Abstract
We reviewed prospectively collected data of patients with maxillary sinus squamous cell carcinoma who had been given superselective intra-arterial cisplatin and concomitant radiation (RADPLAT) at Hamamatsu University School of Medicine, University Hospital between 2004 and 2011 to assess the effectiveness and safety of this therapeutic approach.
Twenty-six patients underwent conventional radiation (60-66 grays) with 5 to 6 weekly infusions of intra-arterial cisplatin (100-120 mg/m2) and systemic sodium thiosulfate neutralization. Twenty-one patients (80.8%) of the 26 patients had T4 disease. Of these 26 patients 8 were treated with Induction chemotherapy (systemic chemotherapy or superselective intra-arterial cisplatin) followed by RADPLAT, whereas the other 18 did not receive any pretreatment before RADPLAT. We performed salvage surgery only for three of nine patients in whom residual cancer was confirmed or who had local recurrence after RADPLAT.
After a median follow-up period of 20 months, the 2-year overall survival rate was 76.2% for all patients. The local control rate and the progression-free survival rate were 61.9% and 51.9%, respectively. In terms of eyeball preservation, five patients lost their visual function during the observational period. Three patients received cisplatin via the ophthalmic artery to reduce tumors which had deeply infiltrated the orbit or ethmoid sinus and who had become blind. Salvage radical maxillectomy with orbital exenteration was conducted for two patients. Five patients experienced grade 3 or 4 toxicity. Arterial infusion had to be discontinued in two patients because of cerebral infarction and severe colitis.
Short-term follow-up results in our hospital suggest that RADPLAT could be applied effectively to advance the treatment of maxillary sinus squamous cell carcinomas. However, we must recognize that RADPLAT has potential risks regarding cerebrovascular accidents and other serious adverse effects and the late onset side effects are as yet unclear.
