the paranasal sinuses. Laryngoscope 1984;94:102-1 06
  7. iang GL, Ang KK, Peters LJ, et al. Maxillary sinus carcinomas : Natural history and results of postoperative radiotherapy. Radiother Oncol 1991;21:193-200 https://doi.org/10.1016/0167-8140(91)90037-H
  8. Harrison L, Pfister D, Fass K, et al. Concomittant chemotherapy- radiation therapy for advanced unresectable head and neck cancer. Int J Radiat Oncol Bioi Phys 1991;21:703-708 https://doi.org/10.1016/0360-3016(91)90689-2
  9. Roa WHY, Hazuka MB, Sandler HM, et al. Results of primary and adjuvant CT-based 3-dimentional radiotherapy for malignant tumors of the paranasal sinus. Int J Radiat Oncol Bioi Phys 1994;28:857-865 https://doi.org/10.1016/0360-3016(94)90105-8
  10. Brush SE, Bagshaw M. Carcinoma of paranasal sinuses. Cancer 1982;50:154-158 https://doi.org/10.1002/1097-0142(19820701)50:1<154::AID-CNCR2820500129>3.0.CO;2-W
  11. Zaharia M, Salem LE, Travezan R, et al. Postoperative radiotherapy in the management of cancer of the maxillary sinus, Int J Radiat Oncol Bioi Phys 1989;17:967-971
  12. Tsuji H, Kamada T, Arimoto T, et al. The role of radiotherapy in the management of maxillary sinus carcinoma. Cancer 1986;57:2261-2266 https://doi.org/10.1002/1097-0142(19860615)57:12<2261::AID-CNCR2820571204>3.0.CO;2-X
  13. Amendola BE, Eisert D, Harza TA, King ER. Carcinoma of the maxillary antrum. Int J Radiat Oncol Bioi Phys 1981;7: 743-746 https://doi.org/10.1016/0360-3016(81)90467-3
  14. Shibuya H, Horiuchi JI, Suzuki S, et al. Maxillary sinus carcinoma: result of radiation therapy. Int J Radiat Oncol Bioi Phys 1984;10:10211-1026
  15. Yun HG, Park CI, Kim KH. Radiotherapy of squamous cell carcinoma of maxillary antrum. J Korean Soc Ther Radiol 1990;8:45-50
  16. Hayashi T, Nonaka S, Bandoh N, Kobayashi Y, Imada M, Harabuchi Y. Treatment outcome of maxillary sinus squamous cell carcinoma. Cancer 2001;92:1495-1503 https://doi.org/10.1002/1097-0142(20010915)92:6<1495::AID-CNCR1474>3.0.CO;2-P
  17. Itami J, Uno T, Aruga M, Ode S. Squamous cell carcinoma of the maxillary sinus treated with radiation therapy and conservative surgery. Cancer 1998;82:104-107 https://doi.org/10.1002/(SICI)1097-0142(19980101)82:1<104::AID-CNCR12>3.0.CO;2-6
  18. Ogawa K, Toita T, Kakinohana Y, et al. Postoperative radiotherapy for squamous cell carcinoma of the maxillary sinus: analysis of local control and late complications. Oncol Resp 2001;8:315-319
  19. Nishino H, Miyata M, Morita M, Ishikawa K, Kanazawa T, Ichimura K. Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy for maxillary sinus. Cancer 2000;89: 1925-1932 https://doi.org/10.1002/1097-0142(20001101)89:9<1925::AID-CNCR8>3.3.CO;2-8
  20. Nibu KI, Sugasawa M, Asai M, et al. Results of multimodality therapy for squamous cell carcinoma of maxillary sinus. Cancer 2002;94:1476-1482 https://doi.org/10.1002/cncr.10253
  21. Le QT, Fu KK, Kaplan M, Terris DJ, Fee WE, Goffinet DR. Treatment of maxillary sinus carcinoma: a comparison of the 1997 and 1977 American Joint Committee on Cancer Staging Systems. Cancer 1999;86:1700-1711 https://doi.org/10.1002/(SICI)1097-0142(19991101)86:9<1700::AID-CNCR11>3.0.CO;2-4
  22. Yuhua H, Guiyi T, Yuqin Q, et al. Comparison of preand postoperative radiation in the combined treatment of carcinoma of maxillary sinus. Int J Radiat Oncol Bioi Phys 1982;8:1045-1049 https://doi.org/10.1016/0360-3016(82)90175-4
  23. Korohara SS, Webster JH, Ellis F, et al. Role of radiation therapy and surgery in the management of localized epidermoid carcinoma of the maxillary sinus. Am J Roentgenol 1972;114:35-42
  24. Ahmad K, Coordobe RB, Fayos JV. Squamous cell carcinoma of the maxillary sinus. Arch Otolaryngol 1982;7:48-51
  25. Sakata K, Aoki Y, Karasawa K, et al. Analysis of the results of combined therapy for maxillary carcinoma. Cancer 1993;71 :2715-2722 https://doi.org/10.1002/1097-0142(19930501)71:9<2715::AID-CNCR2820710905>3.0.CO;2-0
  26. Lee F, Ogura JH. Maxillary sinus carcinoma. Laryngoscope 1981;91:133-139
  27. Jesse RH. Preoperative versus postoperative radiation in the treatment of squamous cell carcinoma of the paranasal sinuses. Am J Surg 1965;110:592-612 https://doi.org/10.1016/0002-9610(65)90044-9
  28. Hu YH, Tu GY, Qi YQ, et al. Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of maxillary sinus. Int J Radiat Bioi Phys 1982;8:1045-1049 https://doi.org/10.1016/0360-3016(82)90175-4
  29. Sato Y, Morita M, Takahashi H, et al. Combined surgery, radiotherapy and regional chemotherapy in carcinoma of the paranasal sinuses. Cancer 1970;25:571-579 https://doi.org/10.1002/1097-0142(197003)25:3<571::AID-CNCR2820250312>3.0.CO;2-N
  30. Giri SPG, Raddy EK, Gemer LS, et al. Management of advanced squamous cell carcinomas of cancer the maxillary sinus. Cancer 1992;69:657-661 https://doi.org/10.1002/1097-0142(19920201)69:3<657::AID-CNCR2820690310>3.0.CO;2-7
  31. Pezner RD, Moss WT, Tong D, et al. Cervical lymph node metastases in patients with squamous cell carcinoma of the maxillary antrum. Arch Otolaryngol 1980;106:625-629 https://doi.org/10.1001/archotol.1980.00790340033009
  32. Fletcher GH. Nasal and paranasal sinus carcinoma. In: Fletcher GH, Goepfert H, Jesse RHJ, editors. Textbook of radiotherapy. Philadelphia: Lea and Febiger. 1980;408-425
  33. Le QT, Fu KK, Kaplan MJ, et al. Lymph node metastasis in maxillary sinus carcinoma. Int J Radiat Oncol Bioi Phys 2000;46:541-549 https://doi.org/10.1016/S0360-3016(99)00453-8
  34. Dulguerov P, Jacobsen MS, Allal A, Lehmann W, Calcaterra T. nasal and paranasal sinus carcinoma: are we making progress? Cancer 2001;92:3012-3029
  35. Paulino AC, Marks JE, Bricker P, et al. Results of treatment of patients with maxillary sinus carcinoma. Cancer 1998;83:457-465 https://doi.org/10.1002/(SICI)1097-0142(19980801)83:3<457::AID-CNCR14>3.0.CO;2-V
  36. Yoshimura R, Shibuya H, Ogura I, et al. Trimodality combination therapy for maxillary sinus carcinoma. Int J Radiat Oncol Bioi Phys 2002;53:656-663 https://doi.org/10.1016/S0360-3016(02)02771-2