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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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2
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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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3
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Han AY, Nader ME, Lam K, Su SY. Current status of sinonasal cancer survivorship care. Head Neck 2023; 45:2458-2468. [PMID: 37449544 DOI: 10.1002/hed.27457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Sinonasal cancer is a heterogeneous orphan disease of diverse histologies, each with distinct clinical, oncologic, and toxicity profiles. Because of the comparative rarity of these cancers, sinonasal cancers are treated as a grouped diagnosis despite their clinical and biological heterogeneity. Multimodality treatment with a combination of surgery, chemotherapy, and/or radiotherapy is the standard-of-care for advanced-stage patients but there are few surveillance or follow-up practice guidelines or formalized survivorship care pathways. A scoping literature review was conducted via PubMed, EMBASE, and Google Scholar. A total of 112 studies were included, which were grouped along the following topics: surveillance, second primary tumors, quality of life, and symptom burden. Sinonasal cancer tends to exhibit a higher rate of local failure and occur in a delayed fashion compared to mucosal malignancies of the head and neck. Moreover, the site of failure and time-varying risk of recurrence is histology-specific. Following multimodality treatment of the skull base, patients may experience endocrine, visual, auditory, sinonasal, olfactory, and neurocognitive deficits, as well as psychosocial impairments that impact multiple physical and neuropsychological domains, resulting in diminished quality of life. Sinonasal cancer patients would benefit from tailored, histology-specific survivorship programs to address the recurrence, second primary, and functional impairments resulting from disease and treatment toxicity.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Keng Lam
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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4
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Li C, Lu J, Luo Y, Feng D. Case report: Endovascular intervention of internal carotid artery pseudoaneurysm secondary to nasopharyngeal carcinoma radiotherapy. Front Surg 2023; 9:1099416. [PMID: 36713655 PMCID: PMC9879062 DOI: 10.3389/fsurg.2022.1099416] [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: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background Internal carotid artery pseudoaneurysm (PSA) is a serious complication after radiotherapy for nasopharyngeal carcinoma, and once it ruptures and bleeds, it will seriously affect the patient's survival and prognosis. However, because of its relatively low incidence, many medical institutions lack experience in managing this type of emergency. Case information In this case report, we described two cases suffered ruptured internal carotid artery PSA after radiotherapy for nasopharyngeal carcinoma, including their history, diagnosis, and treatment. Both cases underwent emergency endovascular interventions, one of which with long-term healing after embolization of the PSA, and the other one with re-bleeding after embolization and was eventually stopped by embolization of the parent artery. Ultimately, both cases received timely and effective treatment. Conclusion This case report detailed the diagnosis and treatment course of internal carotid artery PSA after radiotherapy for nasopharyngeal carcinoma, which enhanced the understanding of this emergency, and provided valuable information and experience for the treatment strategy of similar PSA on the internal carotid artery.
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Affiliation(s)
| | | | - Yu Luo
- Correspondence: Daqin Feng ; Yu Luo
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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: 9] [Impact Index Per Article: 4.5] [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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6
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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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7
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Flukes S, Hanson M, Bott M, Cohen MA. A Cure for PAINS? A Novel Approach to Management of Proton-Associated Internal Nasal Valve Stenosis. OTO Open 2020; 4:2473974X20952699. [PMID: 32923918 PMCID: PMC7457708 DOI: 10.1177/2473974x20952699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Acquired internal nasal stenosis as a result of radiotherapy to the sinonasal
region can be highly distressing for patients and difficult to correct
surgically. We describe our experience using a controlled radial expansion
balloon to dilate the area of stenosis, followed by stenting to the region. We
achieved excellent results in 3 patients using this technique, with improvement
in subjective nasal airflow across 100% of stenoses and complete resolution in
83%. This technique offers a simple and low-morbidity option for the management
of acquired anterior nasal stenosis and is of particular value in cases of
irradiation, which has the potential for poor tissue healing.
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Affiliation(s)
- Stephanie Flukes
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Martin Hanson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthew Bott
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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8
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Chang H, Chen K, Tao YL, Han F, Ye WJ, Gao YH. Dosimetric parameters predict radiation-induced choanal stenosis in patients with nasopharyngeal carcinoma. Radiat Oncol 2020; 15:142. [PMID: 32503596 PMCID: PMC7275446 DOI: 10.1186/s13014-020-01512-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Radiation-induced choanal stenosis (RICS) severely decreases life quality of patients with nasopharyngeal carcinoma (NPC) and originates from nasal mucositis, which depends on radiation dose. This self-controlled study aimed to find the correlations between dosimetric parameters and RICS. METHODS Totally 49 NPC patients treated with intensity-modulated radiotherapy from May 2010 to Aug. 2013 and diagnosed with RICS during follow-up were enrolled into this study. Minimum point dose, maximum point dose, mean dose (Dmean), dose covering ≥33% volume (D33), dose covering ≥66% volume (D66), and volume receiving ≥60 Gy (V60) were compared between the nasal cavities with and without RICS, through paired t-test. The parameters with difference would enter receiver operating characteristic analysis to determine their cutoff values. Then predicting abilities of the cutoff values were tested by Chi-square test. RESULT The nasal cavities with RICS appeared to have higher Dmean, D33, D66 and V60, compared with those without RICS (P values were 0.014, 0.003, 0.006 and 0.010). Dmean ≥54.22 Gy, D33 ≥ 61.96 Gy, D66 ≥ 46.50 Gy and V60 ≥ 48.13% were demonstrated to be related with a higher risk of RICS. CONCLUSION Dmean, D33, D66 and V60 of nasal cavity might be used as predictors of RICS. Their values needed to be controlled whenever possible, for ameliorating life quality of NPC patients.
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Affiliation(s)
- Hui Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Kai Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Ya-Lan Tao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wei-Jun Ye
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
| | - Yuan-Hong Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
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9
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Silverman DA, Lin C, Tamaki A, Puram SV, Carrau RL, Seim NB, Eskander A, Rocco JW, Old MO, Kang SY. Respiratory and pulmonary complications in head and neck cancer patients: Evidence-based review for the COVID-19 era. Head Neck 2020; 42:1218-1226. [PMID: 32343013 PMCID: PMC7267530 DOI: 10.1002/hed.26217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic. METHODS A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. RESULTS Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks. CONCLUSION Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.
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Affiliation(s)
- Dustin A Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Chen Lin
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Akina Tamaki
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, Ear, Nose & Throat Center, St. Louis, Missouri, USA
| | - Ricardo L Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Nolan B Seim
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
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10
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VanKoevering KK, Sabetsarvestani K, Sullivan SE, Barkan A, Mierzwa M, McKean EL. Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening. J Neurol Surg B Skull Base 2020; 81:75-81. [PMID: 32021753 DOI: 10.1055/s-0039-1679893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background Management of anterior cranial base malignancies requires multidisciplinary care. Radiation therapy remains a mainstay of definitive or adjuvant treatment. Apart from primary hypothyroidism, the effects of radiation on the hypothalamic-pituitary axis after high-dose treatment of head and neck malignancies remain poorly described. We describe a comprehensive screening protocol for surveillance and characterize the incidence of pituitary dysfunction after radiation for anterior cranial base malignancies. Methods A review of patients prospectively enrolled in a skull base registry at an academic center was performed. Included patients had a history of anterior skull base malignancy and external beam radiation to the primary site, with comprehensive post-treatment pituitary serologies and at least 1 year of post-radiation follow-up. Routine hormonal screening was initiated during the study period for all patients with anterior skull base irradiation. Results Eighty-one patients met inclusion. Fifty-eight patients (71%) demonstrated some laboratory abnormality. Thirty patients (37%) demonstrated evidence of hypopituitarism. Twenty-four (29%) demonstrated central hypogonadism, and 16% of patients showed central hypothyroidism. Ten patients (12%) displayed central adrenal insufficiency with six patients demonstrating panhypopituitarism. Primary tumor location and maximum dose of radiation to the gland appeared to correlate with incidence of hypopituitarism. Conclusion Radiation for malignancies of the anterior skull base resulted in a 37% incidence of hypopituitarism in our study. Given the potential morbidity of hypopituitarism, we recommend annual post-treatment screening in these patients. We describe a comprehensive set of serologies that can be utilized, and recommend updating clinical guidelines to reflect the necessity of this screening.
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Affiliation(s)
- Kyle K VanKoevering
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Ariel Barkan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
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11
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Patel J, Chitguppi C, Vimawala S, Epps G, Fastenberg J, Evans J, Rabinowitz M, Rosen M, Nyquist G. Treatment-related morbidity in patients treated for sinonasal malignancy. Int Forum Allergy Rhinol 2020; 10:526-532. [PMID: 31930702 DOI: 10.1002/alr.22509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sinonasal malignancies are a rare, heterogeneous group of tumors that often present at an advanced stage and require multimodal therapy. The presence of high-grade toxicity and sinonasal complications after treatment can negatively impact quality of life. In this study we aim to describe posttreatment morbidity in patients with sinonasal malignancy. METHODS A retrospective analysis of all patients treated for sinonasal malignancy was conducted from 2005 to 2018 at a tertiary referral institution. A total of 129 patients met the inclusion criteria. Primary outcomes were treatment details, pathology, posttreatment complications, and radiation toxicity. Fisher's exact test, chi-square test, and Student t test were used for statistical analysis. RESULTS Mean age was 58.4 (median, 61; range, 19-94) years. After diagnosis, 24 patients had surgery alone, 46 had surgery with radiation alone, 47 had surgery with chemoradiation, and 14 received definitive chemoradiation. Overall, 10.4% (n = 12) of patients had postoperative complications, and 21.0% (n = 22) had high-grade (grade 3-5) radiation toxicity. After radiation, 20% (n = 21) of patients had chronic sinusitis requiring functional endoscopic sinus surgery and 20% (n = 21) had symptomatic nasal obstruction requiring operative debridement. CONCLUSION Sinonasal complications, including nasal obstruction and chronic sinusitis, occur frequently after definitive treatment of sinonasal malignancy and should be addressed when considering quality of life in survivors. These complications occur more frequently in patients who undergo chemoradiation as opposed to surgery alone.
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Affiliation(s)
- Jena Patel
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Chandala Chitguppi
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Swar Vimawala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Gregory Epps
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Judd Fastenberg
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - James Evans
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Mindy Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Marc Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Gurston Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA
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12
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Lakhdar Y, Rochd S, Elbouderkaoui M, Rochdi Y, Nouri H, Raji A. Choanal stenosis post radiotherapy for nasopharyngeal carcinoma: about an endoscopic management. Pan Afr Med J 2019; 34:111. [PMID: 31934253 PMCID: PMC6945375 DOI: 10.11604/pamj.2019.34.111.18968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/20/2019] [Indexed: 11/24/2022] Open
Abstract
Choanal atresia is a rare complication of radiation for nasopharyngeal carcinoma, which has to be early detected. Its treatment is based on endoscopic endonasale surgery. We report a rare case of choanal stenosis observed in a 54-year-old patient, Ho presented 4 years after the end of radiotherapy for nasopharyngeal carcinoma, a progressive bilateral nasal obstruction, anosmia, and rhinorrhea without bleeding. The diagnostic of fibrous stenosis was confirmed by endonasal endoscopic examination coupled to CT scan of nasopharynx. The recanalization via endoscopic endonasal surgery with tube calibration gave a great functional result with the improvement of nasal symptoms. Even after 6 months of follow-up, there were no signs of restenosis.
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Affiliation(s)
- Youssef Lakhdar
- ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
| | - Sara Rochd
- ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
| | | | - Youssef Rochdi
- ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
| | - Hassan Nouri
- ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
| | - Abdelaziz Raji
- ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
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13
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Ajmal A, McKean E, Sullivan S, Barkan A. Decreased quality of life (QoL) in hypopituitary patients: involvement of glucocorticoid replacement and radiation therapy. Pituitary 2018; 21:624-630. [PMID: 30349995 DOI: 10.1007/s11102-018-0918-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Hypopituitary patients are assumed to have decreased QoL due to GHD. However, in placebo controlled trials, the effects of GH replacement are no different from placebo. Hydrocortisone dose > 20 mg/day and pituitary radiation are independently associated with poorer QoL. We assessed QoL in panhypopituitary GH- deficient patients never treated with GH. METHODS Study group was divided into: (a) surgery followed by radiation (n = 21) and (b) surgery alone (n = 32). Mean duration of GHD was 71.4 ± 7.8 months and mean daily hydrocortisone dose was 15 ± 0.7 mg. Control group had transnasal surgery for benign sinus conditions (n = 54). RESULTS AGHDA scores were significantly worse in the entire study group compared to controls (8.1 ± 1.0 vs. 5.1 ± 0.9, p = 0.03). In patients with history of radiation therapy AGHDA scores were significantly worse than in controls (9.1 ± 1.5, p = 0.02) and SNOT-22 (Sino-Nasal Outcome Test) scores were also significantly worse (15.8 ± 2.0 vs. 23.2 ± 3.5, p = 0.04). However, AGHDA scores in patients without history of radiation and on "physiological" dose of hydrocortisone were similar to those in controls (5.1 ± 0.9 vs. 7.3 ± 1.3, p = 0.17). CONCLUSIONS Replacement with hydrocortisone doses not exceeding 20 mg/day and avoidance of radiation therapy was accompanied by normal QoL in patients not replaced with GH. Thus, we suggest that the decreased QoL in hypopituitary patients may not be due to GH deficiency per se, but rather to high hydrocortisone doses and to aftereffects of cranial radiation.
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Affiliation(s)
- Adnan Ajmal
- Division of Metabolism, Endocrinology and Diabetes, Department of Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, Ann Arbor, MI, 48106, USA
| | - Erin McKean
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Ariel Barkan
- Division of Metabolism, Endocrinology and Diabetes, Department of Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, Ann Arbor, MI, 48106, USA.
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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14
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Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy. Indian J Otolaryngol Head Neck Surg 2018; 71:2082-2086. [PMID: 31763298 DOI: 10.1007/s12070-018-1477-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022] Open
Abstract
A prospective longitudinal observational study was conducted on 24 patients of histopathologically confirmed squamous cell carcinoma of buccal mucosa upon whom bilateral 'middle meatal antrostomy was performed during the same sitting as the tumour resection with the main aim to assess the maxillary mucociliary clearance, pre-, during and post-irradiation; and compare the findings with the non-irradiated side in the same patient to avoid any confounding factors. All patients underwent methylene blue dye clearance and saccharine clearance tests before the commencement of radiation therapy, weekly during irradiation and again at first and sixth month of completion of irradiation. Pre-radiation there was statistically no difference (P > 0.05) in clearance times between both sides. But, there was a significant (P < 0.001) increase in saccharin and methylene blue clearance times on the irradiated side in comparison to contralateral non-irradiated side, during and post-radiation. It is concluded that external beam radiotherapy for oral cancers significantly affect ciliary activity in the adjacent maxillary antrum and has no effect on the opposite side. Recovery in mucociliary activity was not seen even after 6 months after radiation therapy.
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15
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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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16
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Surgical management of nasal stenosis following chemoradiation for nasopharyngeal carcinoma. The Journal of Laryngology & Otology 2017; 131:429-432. [PMID: 28196560 DOI: 10.1017/s0022215117000366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nasal stenosis is a rare but significant complication of chemoradiation treatment for nasopharyngeal carcinoma. It can cause distressing obstructive symptoms for the patient and potentially interfere with monitoring for recurrence. Quality-of-life indicators are known to be very poor in this group of patients; however, there is very little evidence in the literature as to management of this complication. METHODS This paper presents an endoscopic day-case surgical procedure to address total posterior nasal stenosis, as conducted in three patients, which involves division of adhesions and removal of the posterior septum and posterior inferior turbinates, without the need for packing or stenting. RESULTS In this series, there was resolution of obstructive symptoms and no recurrence of stenosis during follow up (up to 20 months). CONCLUSION This endoscopic procedure performed to manage total nasal stenosis differs from those previously described in the literature, as post-operative stenting or packing is not required, and removal of the posterior aspect of the septum is performed routinely.
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17
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Waldron NH, Stolp BW, Ogilvie MP, Powers DB, Shaughnessy MR. Transorbital endotracheal intubation: a nonstandard approach to a difficult airway. J Clin Anesth 2016; 34:314-7. [PMID: 27687400 DOI: 10.1016/j.jclinane.2016.05.005] [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: 02/02/2016] [Revised: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for optic neuropathy, complicated by medial wall dehiscence. His course was also complicated by severe radiation trismus, for which he was scheduled to undergo bilateral mandibular coronoidectomies. Given his limited mouth opening, the surgeon requested a nasal endotracheal tube. Because of concerns of traumatizing his nare, we utilized a flexible fiberoptic bronchoscope to perform asleep transorbital intubation. Airway management in patients with severe trismus may require ingenuity.
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Affiliation(s)
- Nathan H Waldron
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - Bryant W Stolp
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - Michael P Ogilvie
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - David B Powers
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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18
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Su Y, Mo CW, Cheng WQ, Wang L, Xu Q, Wu ZC, Wu ZL, Liu LZ, Chen XL. Development and validation of quality of life scale of nasopharyngeal carcinoma patients: the QOL-NPC (version 2). Health Qual Life Outcomes 2016; 14:76. [PMID: 27164979 PMCID: PMC4862168 DOI: 10.1186/s12955-016-0480-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/03/2016] [Indexed: 11/12/2022] Open
Abstract
Background The aim was to develop and validate the quality of life scale for nasopharyngeal carcinoma (NPC) patients, the QOL-NPC (version 2), a specific instrument to measure quality of life for NPC patients. Methods The QOL-NPC was developed and validated according to standard procedures. The patients were assessed using the QOL-NPC, FACT-G, and FACT-H&N. Classical test theory was used to evaluate the reliability, validity, and responsiveness of the QOL-NPC. Results A total of 487 patients (97.4 %) completed the questionnaire. The QOL-NPC comprised four domains, as follows: physical function (eight items); psychological function (five items); social function (five items); and side effects (eight items). All of the items had a lower proportion of missing data. Cronbach's alpha values of the domains ranged from 0.72 to 0.84. The split-half reliability coefficients ranged from 0.77 to 0.84. All of the intra-class correlation coefficients were > 0.8. The normed fit index, non-normed fit index, and comparative fit index were >0.89. The root mean square error of approximation was 0.097, with a 90 % confidence interval (0.093, 0.100). The domain scores of the QOL-NPC were significantly correlated with the FACT-G and FACT-H&N (P < 0.05). All of the domain scores of patients using different amounts of radiotherapy were significantly different (P < 0.001). All domain scores decreased at the completion of radiotherapy, with effect sizes ranging from −0.82 to −0.22. Conclusions The QOL-NPC is valid for measuring QOL with good reliability, validity, and responsiveness. The QOL-NPC is recommended to measure the QOL for Chinese NPC patients.
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Affiliation(s)
- Yong Su
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
| | - Chuan-Wei Mo
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Wan-Qin Cheng
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
| | - Lei Wang
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
| | - Qian Xu
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zu-Chun Wu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zhe-Li Wu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Li-Zhi Liu
- Department of Radiation Oncology, Cancer Centre, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xin-Lin Chen
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
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19
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Yang L, Li H, Wang H, Zhang H, Wang S, Fry AN, Han WW, Wang D. Nasopharyngeal granulomatous mass after radiotherapy for nasopharyngeal carcinoma. Auris Nasus Larynx 2016; 43:330-5. [PMID: 26791589 DOI: 10.1016/j.anl.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/17/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the diagnosis, management and nasal endoscopic surgical outcome of nasopharyngeal granulomatous mass in post-radiation nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS A total of 23 cases of granulomatous mass after radiotherapy for NPC from 2008 to 2013 treated with nasal endoscopic surgery were retrospectively reviewed. RESULTS Radiotherapy dose (p=0.036) and chemotherapy (p<0.001) correlated with the latency period after the treatment against NPC. The symptoms of the 23 patients before the treatment were nonspecific including nasal obstruction, purulent discharge, headache, epistaxis, foreign body sensation and/or hearing impairment. 12 patients (52.2%) were misdiagnosed to be recurrence of NPC by imaging examination (CT/MRI). After the endoscopic surgery treatment, 18 patients were disease free while the other 5 patients had developed a recurrence. Four of those five recurrent patients were cured with the repeated treatment. Histologic findings of granulation tissue with fibrin and inflammatory cells were found in all of the patients. CONCLUSIONS In situ granulomatous masses in post-radiation NPC patients are very prone to be misdiagnosed as recurrence of nasopharyngeal carcinoma. Chemotherapy is a significant independent factor affecting latency period (p=0.029). The nasal endoscopic surgery is an effective therapy for post-radiation nasopharyngeal granuloma; surgery can not only alleviate symptoms, what is more important, but it also helps to confirm the diagnosis.
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Affiliation(s)
- Lu Yang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Houyong Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Huankang Zhang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shuyi Wang
- Department of Pathology, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Allison N Fry
- Florida Ear, Nose, Throat & Facial Plastic Surgery, Orlando, USA
| | - Wade W Han
- Florida Ear, Nose, Throat & Facial Plastic Surgery, Orlando, USA
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
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20
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Nasopharyngeal Stenosis: A Rare Radiotherapy Complication. Indian J Otolaryngol Head Neck Surg 2015; 71:29-31. [PMID: 31741924 DOI: 10.1007/s12070-015-0954-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022] Open
Abstract
Introduction Acquired nasopharyngeal stenosis after radiotherapy for NPC is rare. We report a case of bilateral choanal stenosis and nasopharygeal stenosis in patient treated with chemo radiotherapy for undifferentieted nasopharnygeal carcinoma. Case Report A 68 years old man treated for undifferentiated nasopharyngeal carcinoma with chemo-radiotherapy 10 years before. He complained of complete nasal obstruction, rhinorrhea, anosmia, snoring and hearing loss. Clinical examination and imaging revealed bilateral choanal stenosis and nasopharyngeal stenosis. Patient underwent a transnasal endoscopic resection for scar tissue with stenting of posterior choanae. Restenosis was noted just after stent removal. Second endoscopic resection of stenosis was done, followed by application of mitomycin-C without stenting. Several months later, the patient has good airflow, a patent nasopharynx without reccurence of stenosis. Discussion The use of topical mitomycin-C may prove useful in the treatment and prevention of subsequent restenosis and scar formation in larynx and tracheal. Mitomycin-C application has being shown useful in treating nasopharyngeal stenosis. It is safely used topically in various surgical sites without major side effect. Conclusion Nasopharyngeal stenosis is an unusual complication of radiotherapy that can be successfully treated with combine two modalities: surgical and mitomycin-C as an adjunct.
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21
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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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22
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Post-irradiation otitis media, rhinosinusitis, and their interrelationship in nasopharyngeal carcinoma patients treated by IMRT. Eur Arch Otorhinolaryngol 2015; 273:471-7. [DOI: 10.1007/s00405-015-3518-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
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23
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Miao BP, Zhang RS, Li M, Fu YT, Zhao M, Liu ZG, Yang PC. Nasopharyngeal cancer-derived microRNA-21 promotes immune suppressive B cells. Cell Mol Immunol 2014; 12:750-6. [PMID: 25544502 DOI: 10.1038/cmi.2014.129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/25/2014] [Accepted: 11/29/2014] [Indexed: 12/12/2022] Open
Abstract
The prevalence of nasopharyngeal cancer (NPC) is high in the southern area of China and some other districts in the world. The pathogenesis of NPC is unclear. It is reported that some microRNAs (miR) are involved in the progression of NPC. This study aims to investigate the role of miR-21 in the induction of immune tolerance of NPC. In this study, NPC tissue was collected from patients with NPC. Assessment of miR was performed with real time quantitative RT-PCR. Western blotting was used to assess proteins of interleukin 10 and nuclear factor I-A (NFI-A). Immune cells were analyzed by flow cytometry. The results showed that NPC cell line C666-1 and surgically removed NPC tissue expressed miR-21, which was upregulated by the presence of the Toll-like receptor 3 ligand, Poly I: C. Exposure to miR-21 increased the expression of NFI-A and interleukin (IL)-10 in naive B cells. High frequency of IL-10(+) B cells was detected in the NPC tissue. The NPC- or miR-21-primed B cells suppressed cytotoxic CD8(+) T cell activities. We conclude that NPC-derived miR-21 induces IL-10(+) B cells; the latter is capable of suppressing CD8(+) T-cell activities. miR-21 may be a potential target in the treatment of NPC.
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Affiliation(s)
- Bei-Ping Miao
- Department of Otolaryngology, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Rui-Shi Zhang
- Department of Otolaryngology, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Meng Li
- Allergy & Immunology Center, Shenzhen University, Shenzhen, China
| | - Yun-Ting Fu
- Allergy & Immunology Center, Shenzhen University, Shenzhen, China.,ENT Hospital, Longgang Central Hospital, Shenzhen, China.,Brain Body Institute, McMaster University, Hamilton, ON, Canada
| | - Miao Zhao
- Allergy & Immunology Center, Shenzhen University, Shenzhen, China.,ENT Hospital, Longgang Central Hospital, Shenzhen, China.,Brain Body Institute, McMaster University, Hamilton, ON, Canada
| | - Zhi-Gang Liu
- Allergy & Immunology Center, Shenzhen University, Shenzhen, China
| | - Ping-Chang Yang
- Allergy & Immunology Center, Shenzhen University, Shenzhen, China.,Brain Body Institute, McMaster University, Hamilton, ON, Canada
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