Preservation of the eye in the treatment of sinonasal malignant neoplasms with orbital involvement. A confirmation of the original treatise.

OBJECTIVE: To continue the retrospective analysis reported in 1988 that supported preservation of the eye in the treatment of sinonasal cancers when bony erosion of the orbit was noted on pretreatment radiographic analysis.

DESIGN: Using the eye-sparing protocol previously reported, which included preoperative radiotherapy (with or without chemotherapy, depending on tumor size, involvement, or other characteristic) for malignant neoplasms of the superior nasal vault that had eroded the bony orbit, retrospective analysis of the results of therapy for the additional 33 patients treated between 1986 and 1993 was performed. These data were added to those from the original series to provide a total of 74 patients. Forty-one patients (55%) showed bony erosion at initial evaluation and 14 (19%) had periorbital involvement. During surgery, the periorbita was evaluated by frozen section control. If tumor was found, that region of periorbita was resected and, if necessary, replaced with fascia or split-thickness graft.

RESULTS: Five patients from the original series had orbital sacrifice. Of the remaining 36 patients, 4 (11%) had recurrent disease involving the orbit, but not at the primary site. Twenty (55%) of the 36 patients had no orbital complications, and only 1 (3%) had a permanent motility disturbance and 4 (13%) developed cataracts after radiotherapy.

CONCLUSION: With the use of preoperative radiotherapy in resection of involved periorbita with frozen section control in tumors of the sinonasal vault that involve the bony orbit, the eye can be spared in most instances without compromising oncologic safety.