%0 Journal Article
%T Induction Chemotherapy in Technically Unresectable Locally Advanced Carcinoma of Maxillary Sinus
%A Vanita Noronha
%A Vijay Maruti Patil
%A Amit Joshi
%A Muddu Vamshi Krishna
%A Sachin Dhumal
%A Shashikant Juvekar
%A P. Pai
%A Pankaj Chatturvedi
%A Devendra Arvind Chaukar
%A Jai Prakash Agarwal
%A Sarbani Ghosh
%A Vedang Murthy
%A Anil D¡¯cruz
%A Kumar Prabhash
%J Chemotherapy Research and Practice
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/487872
%X Background. Locally advanced carcinoma of maxillary sinus has been historically reported to have poor prognosis. We evaluated the role of NACT in improving the outcome in these patients. Methods. 41 patients with locally advanced technically unresectable (stage IVa) or unresectable maxillary carcinoma (stage IVb) were treated with induction chemotherapy between 2008 and 2011. The demographic profile, response and toxicity of chemotherapy, definitive treatment received, progression free survival (PFS), and overall survival (OS) were analyzed. Univariate and multivariate analysis were performed to determine factors associated with PFS and OS. Results. The chemotherapy included two drugs (platinum and taxane) in 34 patients (82.9%) and three drugs (platinum, taxane, and 5 FU) in 7 (17.1%). There was no complete response seen in any of the patients, stable disease in 18 (43.9%), partial response in 16 (39%), and progression in 7 (17.1%) patients. After induction, the treatment planned included surgery in 12 (29.3%), CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%), and palliative chemotherapy in 3 (7.3%) patients. Overall, the median PFS was 10.0 months. The OS at 24 months and 36 months was 41% and 35%, respectively. Conclusion. In unresectable maxillary carcinoma, induction chemotherapy has clinically significant benefit with acceptable toxicity. 1. Introduction Carcinoma of maxillary sinus is a rare entity [1]. It represents less than 1% of the tumours in the head and neck. Consequently, there is limited high-level evidence to define the ideal therapy in patients with maxillary tumours [1¨C6]. Epidemiologically, most of the cancers arising in this location are squamous cell carcinoma and are seen in advanced stage [1]. These tumours typically require extensive and morbid surgeries followed by adjuvant radiation. Though these procedures have been shown to improve outcomes, the long-term results are far from satisfactory [5¨C11]. Nearly 25¨C35% of patients have locally advanced unresectable disease [5, 11]. These patients have traditionally been treated with radical radiotherapy, with or without concurrent chemotherapy. The 5-year overall survival in this subgroup of patients is dismal, around 9¨C25% [7, 9, 12]. Considering such results, there is an urgent need for a new treatment paradigm for patients with maxillary carcinomas, especially in patents with unresectable disease or those who will require morbid resections. Induction or neoadjuvant chemotherapy (NACT) prior to definitive local treatment has been used in carcinoma of maxillary
%U http://www.hindawi.com/journals/cherp/2014/487872/