ABSTRACT
OBJECTIVES: This study aimed to evaluate the prognostic value of magnetic resonance imaging (MRI) findings in predicting local recurrence in patients with maxillary sinus cancer treated with super-selective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (RADPLAT). METHODS: This single-center retrospective study included consecutive patients with maxillary sinus squamous cell carcinoma, who underwent RADPLAT between October 2016 and September 2021. MRI was performed before (within 2 weeks) and 1 month after (post-treatment MRI) the start of treatment. Tumor reduction rates and pre-treatment cross-sectional areas were calculated from the maximum cross-sectional areas on pre- and post-treatment MRI T2-weighted axial images. Statistical analyses, including receiver operating characteristic analysis, were performed to assess the predictive value of the tumor reduction rates. RESULTS: Twenty-four patients were included in this study. Recurrence occurred in seven patients with a median time of 213 days. The tumor reduction rates were significantly higher in the benign post-treatment changes group compared to the recurrence group (median, 0.814 vs. 0.174; p < 0.001). The cut-off value for the reduction rate between the groups was 0.3578. No significant difference was observed in the maximum pre-treatment cross-sectional area between the groups (p = 0.664). The inter-observer agreement for the tumor areas was excellent. CONCLUSIONS: The tumor reduction rate calculated from MRI T2-weighted images may be a predictor of local recurrence in patients with maxillary sinus cancer treated with RADPLAT. Patients with lower reduction rates may benefit from early salvage surgeries.
Subject(s)
Antineoplastic Agents , Chemoradiotherapy , Cisplatin , Infusions, Intra-Arterial , Magnetic Resonance Imaging , Maxillary Sinus Neoplasms , Neoplasm Recurrence, Local , Humans , Male , Cisplatin/administration & dosage , Cisplatin/therapeutic use , Female , Middle Aged , Maxillary Sinus Neoplasms/diagnostic imaging , Maxillary Sinus Neoplasms/therapy , Maxillary Sinus Neoplasms/radiotherapy , Maxillary Sinus Neoplasms/pathology , Magnetic Resonance Imaging/methods , Retrospective Studies , Aged , Neoplasm Recurrence, Local/diagnostic imaging , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Adult , Squamous Cell Carcinoma of Head and Neck/diagnostic imaging , Squamous Cell Carcinoma of Head and Neck/therapy , Squamous Cell Carcinoma of Head and Neck/radiotherapy , Squamous Cell Carcinoma of Head and Neck/pathology , Squamous Cell Carcinoma of Head and Neck/drug therapy , Prognosis , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/therapy , Carcinoma, Squamous Cell/pathology , Treatment OutcomeABSTRACT
Fundamento: el carcinoma epidermoide de seno maxilar es de poca frecuencia, capaz de provocar compromiso estético-funcional por lo que su diagnóstico temprano permitirá al paciente un mejor pronóstico. Objetivo: exponer aspectos clínicos del carcinoma epidermoide de seno maxilar. Caso clínico: paciente masculino de raza blanca, 64 años de edad, con aumento de volumen en región orbito-cigomática izquierda de un mes de evolución. La tomografía axial computarizada de senos paranasales reveló imagen heterogénea sugestiva de tumor de seno maxilar del lado izquierdo. El diagnóstico histopatológico reportado fue de carcinoma epidermoide bien diferenciado. Se instauró el tratamiento con quimioterapia y radioterapia concurrente. El motivo de mostrar este caso consiste en aportar experiencias que permitan el diagnóstico temprano de la enfermedad y así mejorar el pronóstico para el paciente. Conclusiones: un examen clínico minucioso conducirá a un diagnóstico precoz de estas enfermedades que presentan una evolución tórpida y carecen de signos patognomónicos sobre todo en sus estadios iniciales. Es de vital importancia el papel protagónico que tiene la Atención Primaria de Salud para la detección del cáncer el cual constituye una de las primeras causas de muerte en Cuba (AU)
Background: squamous cell carcinomas of maxillary sinus are rare. It causes esthetic-functional compromise. Therefore, its early diagnosis will allow the patient better prognosis. Objective: to expose clinical aspects of squamous cell carcinoma in maxillary sinus. Case report: a clinical case is reported from 64-year-old white male patient with swelling over the orbit-zygomatic area that progressed over 1 month. The paranasal sinus CAT scan showed a heterogenic image suggesting a left maxillary tumor. The histopathological diagnosis reported a well- differentiated squamous cell carcinoma. Chemotherapy and radiotherapy can be used in this case. The scope of showing this case is to provide some aspects that allow the early diagnosis of the aforementioned disease as well as to improve the patients prognosis.Conclusions: the deep clinical examination in patients will allow a soon diagnosis of these pathologies that present a torpid evolution lacking pathognomonic signs mainly in first stages. It is of paramount importance the role of the Primary Health Service in the early detection of cancer, which constitutes one of the main causes of death in Cuba (AU)
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/therapy , Maxillary Sinus Neoplasms/diagnostic imaging , Maxillary Sinus Neoplasms/drug therapy , Maxillary Sinus Neoplasms/radiotherapyABSTRACT
Caso clínico: Un varón de 53 años consulta por pérdida de visión en ojo derecho tras irradiación de carcinoma de seno maxilar derecho. La exploración funduscópica muestra hemorragias, exudados, edema macular e isquemia retiniana periférica, compatibles con una retinopatía por radiación. La evolución es tórpida a pesar de tratamiento con láser e inyecciones intravítreas de bevacizumab, finalizando en evisceración del ojo afecto. Discusión: La retinopatía por radiación debe tenerse en cuenta ante cualquier pérdida de visión tras irradiación de cabeza y cuello. El seguimiento oftalmológico a largo plazo de estos pacientes es fundamental para conseguir un diagnóstico precoz (AU)
Clinical case: A 53-year old male presented with visual impairment in right eye after irradiation of right maxillary sinus carcinoma. Funduscopy shows radiation retinopathy: haemorrhages, exudates, macular oedema, and peripheral retinal ischaemia. A poor outcome was achieved despite laser treatment and intravitreal injections of bevacizumab, resulting in evisceration of the affected eye. Discussion: Radiation retinopathy must be considered in any loss of vision after head and neck irradiation. Ophthalmological long-term follow-up of these patients is essential for an early diagnosis (AU)
Subject(s)
Humans , Male , Middle Aged , Retinal Diseases/etiology , Radiotherapy/adverse effects , Maxillary Sinus Neoplasms/radiotherapy , Ischemia/etiology , Retinal Hemorrhage/etiology , Eye Evisceration , Radiation Injuries/complicationsABSTRACT
Objetivo: Describir el comportamiento del cáncer del seno maxilar y la experiencia acumulada durante 10 años en el manejo de este tipo de neoplasia en nuestro hospital mediante el tratamiento con cirugía y radioterapia postoperatoria. Pacientes y método: El presente es un estudio descriptivo, retrospectivo y no aleatorizado, que se llevó a cabo en el Complejo Hospitalario Universitario de Vigo, con 23 pacientes con cáncer de seno maxilar que recibieron tratamiento con fines curativos entre los años 1995 y 2004. Todos fueron sometidos a cirugía radical y radioterapia postoperatoria. Resultados: La supervivencia actuarial a 3 años fue del 47,8 % y la corregida, del 60,8 %. El control local permanente se consiguió en 14/23 (60,8 %) pacientes. La causa principal de fracaso del tratamiento fue la recurrencia local 4/12 (33,3 %). Los factores pronósticos más significativos que afectaron al control local y la supervivencia fueron: el estadio clínico (p < 0,031), la localización del tumor en la supraestructura (p < 0,001) y los márgenes de sección quirúrgicos positivos (p < 0,001). Conclusiones: La recurrencia local es muy alta y generalmente la principal causa de muerte. Hay que explorar nuevos protocolos de tratamiento
Objective: To describe the survival and outcome of maxillary sinus cancer in patients managed with surgery and post-operative radiotherapy during the last 10 years in our hospital. Patients and method: Descriptive, retrospective, non-randomized study of 23 patients with cancer of the maxillary sinus managed at the Vigo University Hospital Complex, Spain, with radical surgery and post-operative radiotherapy, between 1995 and 2004. Results: The 3-year actuarial survival was 47.8 % and the adjusted actuarial survival was 60.8 %. Permanent local tumour control was achieved in 60.8 % of cases (14/23). Local tumour recurrence was the main cause of treatment failure (33.3 %; 4/12). The most significant prognostic factors affecting local tumour control and survival were: clinical stage (P<.031), suprastructural location of the tumour (P<.001), and presence of positive resection margins (P<.001). Conclusions: Local recurrence was found to be very high and generally the main cause of death. New treatment protocols should be assessed
Subject(s)
Male , Female , Middle Aged , Aged , Humans , Maxillary Sinus Neoplasms/radiotherapy , Maxillary Sinus Neoplasms/surgery , Retrospective Studies , Survival Rate , Neoplasm Recurrence, Local/epidemiologyABSTRACT
Los melanomas son neoplasias poco frecuentes, con una alta tasa de mortalidad. La localización primaria en mucosas, supone menos del 1% del total de los melanomas. En el melanoma maligno nasosinusal la clínica inicialmente es poco significativa, las metástasis regionales son raras. El tratamiento más efectvo es el quirúrgico complementado con radioterapia y/o quimioterapia. Presentamos el caso de melanoma mucoso maligno primario nasosinusal, y hacemos una completa revisión bibliográfica actual sobre esta entidad
The melanomas are unusual tumours with a high mortality. The mucosal malignant melanoma type supposes loss than 1% of the total of melanoma. The initial symptoms are unspecific and the regional metastasis are rare. The surgical approach it's the most effective treatment complemented with radiotherapy and or chimiotherapy. We present the case of primary nasal mucosal malignant melanoma and review the litterature of this disease