Salvage surgery improves the treatment outcome of patients with residual/recurrent maxillary sinus cancer after superselective intra-arterial cisplatin infusion with concomitant radiation therapy

Abstract

We have performed superselective intra-arterial cisplatin infusion with concomitant radiotherapy (RADPLAT) for patients with maxillary sinus cancer. The promising treatment outcomes of this non-surgical treatment were reported in past studies. However, few clinical studies have been conducted to evaluate the outcome of salvage surgery following RADPLAT. The purpose of this study was to analyze the treatment outcomes of salvage surgery for patients with recurrent maxillary sinus cancer after RADPLAT. MethodsWe assessed 45 patients who had recurrence following RADPLAT between 1999 and 2017, and conducted a retrospective analysis. We excluded patients who did not complete RADPLAT. Patients were not considered to have completed RADPLAT if they underwent intra-arterial cisplatin less than three times or received a total radiation dose of less than 60 Gy. The primary endpoint was overall survival. The median follow-up period for surviving patients after recurrence was 5.1 years. ResultsTwenty-five of the 45 (56%) patients underwent salvage surgery. The 5-year overall survival rate was 68% in patients who underwent salvage surgery, while all patients who did not undergo salvage surgery died during the observation period.Fifteen of 24 (63%) patients with local recurrence underwent salvage surgery. Eight patients did not undergo salvage surgery because of unresectable disease; five out of the eight patients had unresectable posterior extension. All nine patients with nodal recurrence underwent neck dissection. ConclusionTreatment outcomes of salvage surgery following RADPLAT were favorable enough for it to be generally recommended. To reduce unresectable recurrence, the posterior section should be eradicated by RADPLAT.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…reported a 5‐year OS of 67.6% in 54 patients primarily treated with RADPLAT for maxillary SCC 454 . Similar survival rates have also been seen for recurrent maxillary SCC initially treated with RADPLAT, with a study reporting a 5‐year OS of 68% for salvage surgery for these tumors 434 . However, survival outcomes were lower in a study by Ono et al.…”

“…Two recent studies, both from Japan, have assessed the role of salvage surgery for the treatment of local persistent/recurrent advanced maxillary sinus SCC treated initially with RADiation and intraarterial cisPLATin (RADPLAT). In both series, patients in whom negative surgical margins could be achieved with SS had a significant improvement in their 2‐ and 5‐year survival rates and local disease control 433,434 . However, salvage treatment of advanced epithelial malignancies involving other sinonasal sites seems less effective.…”