Elective neck irradiation in locally advanced squamous cell carcinoma of the maxillary sinus: a review.

This review has been undertaken to evaluate the impact of elective nodal irradiation (ENI) in locally advanced squamous cell carcinoma (SCC) of the maxillary sinus. The indications for radiotherapy (RT) including the dose, the volume to be covered, as well as possible toxicities encountered in the reports available are discussed. A total dose of 50 Gy standard fractionation appears to be efficient in achieving locoregional control in about 95% of all cases with low toxicity. The lymphatic drainage that needs to be covered remains to be defined more clearly, but it seems that there is no need for irradiation of the low neck. Bilateral upper neck irradiation remains controversial. Pattern of nodal failure in patients who received ENI and in those without ENI seem to suggest ipsilateral neck irradiation confined to submandibular and subdigastric/jugulodigastric areas. Finally, matching of the primary (maxillary sinus) tumor fields and neck field(s) must be carefully performed so as not to leave regions of possible under/overdosage of these neck areas. The authors believe that ENI is justified in these patients. However, given the background of only a few studies addressing this issue and anticipated better local control with the newer technologies, this issue needs to be properly studied in the future.