From 1975 to 1977 three cases of primary carcinoma of the bilateral maxillary sinuses have been seen in our clinic. The first case, a 53-year-old female, underwent total maxillectomy and postoperative 60Co irradiation in 1969 due to squamous cell carcinoma of the right maxillary sinus. In 1975, she developed left-side toothache with nasal cbstruction. X-ray examination rev-ealed the desructive changes of the bony wall of the left maxillary sinus. The pathological examination revealed "epidermoid carcinoma" Radiotherapy with association of the anticancer drugs (BUdR, 5FU) appeared effective, but the carcinoma soon recurred after the radiotherapy finished. This patient died of cachexy due to local recurrence and multiple lung metastases in 1977. The second case, a 64-year-old female, underwent right total maxillectomy in 1957 and treated with Radon seeds postoperatively. She developed epistaxis and pain of the left cheek since March in 1975, and a biopsy of the left maxillary antrum revealed squamous cell carcinoma. Partial maxillectomy and postoperative radiotherapy failed to make any improvement, and died of cachexy in 1977. The third case, a 66-year-old male, underwent total maxillectomy with radica neck dissection in 1943 due to basal cell carcinoma of the left maxillary sinus. He was in good health until he developed a swelling and pain of the right cheek at the end of 1976. Exploratory opening of the right maxillary antrum showed squamous cell carcinoma which was confirmed by histological examination. Preoperative radiotherapy with local infusion of anticancer drugs and partial maxillectomy could not control the carcinoma, and recurrence was noticed soon later. Salvage operations were done in three occasions.
By reviewing literature, 34 cases of primary carcinoma of the bilateral maxillary antrums had been found, and 18 patients were male, 15 females and I unknown. The range of the pati-ents' age was from 41 to 84 years old and 62 per-cent of the cases were found between 50 to 69 years old. Different histopathological findings between the first and second cancer were rep-orted in only 27 per-cent. An interval between the first and second cancer was varied from one case to another, but 63 per-cent was within 5 years. The longest inteval was 33 years and 7 months.
The statistical analysis of the 37 cases suggested a possibility that not only the genetic regulation of the immune response, but also radiotherapy done in the treatment of the first cancer were the important factors of carcinogenesis.
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