Management of the neck in maxillary sinus carcinomas

Abstract

Purpose of Review To discuss and review the role for elective treatment of the neck in maxillary squamous cell carcinoma. Improvements in survival have been seen due to improved local therapies and control, therefore the treatment of the neck has become a topic of debate. Recent findings The risk of occult metastases in neck nodes is higher for T 3-4 tumors. The rate of nodal relapse in the N0 neck without elective treatment is 8-15%. With elective irradiation the nodal relapse rate decreases. However, most nodal relapses are accompanied by local failure or distant disease. Local failure remains the most common site of failure and cause of death in this patient population. Summary Treatment failure occurs overall in 62% of all patients, with local recurrence by far the most common site of treatment failure which is rarely amenable to salvage therapy. Therefore elective neck irradiation is not routinely indicated in the clinically N0 neck; those who recur only in the neck can be surgically salvaged more than 50% of the time.

Squamous cell carcinoma of the maxillary sinus: A population‐based analysis

“…It has been posited that these tumors commonly present at higher stages because the paranasal sinuses are hollow air‐filled cavities, thus accommodating significant tumor growth before signs and symptoms are apparent . Moreover, it has been argued that due to limited lymphatic drainage pathways for the maxillary sinus, maxillary tumors can grow insidiously before demonstrating lymphatic involvement . In the current analysis, only 4.0% of cases had distant metastasis, with a higher proportion (22.2%) demonstrating nodal involvement in the neck.…”

“…Diagnosis of MSSCC most often occurs at an advanced stage due to nonspecific symptoms early in the disease, with >80% of patients reportedly presenting with at least stage T3 disease. 8 Local recurrence has proven to be the primary challenge in the treatment of MSSCC, highlighting the importance of local control. 9,10 Traditionally, lymph node involvement at the time of diagnosis of maxillary sinus malignancies has been considered rare due to limited lymphatic drainage.…”

“…9,10 Traditionally, lymph node involvement at the time of diagnosis of maxillary sinus malignancies has been considered rare due to limited lymphatic drainage. 8 However, MSSCC can present with nodal involvement at initial diagnosis. 11,12 In the present analysis, the authors utilize the Surveillance, Epidemiology, and End Results (SEER) database, a nationally representative resource that has proven useful in describing rare clinical entities, [13][14][15][16][17][18][19] to characterize the malignant behavior of MSSCC, including rates and patterns of metastasis.…”

The role of elective neck dissection in the treatment of maxillary sinus squamous cell carcinoma

“…Interestingly, END also had significant effects on survival in tumors > 3 cm and AJCC stage T3. Because most patients with MS‐SCC have few symptoms early in the disease progression, it is rare to diagnose MS‐SCC before it reaches 3 cm, making analysis of the effect of END on smaller tumors (< 4 cm) statistically difficult . Although stratification by tumor size may seem arbitrary, it elucidates an important clinical perspective on the treatment of MS‐SCC.…”

Long noncoding RNA KCNQ1OT1 promotes proliferation, migration, and invasion in maxillary sinus squamous cell carcinoma by regulating miR‐204/EphA7 axis

“…Maxillary sinus squamous cell carcinoma (MSSCC) is rare and comprises 2% to 3% of all head and neck cancers . Since the clinical symptoms of patients with MSSCC are nonspecific in the early stages, detection of MSSCC is often delayed . Although great advance in MSSCC treatment, the survival rate of patients with MSSCC remains poor, which is mainly ascribed to local high recurrence of MSSCC .…”