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Adenocarcinoma of the Ethmoidal Sinus Complex
Surgical Debulking and Topical Fluorouracil May Be the Optimal Treatment
Paul P. Knegt, MD, PhD;
Kim W. Ah-See, MB ChB, FRCS, FRCS(ORL), MD;
Lilly-Ann vd Velden, MD, PhD;
Jeroen Kerrebijn, MD, PhD
Arch Otolaryngol Head Neck Surg. 2001;127:141-146.
Objectives To report our experience with the management of adenocarcinoma of the
ethmoidal sinuses using a regimen of surgical debulking and topical chemotherapy,
to report long-term survival, and to compare our results with recently published
series of patients undergoing craniofacial resection.
Design Review of prospectively collected data.
Setting Tertiary cancer center.
Patients Seventy consecutive patients with ethmoidal adenocarcinoma referred
to the Department of Head and Neck Surgery, University Hospital of Rotterdam,
Rotterdam, the Netherlands, between January 1976 and December 1997. Sixty-two
patients were eligible for primary treatment.
Interventions Surgical debulking via an extended anterior maxillary antrostomy followed
by a combination of repeated topical chemotherapy (fluorouracil) and necrotomy.
Additionally 8 patients (13%) required radiotherapy for local recurrence;
1 patient required surgery for regional lymph node metastases.
Main Outcome Measures Survival measured by the Kaplan-Meier method. Clinical complications
related to the therapy.
Results There were no perioperative deaths. Complications did occur, such as
temporary periorbital swelling (25 patients [40%]) and temporary cerebrospinal
fluid leakage (5 patients [8%]). One patient (1.6%) developed meningitis.
Adjusted disease-free survival at 2, 5, and 10 years is 96%, 87%, and 74%,
respectively.
Conclusion Our 23-year experience with a combination of surgical debulking and
repeated topical chemotherapy for patients with adenocarcinoma of the ethmoidal
sinuses leads us to believe that it represents the current treatment of choice
for these patients for long-term disease-free survival.
From the Department of Head and Neck Surgery, University Hospital Rotterdam,
Rotterdam, the Netherlands.
Corresponding author: Paul P. Knegt, MD, PhD, Department of Head
and Neck Surgery, University Hospital Rotterdam Dijkzigt, 3000 CA Rotterdam,
the Netherlands (e-mail: knegt{at}knod.azr.nl).
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Arch Otolaryngol Head Neck Surg. 2001;127(2):229-230.
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