To assess management options for ethmoid adenocarcinoma.

Retrospective review over 28 years.

Ninety-five patients were included. Statistical analysis using the Kaplan–Meier method was performed to establish survival rates, and univariate analysis to determine prognostic factors. Independent χ² test was used to compare survival rates between T3 and T4a stages operated by transfacial and craniofacial approaches, respectively.

Mean age was 64 years, and 76% patients were stage T3 or T4. Three patients had node metastasis, none of whom had distant metastases at time of diagnosis. Eighty-three percent of patients received surgery and adjuvant radiotherapy on tumor bed. Mean follow-up was 5 years. The recurrence and metastasis rate were 31 and 9% at median time of 3 years, respectively. The disease-specific 5- and 10-year survival rates were 78 and 64%, respectively. The disease-free survival rate was 61 and 44%, respectively, at the same time points. Meningo-encephalic (P = 10⁻⁸), orbit or infratemporal fossae (P = 0.046), and frontal sinus extension (P = 0.02) negatively impacted survival. There was no statistically significant difference in survival rate between T3 and T4a.

Our data suggest that less surgical treatment may be needed than is usually advocated for T1–T4a tumors and that surgery alone may be appropriate for T1–T3 tumors that have been resected with adequate margins in those patients for whom excellent follow-up is anticipated. No neck irradiation is indicated for N0 disease.