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Between 1974 and 1986, 54 cases of squamous cell carcinoma of the maxillary sinus were treated combining surgery, radiotherapy and regional chemotherapy simultaneously. Using UICC (1987) system, these 54 cases were classified into one T1, four T2, thirty-three T3 and sixteen T4. The combined therapy consisted of 1) reduction operation followed by daily cleaning of the necrotic tumor mass; 2) external irradiation with less than 30Gy; 3) intra-arterial infusion of 5-fluorouracil (5-FU) and broxuridine (BUdR); and 4) final tumor resection under general anesthesia. As several modifications were made for the treatment procedure in 1979, the 54 cases were divided into two groups: Group A with 29 cases, which were treated before 1979 and Group B with 25 cases, which were treated after 1979. In this paper, the operative procedure, which we use for T4 cases is described. The first operation is performed after radiotherapy with about 10Gy and in this operation only the necrotic portion of the tumor mass is removed. The maxillary cavity is opened through the sublabial incision. This window is kept open and daily cleaning of the necrotic tumor mass is continued through the window. Three weeks after the simultaneous administration of radiation with 20Gy and 5 intra-arterial infusions of 5-FU and BUdR, the residual tumor is curetted thoroughly under general anesthesia. Surgery is performed through the sublabial window which has been kept open after the reduction surgery. Removal of the residual tumor mass which extends to the pterygomaxillary fossa, nasopharynx, anterior and medial skull base can be performed without difficulty, provided that the tumor mass is removed in pieces.(ABSTRACT TRUNCATED AT 250 WORDS)

A combined treatment for carcinoma of the maxillary sinus - Treatment method for T4 cases.