Primary malignant tumours of the sinonasal tract account for less than 10% of head and neck cancers, of which the maxilla is the second most common subsite and squamous cell carcinoma (SCC) is the most prevalent histological type. Maxillary SCCs commonly present with advanced disease (82% T3 or higher) but nodal metastasis is often low due to limited lymphatic drainage. Improvements have been seen in survival from maxillary SCC due to improved imaging, facilitating surgery and adjuvant therapies, leading to better local control. Thus treatment of the neck has become the focus and a topic of debate, evidenced by numerous reviews and a meta-analysis. This informative review from Memorial Sloan-Kettering (MSKCC) describes the role of elective treatment of the neck in maxillary SCC. Treatment failure overall occurs in 62% of all patients. Local recurrence is the most common site of treatment failure in any stage (44-68% incorporating MSKCC data), which is rarely amenable to salvage therapy. Most cervical relapse is accompanied by uncontrollable primary or distant relapse, explaining the poor survival of those with cervical relapse. Patients with cervical relapse alone can be salvaged in 50-70% of cases. Jatin Shah’s group does not recommend elective neck irradiation routinely in the clinically N0 neck. It is more important to achieve maximum local control with aggressive therapy of the primary tumour than elective neck treatment, which is only recommended by the group of patients with T3/4 primary maxillary sinus SCCs. Elective treatment of the neck in early-stage tumours is not recommended.

Elective neck therapy in maxillary sinus cancer.
Dooley L, Shah J.
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Anna Slovick

Guy's Hospital, London, UK.

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