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Sandeep Samant, MS, FRCS; K. Thomas Robbins, MD; M. Vang, MD; Jim Wan, PhD; J. Robertson, MD

Arch Otolaryngol Head Neck Surg. 2004;130:948-955.

Objective  To report the long-term efficacy of a combined regimen of intra-arterial high-dose cisplatin chemotherapy and concomitant radiation therapy followed by organ-sparing surgery when possible in the treatment of advanced paranasal sinus cancer.

Design  Review of prospectively collected data.

Setting  Academic referral center.

Patients  Nineteen patients with advanced paranasal sinus malignancies with a minimum follow-up of 2 years. Malignancies included 14 squamous cell carcinomas (74%), 2 adenocarcinomas (10%), 2 adenoid cystic carcinomas (10%), and 1 undifferentiated carcinoma (5%). Sixteen patients (84%) had T4 disease.

Intervention  Treatment consisted of preoperative radiation therapy (2.0 Gy/fraction per day; total dose, 50 Gy in 5 weeks) given concomitantly with 3 to 4 weekly infusions of intra-arterial cisplatin (150 mg/m² per week) and systemic sodium thiosulfate neutralization. The regimen included planned surgery performed approximately 8 weeks after completion of radiation therapy. Ten patients underwent a transcranial anterior craniofacial resection; 1, a medial maxillectomy; and 1, an endoscopic restaging only.

Results  After a median follow-up of 53 months, actuarial overall survival at 2 and 5 years was 68% and 53%, respectively. One patient died of myocardial infarction during treatment. No other treatment-limiting toxic effect was noted. Although 3 patients had persistence of disease, delayed local failure occurred only in 2 and distant metastasis in 3. Except for cataract in 2 patients, no visual loss developed.

Conclusion  Despite the advanced stage and unfavorable nature of cancer in this cohort, our results indicate that this regimen holds promise and merits further study.

From the Departments of Otolaryngology–Head & Neck Surgery (Dr Samant), Radiology (Dr Vang), Preventive Medicine (Dr Wan), and Neurosurgery (Dr Robertson), The University of Tennessee Health Science Center, Memphis; and the Division of Otolaryngology–Head & Neck Surgery (Dr Robbins), Southern Illinois University School of Medicine, Springfield. The authors have no relevant financial interest in this article.

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