Optimal timing of postoperative radiotherapy initiation in maxillary sinus cancer patients
, 2, 2
Abstract
Introduction: Maxillary sinus cancer is a relatively rare head and neck malignancy. Despite advances in
treatment, it remains a therapeutic challenge. This study aimed to evaluate treatment outcomes in maxillary
sinus cancer patients depending on the timing of radiotherapy initiation after surgery.
Material and methods: A retrospective analysis of 91 patients treated for maxillary sinus cancer was
performed. Depending on the treatment modality, patients were divided into 3 groups: I — surgery +
adjuvant radiotherapy (n = 77), II — palliative radiotherapy (n = 10), and III — radical radiotherapy only
(n = 4). Overall survival (OS) was assessed.
Results: The longest median OS (30.6 months) was observed in group I. It was demonstrated that the
timing of radiotherapy initiation after surgery is crucial — with 3–4 weeks interval OS was 75 and 60.4
months, respectively. Patients with treatment failure in the form of distant metastases had shorter median
OS (4.4 months) compared to those with local recurrence (10.9 months).
Conclusions: Combined treatment with surgery + adjuvant radiotherapy provides the best results. Postoperative
radiotherapy should be initiated no later than 4 weeks after surgery, which significantly prolongs
median overall survival. Commencing radiotherapy within 3–4 weeks after surgery markedly improves
the prognosis. Patients who developed local recurrence have better prognosis compared to those with
distant metastases.
Keywords: Maxillary sinus cancerradiotherapycombined modality treatmenttreatment timingtime factors
References
- Llorente JL, López F, Suárez C, et al. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol. 2014; 11(8): 460–472.
- Dulguerov P, Jacobsen M, Allal A, et al. Nasal and paranasal sinus carcinoma: Are we making progress? Cancer. 2001; 92(12): 3012–3029, doi: 10.1002/1097-0142(20011215)92:12<3012::aid-cncr10131>3.0.co;2-e.
- Madani I, Bonte K, Vakaet L, et al. Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys. 2009; 73(2): 424–432.
- Franco R, de Matos LL, Kulcsar MA, et al. Influence of time between surgery and postoperative radiation therapy and total treatment time in locoregional control of patients with head and neck cancer: a single center experience. Clinics (Sao Paulo). 2020; 75: e1615.
- Fietkau R. [Effects of the time interval between surgery and radiotherapy on the treatment results]. Strahlenther Onkol. 2000; 176(10): 452–457.
- George JR, Yom SS, Wang SJ. Combined modality treatment outcomes for head and neck cancer: comparison of postoperative radiation therapy at academic vs nonacademic medical centers. JAMA Otolaryngol Head Neck Surg. 2013; 139(11): 1118–1126.
- Ash D, Barrett A, Hinks A, et al. Royal College of Radiologists. Re-audit of radiotherapy waiting times 2003. Clin Oncol (R Coll Radiol). 2004; 16(6): 387–394.
- Williams MV, Drinkwater KJ. Geographical variation in radiotherapy services across the UK in 2007 and the effect of deprivation. Clin Oncol (R Coll Radiol). 2009; 21(6): 431–440.
- Mendenhall WM, Amdur RJ, Hinerman RW, et al. Postoperative radiation therapy for squamous cell carcinoma of the head and neck. Am J Otolaryngol. 2003; 24(1): 41–50.
- Didkowska J, Wojciechowska U, Michalek IM, et al. Cancer incidence and mortality in Poland in 2019. Sci Rep. 2022; 12(1): 10875.
- Nishio N, Fujimoto Y, Hiramatsu M, et al. ＜Editors' Choice＞ Maxillary sinus carcinoma outcomes over 60 years: experience at a single institution. . Nagoya J Med Sci. 2018; 80(1): 91–98.
- Llorente JL, López F, Suárez C, et al. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol. 2014; 11(8): 460–472.
- Franchi A, Bishop JA, Coleman H, et al. Data set for the reporting of carcinomas of the nasal cavity and paranasal sinuses: explanations and recommendations of the guidelines from the international collaboration on cancer reporting. Arch Pathol Lab Med. 2019; 143(4): 424–431.
- Castelnuovo P, Lambertoni A, Sileo G, et al. Critical review of multidisciplinary approaches for managing sinonasal tumors with orbital involvement. Acta Otorhinolaryngol Ital. 2021; 41(Suppl. 1): S76–S89.
- Spiro JD, Soo KC, Spiro RH. Squamous carcinoma of the nasal cavity and paranasal sinuses. Am J Surg. 1989; 158(4): 328–332.
- Dirix P, Vanstraelen B, Jorissen M, et al. Intensity-modulated radiotherapy for sinonasal cancer: improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2010; 78(4): 998–1004.
- Wang F, Ren M, Wu J, et al. Definitive radiation therapy versus postoperative radiation therapy for patients with maxillary sinus cancer invading the upper jaw. J Craniofac Surg. 2019; 30(4): 1234–1238.
- Kreppel M, Amir Manawi NN, Scheer M, et al. Prognostic quality of the Union Internationale Contre le Cancer/American Joint Committee on Cancer TNM classification, 7th edition, for cancer of the maxillary sinus. Head Neck. 2015; 37(3): 400–406.
- Keerio AA, Qayyum MU, Kashif A, et al. Treatment outcomes of maxillary sinus squamous cell carcinoma at a dedicated cancer institute: a retrospective study. Cureus. 2022; 14(6): e25644.
- Wang Ru, Hou L, Huang Z, et al. Prognostic analysis of individualized treatments of malignant tumors primary from maxillary sinus. Ear Nose Throat J. 2022 [Epub ahead of print]: 1455613221115134.
- Wang Yu, Yang R, Zhao M, et al. Retrospective analysis of 98 cases of maxillary sinus squamous cell carcinoma and therapeutic exploration. World J Surg Oncol. 2020; 18(1): 90.