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Risk of sinonasal-cutaneous fistula after treatment for advanced sinonasal cancer.

Abstract

BACKGROUND AND OBJECTIVES
To determine the rate and the risk factors for sinonasal-cutaneous fistula formation after treatment for sinonasal malignancy.
METHODS
Between 1991 and 2002, 99 patients with advanced sinonasal malignancy received radiation therapy +/- surgery. Primary site was maxillary sinus in 30, ethmoid sinus in 19, nasal cavity in 32, nasopharynx in 3, and sphenoid sinus in 15 patients. Eighty-two percent of patients had T4 disease. Sixty-eight percent of patients had undergone surgical resection. Median follow-up was 70.6 months.
RESULTS
Eight patients developed ≥ grade 3 sinonasal-cutaneous fistulas at a median time of 3.8 months after radiation. The overall rates of developing ≥ grade 3 fistulas in the entire group at 2 and 5 years were 6% and 10%, respectively. The fistulas were in the medial canthus in seven patients and in the infraorbital region in one patient. Fistulas developed exclusively along the transfacial incision scar and in patients whose tumors extended to the subcutaneous tissues. In univariate analysis, squamous cell carcinoma histology (P ¼ 0.008), ≤ T4a primary tumor category (P ¼ 0.02), and transfacial incision (P ¼ 0.02) were associated with increased risk of fistula formation.
CONCLUSIONS
Histologic subtype, T category, and quality of the skin and the underlying supporting tissues after transfacial incision are risk factors for sinonasal-cutaneous fistula formation.

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  • Authors

    Cianchetti M, Varvares MA, Deschler DG, Liebsch NJ, Wang JJ, Chan AW

    Institution

    Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

    Source

    Journal of surgical oncology 105:3 2012 Mar pg 261-5

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Antineoplastic Combined Chemotherapy Protocols
    Carcinoma
    Chemotherapy, Adjuvant
    Cisplatin
    Cutaneous Fistula
    Etoposide
    Female
    Fistula
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Nasal Cavity
    Neuroectodermal Tumors
    Paranasal Sinus Diseases
    Paranasal Sinus Neoplasms
    Paranasal Sinuses
    Postoperative Complications
    Radiotherapy
    Radiotherapy, Adjuvant
    Retrospective Studies
    Risk Factors
    Sarcoma
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22375288