The incidence of maxillary sinus cancer accounts for about 1%-2% of the malignant tumors in the head and neck. Due to the lack of specific symptoms and signs in the early stage, most patients are already in the advanced stage when they are diagnosed, and the local anatomical relationship of maxillary sinus is complicated, and the tumor expansion often involves many important tissues and organs in the neighboring area, so it is one of the more difficult tumors in the head and neck to control. Therefore, it is very important to choose the appropriate treatment method to improve the 5-year survival rate and quality of life of patients. In the past 10 years, scholars at home and abroad have adopted various treatment countermeasures for primary cancer, including surgery, radiotherapy, chemotherapy, immunotherapy, etc., and have gained a lot of clinical practice experience, which are briefly reviewed in this paper. Surgical treatment of maxillary sinus cancer has a long history of surgical treatment, since Gensoul (1829) and Ferguson (1848) used facial incision to remove the tumor of the upper collar bone, it has been more than a hundred years, the operation has been improved several times, and great progress has been made in the resection method, repair and reduction of complications. By the 1960s, the development of surgery has basically reached its peak, and the wide range of resection has been expanded to posterior maxilla, infratemporal recess and even through combined craniofacial resection, including part of the skull base together with resection. Due to the limitation of local anatomy, it is still not easy to perform a complete resection satisfactorily in most advanced patients. The 5-year survival rate of conventional surgical resection is basically about 10%-20% due to incomplete resection or implantation of exfoliated cancer cells, resulting in recurrence after surgery. Zhu Wenhua et al. reported that the 5-year survival rate of radiotherapy alone or surgery alone was 20%-25%, and Niu Guanwei reviewed 63 cases of advanced maxillary sinus cancer, 17 cases were operated alone, and their 3-year survival rate was 23.53% and 5-year survival rate was 17.65% respectively. Although it has been reported in the literature that the use of combined craniofacial resection for the treatment of a few selected advanced paranasal sinus cancers can achieve a 5-year survival rate of 50%, the complications are more frequent and the operative mortality rate is 7%-10.7%, so it is clear that this procedure can only be considered for the treatment of a few strictly selected cases. The current view is that as much physiological function as possible should be preserved to improve the quality of survival, because the quality of survival can also directly affect the survival rate. In recent years, surgical oncology tends to be conservative, not to blindly pursue enlargement of resection, but to integrate modern radiotherapy techniques, to reasonably reduce the scope of surgical operations, to improve surgical skills, to preserve the function of the patient’s body and to improve the quality of survival. There are indications that the reduction of surgical trauma is beneficial to the recovery of the immune function of the body. Based on the above, in recent years, most people believe that except for early cases, conventional surgical treatment alone can hardly achieve the curative effect for most patients, and the treatment of maxillary sinus cancer cannot rely on surgery alone, but must be a comprehensive treatment. 2.Radiotherapy for maxillary sinus cancer Since the beginning of the 20th century, X-rays and radium were used to treat the cancer, radiotherapy was also used more often for this disease. In the early years, external X-rays or intracavitary radium were mainly used, but the efficacy was very poor, and complications such as soft tissue and bone necrosis often occurred. However, in the pathological examination of the surgically excised specimens after radiotherapy, about 80% of the cancerous tissues are still visible, so it is difficult to improve the long-term outcome. Some people have used sensitizer or hyperbaric oxygen chamber to improve the efficacy, but the results are not very effective. In recent years, with the continuous modernization and precision of radiotherapy equipment, the development of three-dimensional radiotherapy technology has provided a new treatment tool for maxillary sinus cancer radiation therapy, so that the shape of the high-dose area is close to the shape of the target area in three-dimensional direction, and through intensity-controlled conformal radiotherapy, the tumor control dose can be increased while protecting the surrounding vital organs and normal tissues to the maximum extent. David et al. reported that, when comparing the inverse conformal treatment plan with the three-dimensional conformal plan, the mean dose to the target area was reduced by 65% to 62% with the conformal and conformal plans. David et al. reported that the dose attainment and shape compliance of the target area were better with the intensity plan than with the 3D conformal plan, and that the intensity plan could protect the surrounding vital organs and normal tissues as much as possible. However, due to the complex anatomy of the maxillary sinus area, the large number of surrounding bone structures and air cavities, the density of sensitive and vital organs, the absence of gaps between the target area and sensitive and vital organs, and even the encirclement of vital organs, as well as the limitations of the equipment (e.g., the large width of the multileaf grating), the dose distribution of conformal and intensity-modulated radiation therapy for maxillary sinus cancer is not as satisfactory as theoretically or imagined. The question of whether to irradiate a negative lymph node in the neck is controversial; Grau et al. suggest that preventive irradiation is not needed because of the low risk of neck recurrence in lymph node negative patients, while Jeremic et al. and Le et al. suggest that preventive irradiation is effective in preventing neck recurrence in lymph node negative patients. In the study, out of 96 patients without lymph node metastasis at the time of initial diagnosis, 15 (19.2%) of 78 patients without prophylactic irradiation had neck recurrence (all patients with stage T3-4, 12 of whom had squamous carcinoma), whereas there was no neck recurrence in 18 cases with prophylactic irradiation. Wang Tianquan [13] reported that the survival and local control rates of 71 cases of maxillary sinus cancer were compared between conventional external irradiation and total accelerated hyper-segmentation therapy. The total DT66~80Gy/33~35f/44~46d for 5 times/w, 1 time/d and 2.0Gy per time. The local control rates at 1, 2, 3, 4 and 5 years were 62.8%, 34.3%, 22.9%, 14.3%, 5.7% and 88.6%, 66.7%, 52.8%, 36.3%, 25% for the conventional and full hyper-segmentation groups, respectively. The survival rates at 1, 2, 3, 4, and 5 years were 65.7%, 45.7%, 28.6%, 22.8%, 16%, and 94.4%, 72.2%, 58.3%, 57.2%, 36.1% (P < 0.05) for the conventional irradiation and full accelerated hyper-segmentation groups, respectively, and the late complications and causes of death were not significantly higher in the two groups. There was no significant difference between the two groups in terms of late complications and causes of death. Conclusion: Full accelerated hyper-segmentation radiotherapy can significantly improve the local control rate and survival rate for patients with inoperable advanced maxillary sinus cancer. It has also been reported in overseas literature that hyper-segmentation radiotherapy can significantly improve the efficacy of head and neck tumors, and the related research is under further study. With the progress of radiotherapy equipment and technology, its efficacy will be improved even more. 3. Chemotherapy alone, there is no ideal chemotherapeutic drug yet, and considering the patient's body condition, the resistance or resistance of cancer tumor to drugs and the selectivity of drugs on cancer cells, chemotherapy alone is rarely used for maxillary sinus cancer. Many patients are reluctant to undergo surgery for various reasons, such as possible disfigurement after surgery, high recurrence rate of surgery, and the inability of elderly patients to tolerate surgery, and opt for chemotherapy, mainly systemic chemotherapy and local intra-arterial chemotherapy. Geng Zhongli et al. randomly divided 30 cases of advanced maxillary sinus cancer into two groups: 15 cases in the superficial temporal artery perfusion group, using high-dose hydroxycamptothecin + adriamycin + 5-FU for superficial temporal artery cannula perfusion; 15 cases in the intravenous drip group, using the same dose for intravenous drip, to compare the efficacy of the two groups. Results: 6 cases (40.0%) had complete remission (CR) and 7 cases (46.7%) had partial remission (PR) in the superficial temporal artery infusion group, with an overall remission rate of 86.7%; 1 case (6.7%) had CR and 6 cases (40.0%) had PR in the intravenous drip group, with statistically significant differences in remission rates between the two groups (P < 0.05). Conclusion: Hydroxycamptothecin + Adriamycin + 5-FU perfusion chemotherapy with superficial temporal artery cannulation is a better treatment for advanced maxillary sinus cancer. Zhao Jinlong et al [15] retrospectively analyzed the results of 20 patients with advanced maxillary sinus cancer treated with intraoperative high-dose cisplatin (200 mg/mg2 ) infusion chemotherapy with sodium thiosulfate. 20 patients had an efficiency of 100%, 18 patients were effective and 2 patients were ineffective. The tumor shrank significantly after surgery, and no serious complications occurred except for nausea and other gastrointestinal symptoms. Conclusion: Local high-dose perfusion therapy for maxillary sinus cancer is safe and reliable, improves the survival quality of advanced patients, and can be one of the treatment options for patients with advanced maxillary sinus cancer. Li Jichen et al. reported that 11 patients with advanced maxillary sinus cancer who could not (unwillingly) be treated surgically due to their systemic conditions were treated with super-selective direct arterial perfusion chemotherapy. Among the follow-up cases, 5 cases were in complete remission and 6 cases were in partial remission. Conclusion: Two-way arterial chemotherapy is one of the effective means to treat maxillary sinus cancer and can be part of the comprehensive sequential treatment. 4. Comprehensive treatment of maxillary sinus cancer The treatment methods of maxillary sinus cancer include surgery, radiotherapy, chemotherapy and immunotherapy. Due to the limitation of neighboring organs and the lack of oxygen in the maxillary sinus itself, radiotherapy alone is difficult to cure the cancer, and surgery cannot completely remove the tumor, therefore, it is currently considered that the best choice for the treatment of maxillary sinus cancer is to adopt a comprehensive treatment plan. Although the advantages of combined treatment for maxillary sinus cancer have been widely recognized, there is no consensus on the specific treatment mode so far. In a review of 432 cases of advanced maxillary sinus cancer, Ren Baoyuan et al. showed that the 5-year survival rates were 15.6%, 21.7% and 40.1% for the radiotherapy, surgery and surgery+radiotherapy groups, respectively (40% for preoperative radiotherapy and 43% for postoperative radiotherapy). RW et al. reported that 54 patients received preoperative radiotherapy, postoperative radiotherapy and radiotherapy alone, with five-year local control rates of 61%, 65% and 37%, respectively. However, the radiosensitivity of different pathological types of maxillary sinus tumors varies, and therefore the focus of their treatment protocols is different. Highly differentiated squamous carcinoma: Radiation therapy + surgery should be the treatment of choice. Most of the early-stage patients can be treated satisfactorily with radiotherapy alone, while the late stage is still treated with radiotherapy + surgery. Adenoid cystic carcinoma is a tumor with epithelial origin in small salivary glands, and often invaded by nerve sheath. Radiotherapy options include preoperative radiotherapy, postoperative radiotherapy, and preoperative plus postoperative radiotherapy. There are many debates on whether to operate first or to use radiotherapy first, some think that preoperative radiotherapy has more advantages, some advocate postoperative radiotherapy, and some use half course of radiotherapy before and after surgery, which can kill some cancer cells and inhibit the vitality of cancer cells at the same time, reduce the possibility of distant metastasis and local recurrence, because the radiation dose is small and there is no serious radiotherapy reaction, which is conducive to postoperative wound healing. It has been endorsed by many people. The reasons are: (1) preoperative radiotherapy can control the metastases in the retropharyngeal lymph nodes that are beyond the capability of surgery; (2) preoperative radiotherapy can shrink the tumor, increase the possibility of surgical resection and reduce the risk of rapid recurrence; (3) preoperative radiotherapy can reduce the spread and implantation of cancer cells. According to Niu Guanwei, preoperative radiotherapy can confine and reduce the scope of tumors, so that those tumors that cannot be completely removed can be completely removed and cancer cells can be prevented from spreading. According to Li Junmei et al, preoperative plus postoperative radiotherapy is better than preoperative radiotherapy for the local control of maxillary sinus cancer, but there is no significant difference in 5-year survival rate. The preoperative plus postoperative radiotherapy group can take into account the fact that preoperative radiotherapy can make full use of the good blood supply and sensitivity of microscopic lesions to reduce the viability of cancer cells, which makes it easy to achieve a curative effect after surgery; at the same time, it can take into account the clean surgical margins and target the residual areas for additional radiotherapy, which can be carried out smoothly in a planned manner. Zhang Zhendong reported that the survival rate was not significantly affected by preoperative, postoperative or preoperative plus postoperative adjuvant radiotherapy in comprehensive treatment. Zhang Qing et al. concluded that preoperative radiotherapy is a better treatment modality, but postoperative radiotherapy affects the sensitivity of tumors to radiation due to the lack of local blood supply and low oxygen tension in tissues due to the tissue scar produced by surgery, and it is difficult to design a precise field for postoperative radiotherapy because of the irregular incisions and cavities left by surgery, which increases the chance of recurrence. Zhang Yanping [25] reported that complete surgical resection plus postoperative radiotherapy in 14 patients with advanced disease significantly improved the cure rate and reduced the chance of recurrence. Therefore, radical surgery plus radiotherapy is the main treatment for adenoid cystic carcinoma of the maxillary sinus. Malignant fibrous histiocytoma of the maxillary sinus (MFH) is less common, and its pathology is specific and insensitive to radiation, which makes monotherapy ineffective and prone to metastasis and recurrence. Hua Xiaoyang et al. reported that extensive and complete surgical resection is the main treatment for MFH. Postoperative radiotherapy and chemotherapy can significantly improve the local control rate and reduce metastasis. At present, radical surgery plus radiotherapy is the main treatment for MFH. 4.2 Combination of surgery and chemotherapy Combination of radiotherapy and surgery is currently recognized as a better treatment for maxillary sinus cancer, but radiotherapy has its limitations, is restricted by conditions, and is not suitable for repeated treatment. In contrast, screening chemotherapy can be applied preoperatively for a short period of time and postoperatively on a cyclic basis, which can effectively inhibit the development of tumor and further improve the efficacy of surgery. Since this method is not limited by conditions and equipment, it can be widely used in clinical practice. Pre-operative chemotherapy often uses more than three anti-cancer drugs, which are designed to deliver effective concentration of anti-cancer drugs to the tumor area before the vascular bed in the maxillary sinus area is destroyed, so as to inhibit or kill the biologically active cancer cells, shrink the tumor body in the sinus area, and eliminate the metastatic cancer in the lymph nodes of the posterior pharynx, so as to facilitate the complete removal of the tumor by surgery. Chemotherapy with anti-cancer drugs is effective in killing cancer cells directly or through metabolic effects, especially for occult metastases in the parapharyngeal or lymphatic regions, which can be eradicated by chemotherapy. The primary cancer cells regress and become less active, reducing the ability of surgical wound implantation and local recurrence or metastasis elsewhere. Chemotherapy is less damaging to the skin in the surgical area, and the flap heals easily after surgery, which facilitates rapid postoperative recovery. Li Tianxin et al [28] reported that the 3-year and 5-year survival rates of 60 patients with advanced maxillary sinus cancer were 35% and 30%, respectively, after chemotherapy plus surgery, which were statistically not significantly different from those of radiotherapy plus surgery. 4.3 Combination of chemotherapy, radiotherapy and surgery This regimen is also called triple therapy, mainly using arterial chemotherapy. It was first introduced in Japan, and since 1965, it has become the most popular treatment in Japan. Pre-operative planned radiotherapy and chemotherapy can make use of the maxillary sinus vascular bed and the tumor area to reduce the tumor size before the blood supply is destroyed, so that the tumor can be removed locally without damaging the surrounding vital organs as much as possible. After surgery, the tumor is then treated with appropriate amount of radiotherapy and chemotherapy to kill the subclinical lesions around the surgical field. This is the development direction of comprehensive treatment for maxillary sinus cancer, which is welcomed by patients, as it does not affect the survival rate and local control rate of tumor patients, but also improves the quality of survival. The future development of this treatment is highly anticipated. This method has been used since 1965 by Yasuo Sato et al. After 60 cobalt radiotherapy with 2000 radx2 in the anterior and lateral fields, a superficial facial artery was cannulated under general anesthesia and 5-FU 250 mg was infused (finished in 10 minutes), and the superior collar sinus was opened and drained and the tumor was scraped, removing all the tumor tissue as much as possible, but the scraping area did not exceed the border of the tumor tissue. Then, 5-FU ointment and gauze were filled in (after daily change, necrotic tissues were aspirated out, and the residual tumor tissues were scraped out and then 5-FU ointment and gauze were put in), and the next day, 5-FU 250mg and BUdR 500mg were injected (after the drip lasted for about 1 hour), and radiotherapy was administered. The above treatment was repeated 5-6 times to finish the whole course of treatment. The total amount of 5-FU was 1250-1500mg and 800-1600rad of radiotherapy, at this time, most of the tumor tissue was gone from the sinus. If residual or recurrent cancer is found, additional intracavitary radiotherapy or surgical resection will be performed. The 5-year survival rate was reported to be 58%. In addition, according to the pathological observation of the scraped tumor tissue, if only a small amount of tumor tissue remains after the tumor reduction surgery, the cancer cells can be significantly degenerated by 1000 rad of radiotherapy, and by 1400 rad, few cancer cells with reproductive viability can be seen; compared with the tumor body without scraping, which is combined with radiotherapy only, the latter requires at least 4000-5000 rad of radiotherapy to show the above effect. This performance became the basis for the reduction of radiation therapy. Sato later reduced the amount of radiation therapy to 400 rad and concluded that the recurrence rate was not higher than that of 1200 rad. In the former group, the amount of radiotherapy was mostly more than 6000 rad, including total and partial resection of the upper collar bone, while in the latter group, the amount of radiotherapy was about 5000 rad, mostly with 5-FU, and the average total amount was 2945 mg, and about 80% of the patients had partial resection of the upper collar bone. The 5-year survival rate was 45.9% in the former group (76.2% in stage 2, 50% in stage 3, and 16.7% in stage 4) and 45.1% in the latter group (63.6% in stage 2, 47.6% in stage 3, and 27.5% in stage 4), with no significant difference, except that most of the superior collar bones were preserved in the latter group. In Japan, there is also a combination with enlargement surgery, such as Konon [35] arterial chemotherapy 5-FU 250 mg/dose (30 minutes), followed by radiotherapy, after 1000 rad, upper collar sinus opening and drainage, mobilization 5 times a week, 15 times, total 3750 mg, radiotherapy total 6000 rad, 3 weeks after the end of mobilization and radiotherapy, enlarged radical surgery, and pectoral A total of 70 cases of upper collar sinus cancer were treated with a 5-year survival rate of 71.9%. Mosley et al [36] reported alternating arterial perfusion with BLM and MTX for 24 hours each for 9 days, with BLM 0.75 mg/kg/24h for days 1, 3, 5, 7, and 9 and MTX 0.5 mg/kg/24h for days 2, 4, 6, and 8, and leucovoin 6 mg every 6 hours for 34 hours. once every 6 hours for 34 hours. Radiotherapy was given at the end of the treatment, and the total amount of radiation was 5000-6000 rad. A total of 13 cases were treated, of which 10 cases completed the whole treatment (T3 and T4 in total 9 cases), and no cancer cells were found in 4 cases on specimen examination. 2 years of observation, 3 cases died of distant metastasis, only 1 case recurred, and the long-term efficacy is to be observed. Zhang Xiaotao et al. treated 60 patients with maxillary sinus cancer, including 38 cases of squamous carcinoma, 15 cases of adenocarcinoma, and 7 cases of others; 39 men and 21 women were treated with induction chemotherapy - maxillary sinus opening - radiotherapy - consolidation chemotherapy. Results: The 5-year survival rate of all patients was 46.7% (28/60), of which 16 patients were able to live or work normally and 12 patients were in long-term recuperation; 16 of the deceased patients died of recurrence of the primary focus. Conclusion: The sequential non-surgical resection of maxillary sinus cancer can maximize the preservation of facial and organ functions, reduce complications, and improve the quality of survival, which is more acceptable to patients. The sequential comprehensive treatment plan was completed in all cases, and the clinical symptoms gradually resolved after treatment without serious complications and sequelae in most patients. At the end of treatment, the maxillary sinus cavity was scraped for pathology and no cancer cells were found. After more than 5 years of follow-up, 28 patients survived, and the average 5-year survival rate was 46.7%. In one case, because the tumor invaded the orbital floor, the radiotherapy field included the ipsilateral eye. Two years after radiotherapy, the vision of the eye began to deteriorate, gradually worsened, and after three years, the eye became blind, the eye sunken, and the eye fissure shrunk. In terms of the quality of survival, 16 patients returned to work and labor, while 12 patients were recuperating for a long time due to the combination of other diseases, but were able to take care of themselves. The 2 cases lost to follow-up were counted as deaths. Of the 32 patients who died, 50% (16) died from deterioration of the primary site, 10 died from metastases or other tumors (undiagnosed primary or metastatic), and 4 died from other diseases. Tatsuya Hayashi et al. analyzed the treatment of seventy-four patients with squamous cell carcinoma of the maxillary sinus. 62 patients started a multidisciplinary and comprehensive treatment approach, including preoperative radiotherapy, including a total dose of 50 Gray radiotherapy, maxillary artery infusion with a total dose of 5000 mg 5-FU, plus total or partial maxillary osteotomy, and 59 received complete treatment. 11 patients were treated with radiotherapy alone, and only one patient was treated with a total dose of 5-FU. radiotherapy and only 1 received postoperative radiation therapy. The survival time for this follow-up patient was 117 months. The 5-year overall survival, disease-free survival, and local control rates for those who underwent multidisciplinary combination therapy were significantly better than those who received radiation therapy alone (68.5% vs. 9.1%; 73.2% vs. 18.2%, 84.0% vs. 18.2%). Hiroshi et al. reported that in 26 cases of maxillary sinus cancer with orbital invasion, the 5-year and 10-year survival rates were 68% and 51%, respectively, after preoperative radiotherapy and chemotherapy, local conservative surgery, and postoperative radiotherapy and chemotherapy; the 5-year and 10-year local control rates were 66% and 51%, respectively, thus indicating that the combination of treatment with conservative surgery did not affect the survival and local control rates and improved the survival of patients. The quality of survival was improved. However, this method should be determined according to the extent of tumor invasion in the orbit, and the quality of life should not be pursued at the expense of tumor control rate. In 43 patients with maxillary sinus cancer, Bai Yanxia et al. used a sequential combination of induction chemotherapy with superficial temporal artery cannulation plus surgery plus radical radiotherapy, and another 18 patients were treated with consolidation chemotherapy at the end of the combination. Results: All patients tolerated the treatment regimen, and after 5 years of follow-up, 5 patients were lost, with a follow-up rate of 88.4%. The 5-year survival rate was 46.5% (20/ 43) and the 3-year survival rate was 65.1% (28/ 43) for the whole group. No orbital contents were removed in any of the patients, and 12 patients returned to work and labor. Conclusion:Superficial temporal artery cannulation induction chemotherapy plus surgery plus radical radiotherapy for maxillary sinus cancer is an effective option to improve the long-term outcome. Among them, superficial temporal artery cannulation induction chemotherapy has the advantages of high local drug concentration, obvious tumor regression in the primary foci with a single cycle of chemotherapy, and no delay in surgery; combined with surgery and postoperative radical radiotherapy can improve the local control rate. And postoperative consolidation chemotherapy can further reduce the risk of distant metastasis. Nakatani H et al. treated eight patients with advanced maxillary sinus cancer with high-dose intra-arterial cisplatin infusion (4-6 times (mean 5. 1) and total cisplatin dose of 690 to 910 mg (mean 771 mg)) combined with radiation therapy and surgical resection; only one patient with T4 had local recurrence and the other one had metastases on both sides of the neck. In conclusion, the vast majority of maxillary sinus cancers require comprehensive treatment, which requires the collaboration of physicians from all disciplines and a planned approach to the entire treatment plan. With the continuous updating of imaging and radiotherapy equipment, the development of radiotherapy technology, the continuous improvement of surgical technology and the application of gene therapy, the treatment effect of maxillary sinus cancer will be more improved.