Patterns of Initial Lymph Node Involvement and Recurrence in Patients With Maxillary Sinus Squamous Cell Carcinoma

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Oncology

Background:

• Maxillary sinus squamous cell carcinoma (SCC) presents a challenge regarding elective treatment of cervical lymph node (LN) areas.
• Understanding initial LN involvement and recurrence is crucial for optimizing treatment strategies.

Purpose of the Study:

• To analyze patterns of initial lymph node involvement in maxillary sinus SCC.
• To investigate patterns of regional recurrence in patients with maxillary sinus SCC.
• To guide treatment strategies for elective cervical LN areas in maxillary sinus SCC.

Main Methods:

• Retrospective review of 119 patients with maxillary sinus SCC treated between 2005 and 2023.
• Analysis of treatment modalities including concurrent chemoradiotherapy, neoadjuvant therapy, and upfront surgery.
• Evaluation of initial lymph node status, regional failure sites, and distant metastasis patterns.

Main Results:

• 23.5% of patients had clinical lymph node involvement at diagnosis, predominantly in ipsilateral neck levels I and II.
• Regional failure occurred in 19.8% of cN0 and 32.1% of cN+ patients, with ipsilateral level II being the most common recurrence site.
• Contralateral failures were more frequent in cN+ patients, and lung metastasis was the most common distant failure (14.3%).

Conclusions:

• Initial lymph node involvement patterns in maxillary sinus SCC primarily affect ipsilateral neck levels I and II.
• Understanding recurrence patterns, including contralateral failures and distant metastases, is vital for patient management.
• Findings can refine radiation field design and follow-up strategies for maxillary sinus SCC.