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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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Dang RR, Hu YF, Tsao CK, Young CK, Liao CT, Chen CH, Kang CJ, Huang SF. Serial assessment and long-term radiographic evaluation of the maxillary sinus after inferior maxillectomy and soft tissue free flap reconstruction in patients with oral cancer. Head Neck 2024; 46:300-305. [PMID: 37983958 DOI: 10.1002/hed.27575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE This study evaluates serial radiographic changes in the maxillary sinus of patients with oral cancer after an inferior maxillectomy and a soft tissue free flap reconstruction. METHODS Fifty-six patients were evaluated between Oct 2005 and Mar 2017 from an institutional database. Preoperative and surveillance imaging was reviewed at set time-points. Maxillary sinus scores were allotted based on a modification of the Lund-MacKay staging system. Patients were evaluated for change in sinus score. A univariate (UV) and multivariate (MV) analysis was performed. RESULTS There were 53.5% T3/T4 category tumors and 68% received adjuvant treatment. Median follow-up was 24.4 months. Preoperative mean sinus score was 0.27 ± 0.44 and postoperative mean sinus score at 24 months was 1.2 ± 1.3 (p = <0.001). On UV analysis advanced T-stage at 12 months (OR 6.7, 95% CI 1.2-50.3, p = 0.01) and 24 months (OR 5.2, 95% CI 1.03-36.8, p = 0.04) was associated with significantly higher sinus score. On MV analysis, advanced T-stage continued to be associated with increased odds for higher sinus score (OR 4.9, 95% CI 1.1-26.8, p = 0.039). CONCLUSION A mild increase in postoperative sinus score is seen in this cohort of patients. Advanced T-stage is associated with increased odds for higher sinus scores.
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Affiliation(s)
- Rushil Rajiv Dang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Yu-Feng Hu
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Kang Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Kuang Young
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Han Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Bao X, Wang Y, Li B, Peng L, Ouyang B, Ng CL, Zhuo Y, Wang Q, Li C, Li J. Clinical and dosimetric predictors of radiation-induced rhinosinusitis following VMAT for nasopharyngeal carcinoma: A retrospective study. Heliyon 2024; 10:e23554. [PMID: 38187301 PMCID: PMC10770446 DOI: 10.1016/j.heliyon.2023.e23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background We aimed to investigate the clinical and dosimetric factors associated with radiation-induced rhinosinusitis, and further elucidate the optimal dose-volume constraints for nasopharyngeal cancer patients who underwent volumetric-modulated arc therapy (VMAT). Methods A retrospective review of 196 nasopharyngeal carcinoma (NPC) patients who underwent definitive VMAT between August 2018 and May 2021 was conducted. Both clinical and dose-volume histogram (DVH) data of NPC patients without rhinosinusitis at baseline were selected for analysis. Results The cumulative incidence of post-RT rhinosinusitis at the 3-, 6-, 9-, and 12-months, and >1 year were 29.6 %, 41.3 %, 42.9 %, and 45.4 %, and 47.4 %, respectively. Nasal irrigation was negatively associated with post-RT rhinosinusitis (p < 0.001). Higher cumulative incidences of maxillary and ethmoid sinusitis were associated with V70 > 1.16 % and >1.00 %, respectively (p = 0.027 and p = 0.002). Sphenoid sinusitis was more frequent when Dmax(maxillary sinus) exceeded 69.2Gy (p = 0.005). Conclusions Regular nasal irrigation may reduce the development of rhinosinusitis. Dose-volume constraints of V70 and Dmax to the maxillary sinus are suggested for VMAT planning. Patients exceeding these thresholds should be closely monitored and potentially offered preventative interventions within 3-6 months post-RT.
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Affiliation(s)
- Xiaomin Bao
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Yan Wang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong, Guangzhou, China
| | - Liang Peng
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Bin Ouyang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong, Guangzhou, China
| | - Chew Lip Ng
- Department of Otolaryngology-Head and Neck Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Yongshi Zhuo
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Qiumin Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Chunwei Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Jian Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
- Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Guangxi, Nanning, China
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Zheng W, Yan T, Liu D, Chen G, Wen Y, Rao X, Wang Y, Zheng H, Yang J, Peng H. Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients. Radiat Oncol 2023; 18:153. [PMID: 37723540 PMCID: PMC10508027 DOI: 10.1186/s13014-023-02331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/08/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients. PATIENTS AND METHODS A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS. RESULTS (1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040). CONCLUSION (1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.
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Affiliation(s)
- Wenya Zheng
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Tao Yan
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Dongjiao Liu
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Geng Chen
- Department of Medical Imaging, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Yingjuan Wen
- Department of Radiation Oncology, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Xiuli Rao
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Yizhe Wang
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Huijuan Zheng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Jiahong Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Hua Peng
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Fang C, Zhong Y, Chen T, Li D, Li C, Qi X, Zhu J, Wang R, Zhu J, Wang S, Ruan Y, Zhou M. Impairment mechanism of nasal mucosa after radiotherapy for nasopharyngeal carcinoma. Front Oncol 2022; 12:1010131. [PMID: 36591522 PMCID: PMC9797686 DOI: 10.3389/fonc.2022.1010131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The nasal mucosa, which performs the crucial functions of filtering, humidifying and temperature regulation, is one of the most vulnerable areas of nasopharyngeal carcinoma (NPC) patients after radiotherapy (RT). Following RT, NPC patients experience a series of pathological changes in the nasal mucosa, ultimately leading to physiological dysfunction of the nasal epithelium. This article systematically reviews the clinical and pathological manifestations of RT-related nasal damage in NPC patients and summarizes the potential mechanism of damage to the human nasal epithelium by RT. Finally, we outline the current mechanistic models of nasal epithelial alterations after RT in NPC patients and provide additional information to extend the in-depth study on the impairment mechanisms of the nasal mucosa resulting from RT. We also describe the relationship between structural and functional alterations in the nasal mucosa after RT to help mitigate and treat this damage and provide insights informing future clinical and fundamental investigations.
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Affiliation(s)
- Caishan Fang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu Zhong
- Department of Radiotherapy, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tengyu Chen
- Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Dan Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunqiao Li
- Department of Otolaryngology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangjun Qi
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junxia Zhu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruizhi Wang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinxiang Zhu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shunlan Wang
- Department of Otolaryngology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Ruan
- Department of Otolaryngology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Min Zhou, ; Yan Ruan,
| | - Min Zhou
- Department of Otolaryngology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Min Zhou, ; Yan Ruan,
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Lin WC, Kuo YH, Hsu CJ, Wu HP, Hsu YJ. Worsening Rhinosinusitis as a Prognostic Factor for Patients with Nasopharyngeal Carcinoma: A Retrospective Study. Biomedicines 2022; 10:3235. [PMID: 36551991 PMCID: PMC9775390 DOI: 10.3390/biomedicines10123235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Rhinosinusitis is common in patients with nasopharyngeal carcinoma (NPC). Our study aimed to explore the role of rhinosinusitis severity in NPC prognosis. Medical records and radiologic examinations of 90 patients with NPC at a single medical center from 2009−2016 were retrospectively analyzed. The Lund−Mackay (L−M) score was obtained for each patient before and after 6 months of treatment. Rhinosinusitis diagnosis was based on L−M scores of ≥4. L−M score differences were calculated as pre-treatment rhinosinusitis (PRRS) minus post-treatment rhinosinusitis (PSRS). L−M score difference was sub-grouped into “L−M scores > 0”, “L−M scores = 0”, and “L−M scores < 0”. Clinical staging of our patients based on the American Joint Committee on Cancer 7th edition were: stage I in nine, stage II in seventeen, stage III in twenty-two, and stage IV in forty-two patients; twenty-seven (30%) patients had died. PRRS incidence was 34.4%, and PSRS was 36.7%. Median of L−M scores difference was 0 (−2.2). L−M score difference was an independent prognostic factor for the overall survival of patients with NPC (p < 0.05). Therefore, worsening rhinosinusitis was a prognostic factor for patients with NPC. Clinicians should consider NPC as a warning sign of poor prognosis during routine follow-ups.
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Affiliation(s)
- Wei-Chieh Lin
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Taichung 427, Taiwan
| | - Chuan-Jen Hsu
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hung-Pin Wu
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yuan-Jhen Hsu
- Department of Otolaryngology, Head and Neck Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan
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Sinonasal Side Effects of Chemotherapy and/or Radiation Therapy for Head and Neck Cancer: A Literature Review. Cancers (Basel) 2022; 14:cancers14092324. [PMID: 35565453 PMCID: PMC9105089 DOI: 10.3390/cancers14092324] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy and chemotherapy represent important treatment modalities for head and neck cancer. Rhinosinusitis and smell alterations are common side effects in the sinonasal region. This review will summarize and analyze our current knowledge of the sinonasal side effects of chemotherapy and/or radiation therapy for head and neck cancer (HNC), with a specific focus on mucosal and olfactory disorders. A review of the English literature was performed using several databases (PubMed, Embase, Cochrane, Scopus). Fifty-six articles were included in qualitative synthesis: 28 assessed mucosal disorders (rhinitis or rhinosinusitis), 26 evaluated olfactory alterations, and 2 articles addressed both topics. The incidence and severity of olfactory dysfunction and chronic rhinosinusitis were highest at the end of radiotherapy and at three months after treatment and decreased gradually over time. Smell acuity deterioration and chronic rhinosinusitis seemed to be related to radiation dose on olfactory area and nasal cavities, but different degrees of recovery were observed. In conclusion, it is important to establish the severity of chronic rhinosinusitis and olfactory dysfunction in order to find strategies to support patients and improve their quality of life.
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Hemmi T, Suzuki J, Ishii R, Ikeda R, Kobayashi Y, Ikushima H, Nomura K, Sugawara M, Ohkoshi A, Katori Y. Effect of treatments for head and neck cancer on sinus shadow on computed tomography. Auris Nasus Larynx 2022; 49:1019-1026. [PMID: 35341622 DOI: 10.1016/j.anl.2022.03.020] [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: 12/03/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Head and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital. METHODS The patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund-Mackay (LM) staging system. RESULTS In total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020). CONCLUSION We found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.
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Affiliation(s)
- Tomotaka Hemmi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Ryo Ishii
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hiroyuki Ikushima
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-ku, Sendai, Miyagi 980-0803, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-ku, Sendai, Miyagi 980-0803, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy. Cancers (Basel) 2022; 14:cancers14010225. [PMID: 35008389 PMCID: PMC8750360 DOI: 10.3390/cancers14010225] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Chronic rhinosinusitis (CRS) is a common treatment complication in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. In this study, we aimed to investigate the incidence and severity of CRS in NPC patients who underwent intensity-modulated proton therapy (IMPT) by evaluating the sinus mucosa change in imaging studies, and we compared these patients with those who underwent volume-modulated arc therapy (VMAT). This was a retrospective case–control study in which 53 and 54 patients were treated with IMPT and VMAT, respectively. We noted that patients in the IMPT group had a significantly lower incidence and decreased severity of sinus mucosa abnormality than those with VMAT. Better and faster recovery of sinonasal function after radiotherapy in the IMPT group was also observed. IMPT techniques deposit the bulk of their radiation doses in highly confined areas, allowing lower exposure of non-target organs during irradiation, which results in more sinonasal mucosa being retained. Abstract In the past decade, patients with nasopharyngeal cancer (NPC) have been deemed candidates for proton radiotherapy, due to the large and comprehensive target volumes and the necessity for the retention of the surrounding healthy tissues. In this study, we aimed to compare the incidence and severity of post-irradiation sinusitis by detecting sinus mucosa diseases (SMDs) via the magnetic resonance imaging (MRI) of patients with NPC after intensity-modulated proton therapy (IMPT) and volume-modulated arc therapy (VMAT). A total of 53 patients in the IMPT group and 54 patients in the VMAT group were enrolled in this study. There were significantly lower endoscopic scores and Lund–Mackay staging scores determined from MRI scans in the IMPT group during different follow-up periods. For the most vulnerable sinuses, the incidence and severity of SMD were the highest during the third post-radiotherapy month in both groups. These decreased steadily, and there was no significant increase in the incidence and severity of SMD during the second post-radiotherapy year in the IMPT group. Our data show that NPC patients with IMPT have a significantly lower incidence and decreased severity of SMD than those with VMAT. A better and faster recovery of sinonasal function after radiotherapy in the IMPT group was also observed.
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Lerner DK, Filimonov A, Filip P, Liu K, Russell S, Shah J, Spock T, Schaberg M, Del Signore A, Colley P, Govindaraj S, Khan MN, Iloreta AM. Sinonasal Issues After Maxillectomy With Free Flap Reconstruction: Incidence and Clinical Approach. Laryngoscope 2021; 132:67-72. [PMID: 34191297 DOI: 10.1002/lary.29718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm. METHODS Retrospective review of patients who underwent maxillectomy and free flap reconstruction at a tertiary care center. RESULTS Fifty-eight patients were included, 25 (43.1%) of them had documented sinonasal complaints postoperatively. Eleven patients subsequently underwent revision surgery for sinonasal complaints. Among the 25 patients with sinonasal complaints, 22 patients (88.0%) had nasal crusting, 17 (68.0%) had nasal obstruction, 12 (48.0%) had rhinorrhea, 9 (36.0%) had facial pain or pressure, and 7 (28.0%) had foul odor. Twenty-two patients (88.0%) had multiple sinonasal complaints. There was a higher incidence of both sinonasal complaints and surgical intervention in patients who underwent adjuvant radiation, but this was not statistically significant (47.7% vs 28.6%, P = .235; 29.4% vs 7.1%, P = .265). CONCLUSIONS Sinonasal complaints are common following free flap reconstruction for a maxillectomy defect and should be screened for at postoperative visits, with early referral to a rhinologist for consideration of endoscopic sinus surgery. Nonsurgical treatment strategies include large-volume nasal saline irrigations, xylitol irrigations for persistent inflammatory symptoms, and culture-directed antibiotic irrigations for persistent infectious symptoms. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- David K Lerner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Andrey Filimonov
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Peter Filip
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Katherine Liu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stephen Russell
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Janki Shah
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Todd Spock
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Madeleine Schaberg
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Patrick Colley
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mohemmed Nazir Khan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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11
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Hollingsworth BA, Cassatt DR, DiCarlo AL, Rios CI, Satyamitra MM, Winters TA, Taliaferro LP. Acute Radiation Syndrome and the Microbiome: Impact and Review. Front Pharmacol 2021; 12:643283. [PMID: 34084131 PMCID: PMC8167050 DOI: 10.3389/fphar.2021.643283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
Study of the human microbiota has been a centuries-long endeavor, but since the inception of the National Institutes of Health (NIH) Human Microbiome Project in 2007, research has greatly expanded, including the space involving radiation injury. As acute radiation syndrome (ARS) is multisystemic, the microbiome niches across all areas of the body may be affected. This review highlights advances in radiation research examining the effect of irradiation on the microbiome and its potential use as a target for medical countermeasures or biodosimetry approaches, or as a medical countermeasure itself. The authors also address animal model considerations for designing studies, and the potential to use the microbiome as a biomarker to assess radiation exposure and predict outcome. Recent research has shown that the microbiome holds enormous potential for mitigation of radiation injury, in the context of both radiotherapy and radiological/nuclear public health emergencies. Gaps still exist, but the field is moving forward with much promise.
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Affiliation(s)
- Brynn A Hollingsworth
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
| | - David R Cassatt
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
| | - Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
| | - Carmen I Rios
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
| | - Merriline M Satyamitra
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
| | - Thomas A Winters
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
| | - Lanyn P Taliaferro
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, United States
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12
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p63 +Krt5 + basal cells are increased in the squamous metaplastic epithelium of patients with radiation-induced chronic Rhinosinusitis. Radiat Oncol 2020; 15:222. [PMID: 32977822 PMCID: PMC7517817 DOI: 10.1186/s13014-020-01656-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Squamous metaplasia (SM) is an irreversible form of airway epithelial remodeling. Hyperproliferation of basal cells was observed in squamous metaplastic epithelium of chronically inflamed airway. However, the association of such aberrant proliferation of basal cells with SM in the nasal epithelium after radiation damage remains unclear. The aim of this study was to investigate SM and accompanying levels of p63+Krt5+ (basal cell markers) cells in the nasal epithelium of patients with radiation-induced chronic rhinosinusitis (CRSr) and patients with chronic rhinosinusitis without nasal polyps (CRSsNP) compared to healthy controls. Methods We assessed the prevalence of SM and the expression of p63+, Krt5+, p63+Krt5+, and Ki67+ cells through immunofluorescence(IF) staining of the inferior turbinate (IT) tissues from patients with CRSr (n = 36), CRSsNP (n = 33) and controls (n = 28). Results The prevalence of SM and the number of p63+Krt5+ cells were both significantly increased in patients with CRSr compared to patients with CRSsNP and controls. The number of Ki67+ cells were both significantly increased in patients with CRSr and CRSsNP compared to controls, but the ratio of Ki67+ cells to p63+Krt5+ cells was significantly lower in patients with CRSr compared to patients with CRSsNP. In patients with CRSr, an increased number of p63+Krt5+ basal cells was observed in SM epithelium compared to non-SM epithelium. Conclusion SM is increased in the nasal epithelium of patients with CRSr, in which aberrant levels of p63+Krt5+ basal cells serves as an important pathologic feature in the squamous metaplastic epithelium.
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13
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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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14
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Stoddard TJ, Varadarajan VV, Dziegielewski PT, Boyce BJ, Justice JM. Detection of Microbiota in Post Radiation Sinusitis. Ann Otol Rhinol Laryngol 2019; 128:1116-1121. [PMID: 31304771 DOI: 10.1177/0003489419862583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A shift in the microbiota of chronic rhinosinusitis has been described after radiotherapy to the sinonasal cavity and skull base. There is a paucity of literature characterizing the bacteriology of post radiation sinusitis using next-generation gene sequencing techniques. This study aims to describe and compare the microbial flora of rhinosinusitis after radiotherapy using both culture and molecular techniques for microbial DNA detection. METHODS The medical records of patients treated with external beam radiation for sinonasal, nasopharyngeal, or skull base malignancy were reviewed at a tertiary care facility. Patients' sinonasal cavities were swabbed for routine culture or brushed for molecular gene sequencing. Swab specimens were processed for standard microbial culture, and brush specimens were sent for gene sequencing at Micro GenX Laboratory (Lubbock, Texas, USA). RESULTS Twenty-two patients were diagnosed with chronic sinusitis after undergoing radiotherapy. Staphylococcus aureus was the most common organism identified by both culture and gene sequencing, followed by Pseudomonas aeruginosa. Several additional organisms were detected by gene sequencing that were not isolated by routine culture techniques. Gene sequencing identified pathogens differing from culture results in 50% of patients examined. CONCLUSION The bacteriology of post radiation sinusitis appears to resemble the microorganisms responsible for chronic sinusitis in healthy adults. Next generation gene sequencing techniques may reveal additional organisms responsible for sinusitis and provide complementary results that may impact the medical treatment of post radiation sinusitis.
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Affiliation(s)
| | | | | | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, USA
| | - Jeb M Justice
- Department of Otolaryngology, University of Florida, Gainesville, USA
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15
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Huang CJ, Huang MY, Shih MCP, Cheng KY, Lee KW, Lu TY, Yuan SS, Fang PT. Post-radiation sinusitis is associated with recurrence in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Radiat Oncol 2019; 14:61. [PMID: 30971260 PMCID: PMC6458621 DOI: 10.1186/s13014-019-1261-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study investigated the impact of post-radiation sinusitis on the prognosis of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). METHODS Two hundred and thirty patients with non-metastatic NPC were analyzed in terms of freedom from local failure (FFLF), freedom from distant failure (FFDF), overall survival (OS), and disease-free survival (DFS). For each patient, the status of the sinus mucosa was flexibly assessed by documenting mucosal changes as indicated by differences between images obtained before radiotherapy and more than 6 months post-radiation. RESULTS With a median follow-up of 39.7 months (8 to 81 months), 19 (8.26%) patients relapsed locally, 13 (5.65%) patients failed in the neck, and 26 (11.3%) patients developed distant metastases. The presence of sinusitis noted in images post-radiation was a significant predictor for DFS (p = 0.001), FFLF (p = 0.004), and FFDF (p = 0.015), in addition to having high negative predictive value for local relapse (97.5%). CONCLUSIONS This is the first study to investigate the prognostic value of post-radiation sinusitis in NPC patients treated with IMRT. Post-radiation sinusitis was found to be a significant predictor for DFS, FFLF, and FFDF, and was also found to have high negative predictive value for local recurrence (97.5%). It may thus be used as an additional tool for clinicians to determine the possibility of recurrence.
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Affiliation(s)
- Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chen Paul Shih
- Department of Medical imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Radiology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-yuan Cheng
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ka-Wo Lee
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-Ying Lu
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shyng-Shiou Yuan
- Translational Research Center, Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pen-Tzu Fang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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16
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Park YM, Cho JG, Woo JS. Chronic sinusitis in head and neck cancer patients who received radiotherapy or chemoradiotherapy. Eur Arch Otorhinolaryngol 2018; 275:2805-2811. [DOI: 10.1007/s00405-018-5114-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/28/2018] [Indexed: 11/25/2022]
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17
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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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18
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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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19
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Effect of intranasal steroids on rhinosinusitis after radiotherapy for nasopharyngeal carcinoma: clinical study. The Journal of Laryngology & Otology 2016; 130:265-71. [PMID: 26740194 DOI: 10.1017/s0022215115003448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Post-irradiation rhinosinusitis is one of the most common untoward side effects in patients with nasopharyngeal carcinoma. This study aimed to evaluate the effect of fluticasone propionate aqueous nasal spray on post-irradiation rhinosinusitis. METHODS Nasopharyngeal carcinoma patients who had undergone radiotherapy and subsequently developed chronic rhinosinusitis were randomised to receive either fluticasone propionate aqueous nasal spray 200 µg plus nasal irrigation or a single nasal irrigation, for six months. A questionnaire, nasal endoscopy and computed tomography were used to evaluate rhinosinusitis severity, at the beginning of treatment, and at three and six months after treatment. RESULTS The group who received fluticasone propionate aqueous nasal spray combined with irrigation had fewer nasal complaints (overall symptoms, blocked nose and headache were reduced), a better quality of life and less severe endoscopic findings than those who only received nasal irrigation at three and six months after treatment. CONCLUSION Nasal steroids are a safe and effective therapy for patients with post-irradiation rhinosinusitis.
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20
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Gray ST, Sadow PM, Lin DT, Sedaghat AR. Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy. Laryngoscope 2015; 126:304-15. [PMID: 26309057 DOI: 10.1002/lary.25435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Patients with a history of sinonasal malignancy can develop chronic rhinosinusitis (CRS) as a consequence of their oncologic treatment. Some patients will fail medical management and require endoscopic sinus surgery (ESS). This study reviews the use of ESS in the management of CRS in patients previously treated for sinonasal malignancy. STUDY DESIGN Retrospective review. METHODS All patients with a history of sinonasal malignancy who developed CRS and underwent ESS were reviewed. Preoperative and postoperative imaging and symptoms were collected. Major complications (bleeding, orbital injury, and cerebrospinal fluid leak) and minor complications (adhesion formation) and postoperative healing were reviewed. RESULTS Eighteen patients were identified. All patients presented with symptoms of CRS and sinonasal crusting. Additionally, five patients presented with recurrent facial cellulitis, and six patients had mucoceles. No major complications were encountered. Postoperatively, all patients reported a subjective improvement in their sinonasal symptoms. Comparison of pre- and post-ESS imaging revealed a significant improvement in Lund-Mackay scores after ESS (P < 0.001) from 12.8 (range 5-22) to 7 (range). Despite symptomatic improvement, all patients continued to have nasal crusting. All patients who initially presented with recurrent facial cellulitis had no further episodes after ESS. None of the endoscopically drained mucoceles recurred. CONCLUSION For patients previously treated for sinonasal malignancy with refractory CRS, ESS appears to be a safe and effective treatment option. ESS in these patients results in subjective improvement in sinonasal symptoms as well as objective improvement in radiographic CRS disease burden, although sinonasal crusting will likely not resolve. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology
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21
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Hsin CH, Tseng HC, Lin HP, Chen TH. Sinus mucosa status in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: A 5-year follow-up. Head Neck 2015; 38:29-35. [PMID: 25196950 DOI: 10.1002/hed.23849] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sinus mucosa abnormalities on image studies, which is the major diagnostic measure for sinusitis, were investigated in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). METHODS A retrospective review of the MRIs for patients with NPC was conducted. Sinus mucosa abnormalities were staged by the Lund-Mackay system. RESULTS A total of 94 patients were enrolled in this study. The rate and severity of sinus abnormalities were highest on the third postradiotherapy month (p < .005, t test). There was no significant increase in the incidence of abnormalities on the fifth postradiotherapy year (t test). The anterior ethmoid and maxillary sinuses were the most affected sinuses before and after radiotherapy (p < .005, chi-square test). CONCLUSION Our data showed that the anterior ethmoid and maxillary sinuses were the most vulnerable sinuses for therapeutic toxicity after IMRT in patients with NPC. In the long run, however, the application of IMRT does not significantly increase the incidence of sinus toxicities.
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Affiliation(s)
- Chung-Han Hsin
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsien-Chun Tseng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Huang-Pin Lin
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Tsai-Hsin Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan
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22
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Xiang L, Fa-ya L, Ping H, Hua Z, Qiu-jian C, Xiao-yu J, Rui-Chen L, Xiao-Ming H. Management of radiation-induced early nasal adhesion after radiotherapy for nasopharyngeal carcinoma. Am J Rhinol Allergy 2013; 27:e82-4. [PMID: 23883797 DOI: 10.2500/ajra.2013.27.3915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study investigates the conservative management of radiation-induced early nasal adhesion after radiotherapy for nasopharyngeal carcinoma (NPC). METHODS From June 2008 to June 2010, patients with bilateral or unilateral early nasal adhesion after radiotherapy for NPC were selected. All patients received endoscopic management and then nasal irrigation daily and nasal steroids spray for at least 3 months. All of the clinical data and follow-up endoscopy were analyzed. RESULTS There were 40 patients enrolled. The mean follow-up period was 19.6 months (range, 12-24 months) after procedure. Thirty-eight patients (95%) had patent nasal cavity during follow-up. Two patients (5%) had not received endoscopy regularly and developed severe fibrosis. For the whole group, nasal obstruction, rhinorrhea, hyposmia, and xerostomia all were improved from before management according to visual analog score (p < 0.05). CONCLUSION Therapeutic endoscopy in combination with nasal steroid sprays and nasal irrigation provides a convenient, simple, effective, and minimally invasive therapy to treat early radiation-induced nasal adhesion patients.
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Affiliation(s)
- Liu Xiang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
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23
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Liu X, Huang X, Sun W, Zeng L, Han P. Endoscopic Surgery for Acquired Choanal Atresia after Radiotherapy for Nasopharyngeal Carcinoma. Am J Rhinol Allergy 2011; 25:188-92. [PMID: 21294973 DOI: 10.2500/ajra.2011.25.3590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background This study was designed to investigate the role of endoscopic surgery for acquired choanal atresia after radiotherapy for nasopharyngeal carcinoma. Methods Twenty-two patients with bilateral or unilateral acquired choanal atresia received transnasal endoscopic surgery with the aid of a powered microdebrider to open atresia choana and received endoscopic sinus surgery simultaneously if they had sinusitis. Merocel epistaxis packing was used to pack the nasal airway for 3 days postoperatively. All of the patients underwent endoscopy regularly for follow-up. Results Sixteen patients with acquired bilateral choanal atresia and 6 with unilateral choanal atresia were included in this study. The median age was 46 years old (range, 33–65 years). Twenty-one patients had sinusitis. Sixteen patients with bilateral choanal atresia and 4 patients with unilateral atresia had bilateral sinusitis. One patient with unilateral atresia had ipsilateral sinusitis. The mean follow-up period was 35 months (range, 12–72 months) after surgery. Twenty patients were symptom-free after a single operation; nasal obstruction, rhinorrhea, and xerostomia improved significantly for these patients. Two patients had unilateral restenosis that required revision surgery, and both were subsequently free from further restenosis. No complications occurred. Conclusion Acquired posterior choanal atresia after radiotherapy can be successfully treated with transnasal endoscopic resection assisted by a powered instrument without stenting.
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Affiliation(s)
- Xiang Liu
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou PR China
| | - Xiaoming Huang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou PR China
| | - Wei Sun
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou PR China
| | - Liang Zeng
- Department of Otolaryngology, Zhuhai People's Hospital, Zhuhai, PR China
| | - Ping Han
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou PR China
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24
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Arens R, Sin S, Willen S, Bent J, Parikh SR, Freeman K, Wootton DM, McDonough JM, Shifteh K. Rhino-sinus involvement in children with obstructive sleep apnea syndrome. Pediatr Pulmonol 2010; 45:993-8. [PMID: 20648667 DOI: 10.1002/ppul.21284] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) is commonly associated with adenotonsillar hypertrophy. We hypothesized that respiratory perturbations extend to other regions of the upper respiratory tract in such children, particularly to rhino-sinus regions. STUDY DESIGN A prospective case control study using Magnetic Resonance Imaging (MRI) of the upper airway and surrounding tissues of OSAS and controls. Magnetic resonance imaging was used to evaluate radiographic changes within the: paranasal sinuses, middle ear and mastoid air cells, and the nasal passages. RESULTS We studied 54 OSAS (age 5.7 ± 3.0 years) and 54 controls (age 6.2 ± 2.0 years, P = NS). Children with OSAS had significantly more opacification of: maxillary sinuses (P < 0.05), sphenoid sinuses (P < 0.01), and mastoid air cells (P < 0.01). They also had significantly more: middle ear effusions, (P < 0.001), prominence of inferior nasal turbinate(s) (P < 0.05), and deviation of the nasal septum (P < 0.05). CONCLUSIONS Childhood OSAS is associated with a wide range of upper respiratory tract perturbations and is not limited to adenoid and tonsillar hypertrophy.
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Affiliation(s)
- Raanan Arens
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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25
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Liang KL, Jiang RS, Lin JC, Chiu YJ, Shiao JY, Su MC, Hsin CH. Central nervous system infection in patients with postirradiated nasopharyngeal carcinoma: a case-controlled study. Am J Rhinol Allergy 2009; 23:417-21. [PMID: 19671259 DOI: 10.2500/ajra.2009.23.3336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection. OBJECTIVE The purpose of this study was to better understand this clinical entity. METHODS From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated. RESULTS The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001). CONCLUSIONS Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.
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Affiliation(s)
- Kai-Li Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
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26
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Huang CC, Chang PH, Lee TJ, Chuang CC, Chang JTC. Preirradiation sinus mucosal disease in patients with nasopharyngeal carcinoma. Am J Otolaryngol 2009; 30:300-4. [PMID: 19720246 DOI: 10.1016/j.amjoto.2008.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 05/23/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The objective of this study was to evaluate the incidence and the possible risk factors for preirradiation abnormalities of the sinus mucosa in patients with nasopharyngeal carcinoma (NPC) by magnetic resonance imaging. MATERIALS AND METHODS Medical records and magnetic resonance imaging results were reviewed and compared between a group of patients with NPC and a control group. The Lund-Mackay system for staging of rhinosinusitis (Lund score) was used as a tool for the investigation. RESULTS The incidence of sinus mucosal abnormalities was 32.1% in the NPC group and 20.7% in the control group (P = .041). The patients with NPC demonstrated a higher incidence of sinus abnormalities in nearly all sinuses. However, only the incidence of disease in the posterior ethmoid (P = .002) and sphenoid sinus (P = .006) was significantly increased in patients with NPC. The incidence and the severity of sinus abnormalities in male patients with NPC were significantly higher than that in female patients. Patients with advanced T stage showed significantly higher Lund scores (P = .015) than patients with early T stage. CONCLUSION The results supported the hypothesis that patients with NPC might be prone to have chronic infection and might be partially immunocompromised by Epstein-Barr virus. Female patients may have an inherited genetic advantage that protects against Epstein-Barr virus infection or lessens its devastating effects.
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Wang JH, Lee BJ, Lee JH, Kim IJ, Jang YJ. Development of mucosal thickening after radiotherapy in contralateral sinuses of patients with nasal cavity and/or paranasal sinus carcinoma. Ann Otol Rhinol Laryngol 2009; 117:844-8. [PMID: 19102131 DOI: 10.1177/000348940811701109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the development of radiotherapy (RT)-induced mucosal thickening (MT) of the contralateral sinuses in patients with nasal cavity and/or paranasal sinus carcinoma. METHODS We retrospectively reviewed the medical records and the initial and follow-up computed tomography (CT) scans of 37 patients with RT and 10 controls without RT. The CT scans were scored on the Lund-Mackay (LM) staging system. RESULTS Fifteen of the 37 patients had MT before RT, and the mean LM score was 0.68. The MT incidence significantly increased, to 72.9% (p = 0.009), and the LM score significantly increased, to 2.84 (p < 0.001), by 3 months after RT, after which the LM score decreased gradually to 1.73 at 36 months after RT. Four of the 10 controls had MT before treatment, and their mean LM score was 0.7. Their MT incidence and LM score had not changed significantly at 3 months after treatment. The pretreatment LM scores of the patient group and the control group were not significantly different, but their posttreatment LM scores were significantly different at the 3-month follow-up (p = 0.033). CONCLUSIONS Use of RT in patients with nasal cavity and/or paranasal sinus carcinoma may cause a significant increase in the incidence of MT and in the LM scores in all sites of the paranasal sinuses by 3 months after RT, after which the LM score decreases gradually.
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Affiliation(s)
- Jong Hwan Wang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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d'Espiney Amaro C, Montalvão P, Henriques P, Magalhães M, Olias J. Nasopharyngeal carcinoma: our experience. Eur Arch Otorhinolaryngol 2008; 266:833-8. [PMID: 18830701 DOI: 10.1007/s00405-008-0822-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 09/19/2008] [Indexed: 11/30/2022]
Abstract
The objectives of our study were to characterize nasopharyngeal carcinoma patients in the Portuguese Institute of Oncology Hospital in Lisbon (IPOLFG) and identify the main factors that interfere with patients survival rate. We performed a retrospective study involving 157 patients (65% male and 35% female) between the years 2000 and 2005, and a histological classification according to Health World Organization. We constructed a Kaplan-Meier survival curve for the studied patients and evaluated the significance of the different studied factors with a Pearson correlation study. With an average age of 53 years, most of the carcinomas were type III (58%), followed by type II (30%) and at last type I (8%). Fifty-one of carcinomas were in stage IV at time of diagnosis. Ninety-five patients (60%) had remission. Five-year actuarial survival rate of all patients was 65.1%. There was a significant difference (P = 0.033) in the actuarial survival rate of staged IV patients treated with adjuvant chemotherapy. Undifferentiated nasopharyngeal carcinoma is the most frequent type in our geographic area. Chemotherapy improves survival rate, mainly in late stages.
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Affiliation(s)
- Carla d'Espiney Amaro
- Otorhinolaryngology Department, Portuguese Institute of Oncology Hospital in Lisbon (IPOLFG-EPE), Lisbon, Portugal.
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Liang KL, Kao TC, Lin JC, Tseng HC, Su MC, Hsin CH, Shiao JY, Jiang RS. Nasal Irrigation Reduces Postirradiation Rhinosinusitis in Patients with Nasopharyngeal Carcinoma. ACTA ACUST UNITED AC 2008; 22:258-62. [DOI: 10.2500/ajr.2008.22.3166] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Radiotherapy (RT) is the standard treatment for NPC. The newer RT technique, intensity-modulated radiotherapy (IMRT) has become popular in recent years. IMRT-induced rhinosinusitis is not uncommon in postirradiated NPC patients but the incidence and the disease course have not been reported. The purpose of this study was to determine the IMRT effect on the paranasal sinuses and evaluate the efficacy of nasal irrigation on the management of RT-induced rhinosinusitis. Methods NPC patients who completed IMRT from October 2004 to May 2006 were enrolled in the study and were randomly allocated to irrigation or nonirrigation groups. Patients in the irrigation group performed daily nasal irrigation until 6 months after RT. The severity of postirradiated rhinosinusitis was evaluated by nasal endoscopy, questionnaire, and computed tomography until a year after RT. Results One hundred seven postirradiated NPC patients completed the study. Among them, 44 patients performed daily nasal irrigation until 6 months after RT, and the other 63 patients did not perform nasal irrigation after RT. Patients in the irrigation group had significantly lower endoscopic and questionnaire scores than patients in the nonirrigation group (p = 0.001 and 0.0001, respectively) from pre-RT to 6 months after RT. The between-group differences were most obvious at the post-RT second and third months. Conclusion Rhinosinusitis is a common acute post-RT complication in NPC patients. Our results showed that nasal irrigation was a safe and effective method for the management of this acute complication.
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Affiliation(s)
- Kai-Li Liang
- Departments of Otolaryngology, Taichung, Taiwan
- Departments of Medicine, Taichung, Taiwan
| | - Ta-Cheng Kao
- Department of Pathology, China Medical University, Taichung, Taiwan
| | - Jin-Ching Lin
- Departments of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Mao-Chang Su
- Departments of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Han Hsin
- Departments of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - Rong-San Jiang
- Departments of Otolaryngology, Taichung, Taiwan
- Departments of Medicine, Taichung, Taiwan
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