Maxillary sinus carcinoma. Natural history and outcome

To assess natural history, treatment outcome and pattern of relapse in patients with maxillary sinus carcinoma. A review was conducted of the medical records of all adult patients with maxillary sinus carcinoma, who were treated at King Faisal Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia, between January 1990 and December 1999. A total of 60 patients were identified for analysis, 36 men and 24 women; the median age was 58-years [range 23-95]. Major presenting symptoms were facial swelling 55%, facial pain 50%, and nasal obstruction 43.4%, with a median duration of 5-months [range 1-24]. Histology was quamous cell carcinoma in 71.7% and adenoid cystic in 16.7%. They were restaged according to American Joint Committee on Cancer classification 1997 as II, III and IV in 1, 10 and 49. Thirty patients received treatment with curative intent [surgery in 4 patients, radiotherapy in 2, and combined modality in 24], 6 patients refused treatment and 24 were treated palliatively. With a median follow up of 50-months [range 2-128] in surviving patients treated with a curative intent, 12/30 failed locally, 4/30 in the regional neck nodes and 2/30 had systemic relapse. The actuarial 5-year overall survival [OS], relapse free survival [RFS] and local control rate [LC] were 55%, 39% and 51%. Treatment modality was the only significant prognostic factor for outcome, with 5 year OS, RFS and LC of 72%, 49% and 61%, for combined modality using surgery followed by radiotherapy compared to 0% for single approach [p=0.0003, p=0.0052 and p=0.0098]. This study indicates that the majority of our patients presented with advanced disease, resulting in poor outcome to conventional treatment modalities. Efforts should be directed to minimize the delay in diagnosis at the primary care level. Combined modality treatment should be offered to all patients with locally advanced disease. New approaches such as neoadjuvant or concurrent chemoradiotherapy with or without surgery need to be considered and evaluated in prospective studies

Uterine sarcoma: analysis of treatment failure and survival

During the period from January 1985 to June 1999, 75 patients with uterine sarcoma were accrued in the National Cancer Institute, Cairo University. Surgery was the initial therapy for all patients. Of the 75 patients, 34 received postoperative irradiation and/or chemotherapy. Twenty-two [32%] survived 2 years, while 3 patients [4.3%] survived 5 years. The overall recurrence rate was similar in patients who received adjuvant treatment [94%] and in those who did not [97%]. There was no difference in local pelvic recurrence between patients who received adjuvant therapy and those who did not [2 1.4% Vs. 25%]; however the median time to pelvic recurrence was longer, 11 months [range 2-21 months] for the irradiated group versus 6 months [range 2-11 months] for the non irradiated group. There was neither a difference in the incidence of distant relapse [38.2% vs. 34.4%], nor a difference in the median time to relapse, 7 months for both [range 2-17] be-tween patients who received adjuvant therapy and those who did not. Local and distant relapses were observed in 27% of patients who received adjuvant therapy versus 32% in the no adjuvant therapy group, with a median time to relapse of 3 months [1-10 months] for both groups. Most of the failures occurred in the pelvis, followed by lung and abdomen. Relapsing patients did not benefit of either local radiotherapy or chemotherapy. In conclusion, uterine sarcomas have an aggressive clinical behavior, with a propensity to recur both locally and at remote sites. Surgery in the form of total abdominal hysterectomy [TAH] plus bilateral salpingio-oophorectomy remains the treatment of choice. The role of pelvic lymphadenectomy and aortic lymph node sampling may be beneficial especially in early stage disease, although its role in improving survival has not yet been demonstrated. There is no definite evidence that adjuvant pelvic irradiation or systemic chemotherapy improves survival. The policy of adjuvant therapy following surgery for uterine sarcoma needs further evaluation