Induction chemotherapy with paranasal sinus cancer for management of the orbit

Paranasal sinus cancers often extend into the orbit and the intra-orbital extension is thought to affect prognosis of the tumor. In case of intra-orbital extension of the cancers, surgical treatments including the orbital evisceration are usually selected, while chemo radiotherapy (CRT) is performed for the patients who would not like to have a surgery. Recently intra-arterial cisplatin and concomitant radiation therapy is attracting attentions as an organ preserving treatment option. It achieves good local control with orbital preservations. However, the effects of induction chemotherapy (ICT) on the organ preservation have not been well discussed. The purpose of this study was to investigate the effects of systemic chemotherapy for paranasal sinus cancers extending into the orbit on the orbital preservation. Twenty patients with locally advanced paranasal cancer extending to the orbit were treated from 2006 to 2016 at our hospital. The treatment and their oncological outcomes were reviewed. Of the 20 patients, 17 patients had maxillary sinus cancer. Twelve lesions (60%) were diagnosed as T4a, and 8 lesions (40%) as T4b. Regarding N classification, 10 patients (50%) were diagnosed as N0, 2(10%) as N1, 6 (30%) as N2b, and 2 (10%) as N2c. Sixteen patients (80%) were treated with ICT followed by surgery or CRT while the remainders had definitive radiation or CRT. Complete response (CR) and partial response (PR) were achieved in 1 (6%) and 5 (31%) patients respectively. Seven patients had the surgery after ICT, and R0 resection was achieved in 3 patients (43%). The 3-year disease free survival for patients of PR/CR was 100%, 60% for patients of stable/progressive disease after ICT, in contrast to 50% for patients without ICT. The orbital preservation was achieved in 14(88%) of 16 patients who treated with ICT. ICT has a potential to contribute to orbital preservation in the treatment of paranasal sinus cancers.