Figure 3.

The panel shows two examples of locally advanced poorly differentiated squamous cell carcinoma of the right maxillary sinus (A,B). Both patients underwent neoadjuvant chemotherapy (3 cycles) with taxane, cisplatin, and 5-fluorouracile, which resulted in a heterogenous response: the first tumor (C) showed a partial response (arrows), whereas the second one (D) progressed throughout chemotherapy. Based on the response to chemotherapy, the first patient was treated through intensity-modulated proton therapy combined with concomitant platinum-based chemotherapy, which led to a complete response with no relevant toxicity (E). The second patient was instead operated on through a total maxillectomy extended to the infratemporal fossa and upper parapharyngeal space, orbital exenteration (F), anterior and middle craniectomy with dural resection, skull base multilayer graft-based reconstruction, and anterolateral thigh free flap.