Adenocarcinoma of the ethmoidal sinus complex -: Surgical debulking and topical fluorouracil may be the optimal treatment

Objectives: To report our experience with the management of adenocarcinoma of the ethmoidal sinuses using a regimen of surgical debulking and topical chemotherapy, to report long-term survival, and to compare our results with recently published series of patients undergoing craniofacial resection. Design: Review of prospectively collected data. Setting: Tertiary cancer center. Patients: Seventy consecutive patients with ethmoidal adenocarcinoma referred to the Department of Head and Neck Surgery, University Hospital of Rotterdam, Rotterdam, the Netherlands, between January 1976 and December 1997. Sixty-two patients were eligible for primary treatment. Interventions: Surgical debulking via an extended anterior maxillary antrostomy followed by a combination of repeated topical chemotherapy (fluorouracil) and necrotomy. Additionally 8 patients (13%) required radio-therapy for local recurrence; 1 patient required surgery for regional lymph node metastases. Main Outcome Measures: Survival measured by the Kaplan-Meier method. Clinical complications related to the therapy. Results: There were no perioperative deaths. Complications did occur, such as temporary periorbital swelling (25 patients (40%]) and temporary cerebrospinal fluid leakage (5 patients [8%]). One patient (1.6%) developed meningitis. Adjusted disease-free survival at 2, 5, and 10 years is 96%, 87%, and 74%, respectively. Conclusion: Our 23-year experience with a combination of surgical debulking and repeated topical chemotherapy for patients with adenocarcinoma of the ethmoidal sinuses leads us to believe that it represents the current treatment of choice for these patients for long-term disease-free survival.