Recurrences after primary treatment of maxillary malignant tumors

C o p y r i g h t © M u n k s g a a r d 1994

Int. J. Oral Maxillofac. Surg. 1994; 23:124 Printed in Denmark. All rights reserved

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Oral &,_ Maxillofacial Surgery ISSN 0901-5027

Abstracts from international literature Lip c a n c e r I n c i d e n c e trends in Connecticut, 1935-1985 J. Chen, R. V. Katz, D. J. Krutchkoff, E. Eisenberg Cancer 1992: 70:2025-30

Suspicions have recently arisen that cancer of the lip may exert an undue influence on overall oral cancer statistics, and, therefore, possibly distort the true picture of intraoral cancer. The authors investigated this question through epidemiologic analysis. A total of 2291 cases of lip cancer recorded by the Connecticut Tumor Registry (CTR) from 1935 to 1985 (23.6% of all oral cancer) were analyzed. Occurrence trends for men and women had different patterns: for men, the age-adjusted incidence rates showed a fivefold decrease during the 51-year study; for women, the rates were relatively low and constant during the same period. Analysis for age-specific rates revealed that the older the age group, the higher the incidence rates for both sexes. Squamous cell carcinoma accounted for at least 87.4% of all lip cancers (96.2%, if nonspecified epithelial neoplasms are assumed to be squamous cell carcinoma). The vermilion border of the lower lip was the most common site. Moderately differentiated tumors were most common (48.5%), closely followed by welldifferentiated tumors (44.2%). Analysis by county showed that the crude incidence rates for men in New London and Windham counties exceeded the average Connecticut statewide rates. The authors concluded that the epidemi-

ology of Connecticut lip cancer differs significantly from that of intraoral squamous cell carcinoma in the same population studied within the same period of time. Epidemiologic studies involving "oral cancer" should direct attention to anatomic subsite to consider differences in disease trends according to specific location. H. TIDEMAN

R e c u r r e n c e s after p r i m a r y t r e a t m e n t of m a x i l l a r y malignant tumors w. o. Olshanskij, A. M. Sdvijkov, I. G. Russakov, A. G. Kislitchko Vestnik Otorinolaryngologij Russia 1991: 55:22-5

A group of 91 patients with malignant tumors of the maxillary complex were followed up for 11 years. The tumors originated from the maxillary sinus (47), the ethmoid sinus (18), the nasal structures (12), and the maxillary alveolus (14). There were 66 (72.5%) patients with carcinoma and 25 (27.55) with sarcoma. Thirteen patients (14.3%) had stage III disease and 23 (19.3%) had stage IV, while in 55 patients (66.4%) a classification could not be made because of previous surgery or because no pertinent data were available. In 40 patients, resection included part of the orbital wall and periorbital tissue, but the eye was left intact. In 25 patients, the eye had to be removed as well. In 24 patients, the zygomatic bone was included in the resection, and in five patients, bone of the basal skull in the region

of the anterior cranial fossa had to be resected. In 43 patients, the soft tissues of the face were included in the resection. Recurrences were seen in 47 of 91 patients. Early recurrences (within 2 years) were observed in 37 patients, of whom 21 already had recurrent tumor after 6 months. Ten patients had recurrence between 2 and 11 years afterwards. Adenocystic carcinoma appeared to be the most frequently recurring tumor, followed by adenocarcinoma, chondrosarcoma, and osteosarcoma. The authors discuss the possibility of resection of the floor of the anterior cranial fossa when the tumor has invaded that area. In only one of the five patients in whom such a resection was performed did they see a recurrence. The treatment of recurrences depended on individual circumstances. Small recurrences in areas with adequate access were treated with electrosurgery. In bigger recurrent tumors, additional resection was done. When radical resection could not be achieved, chemotherapy, radiotherapy, or both were used after surgery. The long-term survival after treatment for recurrences was encouraging; 19 patients (40.4%) were free of disease at the last examination, and for 14 (29.7%) this was already more than 5 years. Twenty-six patients (55.3%) had died by the end of the follow-up period; 25 from the tumors and one from systemic disease. The chemotherapy used by the authors also included application of local packs consisting of resorbable polymers soaked in cytostatic drugs such as carminomycin, prospidin, and bleomycin. V. STEFANOFF