Reappraisal of trimodal combination therapy for maxillary sinus carcinoma.

The introduction of trimodal combination therapy (surgery + radiation + intraarterial infusion) for maxillary carcinoma resulted in a change in the sites of recurrence and no satisfactory improvement in the local control rate. To examine the cause of these phenomena, external carotid angiography was performed on 51 patients prior to the start of the therapy and the results of the treatment were studied. Angiographic findings indicated that maxillary carcinoma is fed not only by the maxillary artery, but also by the internal carotid, facial, transverse facial and other arteries from the external carotid artery. The multiplicity of feeders causes irregular distribution of the intraarterially infused antimetabolites. Irregular and local low distribution of antimetabolites may well bring about the high rate of recurrence. The results of intraarterial transcatheter TC-99m-MAA injection were also in accord with the angiographic findings.