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LETTER TO THE EDITOR
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 213-214

Long-term survival outcomes of technically unresectable carcinoma maxilla postinduction chemotherapy


1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication13-Jul-2018

Correspondence Address:
Dr. Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sajc.sajc_165_18

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How to cite this article:
Dhumal SB, Patil VM, Joshi A, Noronha V, Chandrasekharan A, Pai P, Prabhash K. Long-term survival outcomes of technically unresectable carcinoma maxilla postinduction chemotherapy. South Asian J Cancer 2018;7:213-4

How to cite this URL:
Dhumal SB, Patil VM, Joshi A, Noronha V, Chandrasekharan A, Pai P, Prabhash K. Long-term survival outcomes of technically unresectable carcinoma maxilla postinduction chemotherapy. South Asian J Cancer [serial online] 2018 [cited 2018 Aug 20];7:213-4. Available from: http://journal.sajc.org/text.asp?2018/7/3/213/236572

Dear Editor,

Carcinoma of the maxillary sinus is a rare malignancy.[1],[2] Due to this, there are limited prospective studies that have been reported. As the early stages of this malignancy remain asymptomatic, most patients get diagnosed in a locally advanced stage.[1] Due to its anatomical proximity to vital structures, surgical resection is a challenge, especially in locally advanced stages. However, surgical resection remains the cornerstone of management of this cancer.[3] In a study done by Iyer et al. in resectable locally advanced maxillary sinus cancers, surgical resection was associated with a 5-year disease-specific survival of 71% versus 0% in chemoradiation arm (P = 0.05).[4] However, in very locally advanced borderline resectable maxillary sinus carcinoma, upfront surgery is not possible. We had reported our initial results in 41 patients treated between 2008 and 2011 with induction chemotherapy in these tumors.[5] In this letter, we report the long-term results of patients treated with this strategy.

Forty-one patients with locally advanced technically unresectable maxillary sinus carcinoma were treated with two cycles of induction chemotherapy. All patients had T4 disease. The induction chemotherapy consisted of either three-drug regimen of docetaxel, cisplatin, and 5-fluorouracil or two-drug regimen of taxane (docetaxel or paclitaxel) and platinum (cisplatin or carboplatin). The chemotherapy regimens received were TPF in 7 patients, docetaxel-platinum in 15 patients, and rest received paclitaxel-platinum. The median cycles received were 2. Postinduction regimen, the response rate was 39% (16 patients). These patients were then discussed in a multidisciplinary joint clinic. The further treatment these patients underwent were surgical resection followed by postoperative chemoradiation in 8 patients, radical chemoradiation in 21 patients, radical radiation in 1 patient, palliative radiation in 1 patient, palliative chemotherapy in 4 patients, and best supportive care in 6 patients.

R version 3.4.2 (R Foundation for Statistical Computing, Vienna, Austria) was used for analysis. Kaplan–Meier method was used for the estimation of progression-free survival (PFS) and overall survival (OS). Follow-up was calculated using reverse Kaplan–Meier method. Cox regression analysis was used to identify factors affecting PFS and OS. The median follow-up was 66.3 months. The 5-year progression-free survival rate and OS rate were 15.2% (95% confidence interval [CI] 3.2%–27.2%) and 16.9% (95% CI 4.9%–28.9%), respectively. The factors which were independently associated with an improvement in PFS and OS were grade of tumor and serum albumin level [Table 1].
Table 1: The impact of different factors on progression-free survival and overall survival

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The outcomes of T4 carcinoma maxilla reported in the literature are poor.[1] Even resected T4 maxillary sinus carcinomas have a 5-year OS between 20% and 36%.[6],[7],[8] The outcomes of resectable carcinoma maxilla who are treated with chemoradiation are dismal.[4] The 5-year disease-specific survival in these patients is 0%. Considering these outcomes, strategy of providing induction chemotherapy followed local treatment based on response seems reasonable. In view of the rarity of this malignancy, it is unlikely that a prospective randomized study would be conducted in this malignancy. Hence, we opine that, in view of the long-term results seen with induction therapy, induction followed by local treatment should be considered as an option in technically unresectable maxillary sinus carcinomas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dubal PM, Bhojwani A, Patel TD, Zuckerman O, Baredes S, Liu JK, et al. Squamous cell carcinoma of the maxillary sinus: A population-based analysis. Laryngoscope 2016;126:399-404.  Back to cited text no. 1
    
2.
Gibson TN, McNaughton DP, Hanchard B. Sinonasal malignancies: Incidence and histological distribution in Jamaica, 1973-2007. Cancer Causes Control 2017;28:1219-25.  Back to cited text no. 2
    
3.
Al-Jhani AS, Al-Rajhi NM, El-Sebaie MM, Nooh NS, Mahasen ZZ, Al-Amro AS, et al. Maxillary sinus carcinoma. Natural history and outcome. Saudi Med J 2004;25:929-33.  Back to cited text no. 3
    
4.
Iyer NG, Tan DS, Tan VK, Wang W, Hwang J, Tan NC, et al. Randomized trial comparing surgery and adjuvant radiotherapy versus concurrent chemoradiotherapy in patients with advanced, nonmetastatic squamous cell carcinoma of the head and neck: 10-year update and subset analysis. Cancer 2015;121:1599-607.  Back to cited text no. 4
    
5.
Noronha V, Patil VM, Joshi A, Krishna MV, Dhumal S, Juvekar S, et al. Induction chemotherapy in technically unresectable locally advanced carcinoma of maxillary sinus. Chemother Res Pract 2014;2014:487872.  Back to cited text no. 5
    
6.
Hayashi T, Nonaka S, Bandoh N, Kobayashi Y, Imada M, Harabuchi Y, et al. Treatment outcome of maxillary sinus squamous cell carcinoma. Cancer 2001;92:1495-503.  Back to cited text no. 6
    
7.
Santos MR, Servato JP, Cardoso SV, de Faria PR, Eisenberg AL, Dias FL, et al. Squamous cell carcinoma at maxillary sinus: Clinicopathologic data in a single Brazilian institution with review of literature. Int J Clin Exp Pathol 2014;7:8823-32.  Back to cited text no. 7
    
8.
Waldron JN, O'Sullivan B, Gullane P, Witterick IJ, Liu FF, Payne D, et al. Carcinoma of the maxillary antrum: A retrospective analysis of 110 cases. Radiother Oncol 2000;57:167-73.  Back to cited text no. 8
    



 
 
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