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Levi L, Havazelet S, Moskovitz A, Soudry E. Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients. Laryngoscope 2024. [PMID: 38738794 DOI: 10.1002/lary.31504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). METHODS A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. RESULTS Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. CONCLUSION Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Lirit Levi
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Shany Havazelet
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Anner Moskovitz
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shah RR, Maina IW, Patel NN, Triantafillou V, Workman AD, Kuan EC, Tong CCL, Kohanski MA, O'Malley BW, Adappa ND, Palmer JN. Incidence, risk factors, and outcomes of endoscopic sinus surgery after endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 10:521-525. [PMID: 32104979 DOI: 10.1002/alr.22486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/19/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients undergoing endoscopic resection of neoplasms with both sinonasal and skull base involvement can develop chronic rhinosinusitis (CRS) after treatment and may occasionally benefit from additional endoscopic sinus surgery (ESS). We investigate risk factors and outcomes associated with revision ESS (rESS) after endoscopic skull-base surgery (SBS) for neoplasms with combined sinonasal and skull base involvement. METHODS A retrospective review of patients with neoplasms with both sinonasal and skull base involvement who underwent endoscopic resection at a single tertiary care academic institution from 2004 through 2017 was performed. Eighty-three patients were included. Main outcome measures included incidence and timing of revision surgery, Lund-Mackay (LM) scores, and 22-item Sino-Nasal Outcome Test (SNOT-22) scores. RESULTS rESS was performed in 21 (25%) cases, 15 (18%) of which were due to CRS. Time between initial resection and rESS was an average of 42 months (range, 6 to 142 months). Pre-SBS and post-SBS LM scores were not significantly different (5.0 vs 4.7, p = 0.640), although pre-SBS and post-SBS SNOT-22 scores showed significant improvement (32.6 vs 24.5, p = 0.030). Malignant pathology correlated with need for rESS (odds ratio [OR] 5.07, p = 0.04), as well as treatment including chemotherapy (OR 5.10, p = 0.003) and radiation (OR 4.15, p = 0.013). CONCLUSION A significant proportion of patients develop clinically significant sinusitis after endoscopic SBS for neoplasms with combined sinonasal and skull base involvement and may benefit from rESS. Intervention occurred, on average, 3.5 years after initial tumor resection. Malignant pathology, radiation therapy, and chemotherapy correlate with need for rESS.
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Affiliation(s)
- Ravi R Shah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ivy W Maina
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Neil N Patel
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - Vasiliki Triantafillou
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alan D Workman
- Department of Otolaryngology, Harvard Medical School, Boston, MA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Bert W O'Malley
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
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Lu Y, Lu Y, Cheng H, Hsin C, Yang S, Wang P, Yeh H. Chronic rhinosinusitis after radiotherapy in patients with head and neck cancer: a population‐based cohort study in Taiwan. Int Forum Allergy Rhinol 2020; 10:692-697. [DOI: 10.1002/alr.22526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Yen‐Ting Lu
- Department of OtolaryngologySt. Martin De Porres Hospital Chiayi Taiwan
- Department of OtolaryngologyChung Shan Medical University Hospital Taichung Taiwan
- Institute of MedicineChung Shan Medical University Taichung Taiwan
| | - Ying‐Chou Lu
- Department of OtolaryngologySt. Martin De Porres Hospital Chiayi Taiwan
| | - Hui‐Chen Cheng
- Department of OphthalmologyTaipei Veterans General Hospital Taipei Taiwan
- Department of Ophthalmology, School of MedicineNational Yang‐Ming University Taipei Taiwan
- Program in Molecular Medicine, School of Life SciencesNational Yang‐Ming University Taipei Taiwan
- Department of Life Sciences and Institute of Genome Sciences, School of Life SciencesNational Yang‐Ming University Taipei Taiwan
| | - Chung‐Han Hsin
- Department of OtolaryngologyChung Shan Medical University Hospital Taichung Taiwan
- Institute of MedicineChung Shan Medical University Taichung Taiwan
| | - Shun‐Fa Yang
- Institute of MedicineChung Shan Medical University Taichung Taiwan
- Department of Medical ResearchChung Shan Medical University Hospital Taichung Taiwan
| | - Po‐Hui Wang
- Institute of MedicineChung Shan Medical University Taichung Taiwan
- Department of Obstetrics and GynecologyChung Shan Medical University Hospital Taichung Taiwan
| | - Huan‐Jui Yeh
- Department of Physical Medicine and RehabilitationTaoyuan General Hospital Ministry of Health and Welfare Taoyuan Taiwan
- Institute of Public HealthNational Yang‐Ming University Taipei Taiwan
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Hiyama T, Sekiya K, Kuno H, Oda S, Kusumoto M, Minami M, Kobayashi T. Imaging of extracranial head and neck lesions in cancer patients: a symptom-based approach. Jpn J Radiol 2019; 37:354-370. [PMID: 30911985 DOI: 10.1007/s11604-019-00832-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/17/2019] [Indexed: 02/06/2023]
Abstract
Besides intracranial lesions, neurological symptoms are also caused in cancer patients by extracranial lesions in the head and neck. Common symptoms caused by such lesions include visual loss, visual field defect, diplopia, ptosis, sensory abnormalities of the head and neck region, facial nerve palsy, dysphagia, dysarthria, hoarseness, and syncope. Some cancer patients often have multiple cranial nerve involvement, which is associated with several syndromes such as jugular foramen syndrome. The main causes of cranial nerve dysfunction due to extracranial lesions include bone and nodal metastasis, perineural tumor spread, inflammation, and radiation injury. The location of the lesions causing the neurological symptom may be estimated by the symptoms and physical examination. However, CT/MRI is critical for reaching the final diagnosis and for treatment planning and management of the cancer patients. Moreover, early identification of the extracranial lesions may significantly affect patient care and alter outcomes. Thus, radiologists should be familiar with imaging findings of the common neurological disorders and the complex anatomy of the head and neck region, which should be checked in cancer patients with neurological symptoms.
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Affiliation(s)
- Takashi Hiyama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Kotaro Sekiya
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hirofumi Kuno
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shioto Oda
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.,Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Manabu Minami
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Endoscopic Surgery for Delayed Sinonasal Complications of Radiation Therapy for Nasopharyngeal Carcinoma: A Subjective Outcome. Int J Radiat Oncol Biol Phys 2018; 100:1222-1227. [PMID: 29439883 DOI: 10.1016/j.ijrobp.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/24/2017] [Accepted: 01/03/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Delayed sinonasal complications of radiation therapy include choanal stenosis, osteoradionecrosis, chronic sinusitis, and intranasal synechiae. Only sporadic cases on their surgical treatment have been reported, with equivocal results. METHODS AND MATERIALS We performed a prospective case series of all patients who had been surgically treated for delayed sinonasal complications of radiation therapy in our institution during the past 10 years. The inclusion criteria required ≥6 months of follow-up after surgery. The included patients were asked to complete a Sino-Nasal Outcome Test 16-item questionnaire preoperatively and 6 months after surgery. RESULTS Nine patients with history of radiation therapy for nasopharyngeal carcinoma were included in our series. In all cases, partial or complete subjective improvement occurred. CONCLUSIONS In select cases, endoscopic sinus surgery could be of benefit in the treatment of delayed sinonasal complications of radiation therapy.
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Kuhar HN, Tajudeen BA, Heilingoetter A, Mahdavinia M, Gattuso P, Ghai R, Gunawan F, Diaz AZ, Tolekidis G, Batra PS. Distinct histopathologic features of radiation-induced chronic sinusitis. Int Forum Allergy Rhinol 2017; 7:990-998. [PMID: 28736997 DOI: 10.1002/alr.21989] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/26/2017] [Accepted: 06/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a commonly observed sequela after radiation therapy to the paranasal sinuses. The histopathologic features of radiation-induced CRS have yet to be determined and may have major implications in disease management. METHODS A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund-Mackay score (LMS), and 22-item Sino-Nasal Outcome Test (SNOT-22) scores were compared among patients with radiation-induced CRS (CRSr), CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP). RESULTS Fifteen CRSr, 43 CRSsNP, and 56 CRSwNP patients who underwent FESS were analyzed. Compared with CRSsNP, CRSr cases had increased squamous metaplasia (40.0% vs 9.3%, p < 0.013) and subepithelial edema (53.3% vs. 2.3%, p < 0.001). Compared with CRSwNP, CRSr cases had fewer eosinophils per high-power field (20.0% vs 50.0%, p < 0.034), less basement membrane thickening (33.3% vs 76.8%, p < 0.002), and fewer eosinophil aggregates (0.0% vs 30.4%, p < 0.009). CRSr had significantly greater mean LMS (13.47 ± 5.13 vs 7.07 ± 4.79, p < 0.001) compared with CRSsNP. CONCLUSION Radiation-induced CRS patients exhibited greater squamous metaplasia and subepithelial edema when compared with a cohort of patients with CRSsNP, and decreased eosinophilia and basement membrane thickening compared with a cohort of CRSwNP patients. CRSr cases demonstrated no difference in eosinophilia or neutrophilia compared with CRSsNP, and decreased eosinophilia compared with CRSwNP, lending further credence to the unique nature of radiation in the development of CRS in this patient group. These findings may have major implications with regard to extent of surgical intervention and medical management.
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Affiliation(s)
- Hannah N Kuhar
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Sinus Program-Rush University Medical Center, Chicago, IL
| | | | - Mahboobeh Mahdavinia
- Department of Immunology and Microbiology, Allergy/Immunology Section-Rush University Medical Center, Chicago, IL
| | - Paolo Gattuso
- Department of Pathology-Rush University Medical Center, Chicago, IL
| | - Ritu Ghai
- Department of Pathology-Rush University Medical Center, Chicago, IL
| | - Ferry Gunawan
- Department of Immunology and Microbiology, Allergy/Immunology Section-Rush University Medical Center, Chicago, IL
| | - Aidnag Z Diaz
- Department of Radiation Oncology-Rush University Medical Center, Chicago, IL
| | - George Tolekidis
- Department of Radiation Oncology-Rush University Medical Center, Chicago, IL
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Sinus Program-Rush University Medical Center, Chicago, IL
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Maxfield AZ, Chambers KJ, Sedaghat AR, Lin DT, Gray ST. Mucosal Thickening Occurs in Contralateral Paranasal Sinuses following Sinonasal Malignancy Treatment. J Neurol Surg B Skull Base 2017; 78:331-336. [PMID: 28725520 DOI: 10.1055/s-0037-1598048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/09/2016] [Indexed: 02/03/2023] Open
Abstract
Objective To investigate the incidence and degree of contralateral sinus disease following treatment of sinonasal malignancy (SNM) using radiological findings as an outcome measure. Study Design Retrospective case series. Setting Tertiary referral academic center. Participants Patients with SNM treated with surgical and adjuvant radiotherapy with or without concurrent chemotherapy. Main Outcome Measures Pre- and posttreatment computed tomography and magnetic resonance imaging scans, Lund-Mackay (LM) score, date of diagnosis, chemotherapy, and dosage of radiation therapy (RT). Results There was a significant difference between pre- and posttreatment LM scores ( p < 0.001) of the contralateral paranasal sinuses. There was no statistical significance between the change in pre- and posttreatment LM scores and patient age, gender, chemotherapy, RT dosage, and time lapse between diagnosis and when we performed this study in the univariate and the multivariable analyses. Conclusions Following treatment of SNM with surgical resection and RT, there was a significant increase in incidence and degree of mucosal thickening of the contralateral sinus by LM grading that persisted after the completion of treatment. This indicates the need for long-term follow-up to monitor for chronic rhinosinusitis as a delayed complication following treatment of SNM.
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Affiliation(s)
- Alice Z Maxfield
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Kyle J Chambers
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
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