Role of Elective Neck Management in Maxillary Sinus Squamous Cell Carcinoma

Maxillary sinus carcinoma is relatively rare. Standard treatment consists in surgery followed by adjuvant radiotherapy or chemoradiotherapy. The rate of neck lymph node metastasis during follow-up is about 5-30% and this event is a poor prognostic factor. It often occurs in large primary tumours (T3-T4). The role of prophylactic neck management, selective neck dissection (SND) or elective neck irradiation (ENI), remains unclear in N0 patients. Few studies specifically discuss the role of SND. A French study suggested SND could be proposed when primary surgery is feasible, especially for high tumour volume (T3-T4). Besides, it can be useful for lymph node staging and determining radiotherapy dose and volume. The role of ENI remains unclear and controversial, although some studies suggest a potential reduction of neck relapse with it. ENI (ipsilateral level II, +/Ib and III or bilateral neck according to the primary tumour extension) could be proposed in selected patients, especially for T3-4 disease and when SND has not been performed. Intensity-modulated radiotherapy (IMRT) should be considered, whenever feasible, to reduce toxicity.