Elective management of the N0 neck in maxillary sinus squamous cell carcinoma

Objectives: To demonstrate adequacy of radiation therapy alone to the neck in patients with maxillary sinus squamous cell carcinoma (MS-SCC) without clinical evidence of regional metastasis.Methods: Retrospective review between 2000 and 2018 from a single high-volume tertiary academic head and neck cancer center of all patients with MS-SCC.Results: A total of 55 patients were treated for MS-SCC at our center. A clinically uninvolved neck on presentation was found in 46 patients (83.6%) in the initial dataset. Of the 39 patients with radiologic N0 disease who were treated with primary surgical resection, 15.4% (6 patients) did not undergo any treatment of the neck, 2.6% (1 patient) underwent a neck dissection only, 69.2% (27 patients) received RT only, and 12.8% (5 patients) were treated with both a neck dissection followed by RT. Median follow-up was 26 months (mean 48 months, interquartile range 9-76 months). Five-year overall survival of all patients with N0 necks treated with upfront surgical resection was 46.5% (95% CI, 32.3%-66.9%). No patients with N0 necks had isolated regional recurrence regardless of neck management.Conclusions: Regional recurrence is rare for patients with radiologic N0 MS-SCC. Single-modality elective neck radiation provides excellent regional disease control in these patients.