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Hoeltgen L, Tessonnier T, Meixner E, Hoegen P, Kim JY, Deng M, Seidensaal K, Held T, Herfarth K, Debus J, Harrabi S. Proton Therapy for Advanced Juvenile Nasopharyngeal Angiofibroma. Cancers (Basel) 2023; 15:5022. [PMID: 37894389 PMCID: PMC10605854 DOI: 10.3390/cancers15205022] [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: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE To provide the first report on proton radiotherapy (PRT) in the management of advanced nasopharyngeal angiofibroma (JNA) and evaluate potential benefits compared to conformal photon therapy (XRT). METHODS We retrospectively reviewed 10 consecutive patients undergoing PRT for advanced JNA in a definitive or postoperative setting with a relative biological effectiveness weighted dose of 45 Gy in 25 fractions between 2012 and 2022 at the Heidelberg Ion Beam Therapy Center. Furthermore, dosimetric comparisons and risk estimations for short- and long-term radiation-induced complications between PRT plans and helical XRT plans were conducted. RESULTS PRT was well tolerated, with only low-grade acute toxicities (CTCAE I-II) being reported. The local control rate was 100% after a median follow-up of 27.0 (interquartile range 13.3-58.0) months. PRT resulted in considerable tumor shrinkage, leading to complete remission in five patients and bearing the potential to provide partial or complete symptom relief. Favorable dosimetric outcomes in critical brain substructures by the use of PRT translated into reduced estimated risks for neurocognitive impairment and radiation-induced CNS malignancies compared to XRT. CONCLUSIONS PRT is an effective treatment option for advanced JNA with minimal acute morbidity and the potential for reduced radiation-induced long-term complications.
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Affiliation(s)
- Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Maximilian Deng
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
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Rahmadiyanto Y, Romdhoni AC. Multidiscipline management of giant reccurent nasopharyngeal angiofibroma which extends to paranasal sinuses, orbita, and intracranial in adult. Int J Surg Case Rep 2022; 99:107579. [PMID: 36122425 PMCID: PMC9568708 DOI: 10.1016/j.ijscr.2022.107579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 11/27/2022] Open
Abstract
Nasopharyngeal angiofibroma (NA) is a benign, slowly growing tumour that affects males in their early puberty, and rarely men over 25 years of age. There was an interesting case of a giant recurrent NA in a 62-year-old male, which is challenging to manage due to wide tumour expansion to paranasal sinuses, orbital and intracranial. In cases of large angiofibromas disease, preoperative embolization should be performed to prevent profuse bleeding. Wide expansion of NA can cause post extirpation large defects of the tumour so that optimal defect closure techniques are needed to restore the aesthetics and function of the disturbed organs. This case's diagnosis and management of this disease was carried out by multidisciplinary discussion, and surgical extirpation of the joint tumour was performed in Dr. Soetomo General Academic Teaching Hospital. The tumour was removed by medial maxillectomy with an extended Killian right lateral rhinotomy approach followed by tumour defects reconstruction. The follow up showed that there were still tumour residue and suspicious intracranial abscess, but the patient had no complaint during follow-up for ten months after surgery. Nasopharyngeal angiofibroma (NA) is a benign but locally aggressive tumor and rarely appears in adults. Although it is rare, NA should not be disregarded in elderly patients. Histopathological tests showed different results before surgery. The surgical technique chosen is embolization, MMRL and facial reconstruction through joint surgery ORL-HNS, Ophthalmologist, Neurosurgeon, and Plastic Reconstructive & Aesthetic Surgeon because of the large size of the tumor and has spread aggressively to the intracranial and many blood vessels involved. The result concluded a benign mesenchymal spindle tumour with a differential diagnosis of solitary fibrous tumour, neurofibroma cellular schwannoma, and angiofibroma. The patient was advised to undergo an immunohistochemical examination to establish a tumour diagnosis, but this was not done due to constraints on equipment and family considerations related to the Covid-19 pandemic. Evaluation of the results of surgery and recurrence events has been carried out for 10 months postoperatively and there are no complaints and the patient can carry out activities as usual.
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Affiliation(s)
- Yoga Rahmadiyanto
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Achmad Chusnu Romdhoni
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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Lao WP, Lagabon KJ, Arom GA, Walker PC, Lee SC. Combined endoscopic and transoral resection of a high-staged juvenile nasopharyngeal angiofibroma: A pictorial essay. Head Neck 2020; 43:719-724. [PMID: 33111428 DOI: 10.1002/hed.26516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular and benign tumors that can expand into the skull base. Delay of treatment can result in intracranial invasion, requiring extensive open approaches such as a facial translocation, maxillary swing, or an orbitozygomatic craniotomy. We describe a single-stage, combined endoscopic and transoral approach on a 14-year-old male with extensive high-stage dumbbell-shaped JNA involving the infratemporal fossa, orbit, buccal space, and intracranial extension into Meckel's cave. Successful resection of the tumor and good postoperative outcome was achieved. A transoral approach allowed for greater access to the infratemporal fossa, where endonasal resection was not possible, allowing for improved visualization, greater traction, and dissection. In select highly staged JNAs with significant lateral extension and intracranial involvement, successful and complete resection may be accomplished with this combined approach. Utilization of this approach avoids the morbidity of more invasive open approaches.
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Affiliation(s)
- Wilson P Lao
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Gabriel A Arom
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Paul C Walker
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Steve C Lee
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
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Ralli M, Fusconi M, Visconti IC, Martellucci S, de Vincentiis M, Greco A. Nasopharyngeal angiofibroma in an elderly female patient: A rare case report. Mol Clin Oncol 2018; 9:702-704. [PMID: 30546905 DOI: 10.3892/mco.2018.1735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/05/2018] [Indexed: 11/06/2022] Open
Abstract
'Juvenile' nasopharyngeal angiofibroma, which accounts for <1% of all head and neck neoplasms, occurs predominantly in males between 10 and 18 years of age. The small number of patients older than 30 years confirms that presentation after this age is exceptional. Only rare cases of nasopharyngeal angiofibroma in female patients have been documented to date, and some authors believe that sex chromosome studies are indicated in such cases. The pathogenesis of nasopharyngeal angiofibroma remains unknown, but it has been hypothesized that it is a testosterone-dependent tumor. We herein report a particularly rare case of a 68-year-old woman diagnosed with nasopharyngeal angiofibroma and describe the diagnostic and therapeutic workup. This case describes, to the best of our knowledge, the oldest patient reported in the literature.
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Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, I-00186 Rome, Italy
| | - Massimo Fusconi
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
| | | | | | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, I-00186 Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
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