Treatment of advanced squamous carcinoma of the maxillary sinus by irradiation

Between 1959 and 1972, there were 23 patients with advanced squamous carcinoma of the maxillary sinus treated by radiation therapy as the only modality. Eighteen of these patients had not shown evidence of metastasis and were locally extensive being classified as T3 4N0M0. They received 60-75 Gy (6000-7500 rad) in 6 to 7 1/2 weeks using an anterior portal with opposed lateral wedge pairs to give a homogenous dose. No treatment was given to the neck. Of 10 patients with tumors presenting in the suprastructures, six are living 5 years with no evidence of disease (NED), one is dead of intercurrent disease, one died of metastatic disease with no evidence of tumor at the primary site, and two died of recurrent primary tumor. With suprastructure presentation, radiation therapy as a sole treatment was able to control the primary tumor in eight out of 10 patients. In eight patients in whom the tumor presented in the infrastructure only, one patient was living at 5 years, but this patient had salvage irradiation. One patient died of metastasis but with no evidence of tumor at the primary site. Therefore, six out of eight had uncontrolled or recurrent primary tumor leading to death. It is concluded that in extensive tumors of suprastructure, radiation may be the only modality required to control the primary tumor (80%). In the infrastructure, radiation has failed in 75% of the patients so that surgery may also be required as a planned part of treatment in order to control the primary tumor. Metastatic disease accounted for three of the 10 deaths as a result of tumor.