Delayed Sino‐nasal Complications of Radiotherapy for Nasopharyngeal Carcinoma

Alon, Eran E.; Lipschitz, Noga; Bedrin, Lev; Gluck, Iris; Talmi, Yoav P.; Wolf, Michael; Yakirevitch, Arkadi

doi:10.1177/0194599814530858

Cited by 27 publications

(22 citation statements)

References 17 publications

(48 reference statements)

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“…Interestingly, these complications developed anywhere from 2 to 84 months after completion of radiotherapy. 55 The majority of patients in our study group also presented with severe complications of sinus disease rather than CRS alone. Five patients developed recurrent facial cellulitis, and three patients were experiencing acute bacterial sinusitis with such severity that admission and IV antibiotics were necessary for treatment.…”

Section: Discussionmentioning

confidence: 79%

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Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy

et al. 2015

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Section: Discussionmentioning

confidence: 79%

“…Choanal stenosis was found in 15% of patients, and osteoradionecrosis developed in 8% of patients. Interestingly, these complications developed anywhere from 2 to 84 months after completion of radiotherapy …”

Section: Discussionmentioning

confidence: 99%

Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy

et al. 2015

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“…Similarly, 16% of patients underwent FESS for posttreatment chronic sinusitis. Alon et al reported similar rates of chronic sinusitis (18%) and nasal stenosis (15%) after radiation treatment for nasopharyngeal carcinoma . The incidence of sinonasal complications after radiation treatment for sinonasal carcinoma is relatively significant and should be addressed accordingly.…”

Section: Discussionmentioning

confidence: 95%

Treatment‐related morbidity in patients treated for sinonasal malignancy

Patel

Chitguppi

Vimawala

et al. 2020

Int Forum Allergy Rhinol

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Background: Sinonasal malignancies are a rare, heterogeneous group of tumors that o en present at an advanced stage and require multimodal therapy. The presence of high-grade toxicity and sinonasal complications a er treatment can negatively impact quality of life. In this study we aim to describe pos reatment 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, pos reatment 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. A er 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. A er 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 a er 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. C 2020 ARS-AAOA, LLC.

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“…4,8 Less frequent, more morbid delayed complications include pharyngeal stricture, sinocutaneous fistulae, osteoradionecrosis, and radiation-related sarcomas. 9,10 The toxicity of radiation to the thyroid gland is also well described in the head and neck literature. Various reports highlight a 20 to 50% incidence of post-radiation primary hypothyroidism after neck irradiation, 11,12 likely dependent on the dose of radiation delivered to the thyroid bed.…”

Section: Introductionmentioning

confidence: 97%

Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening

et al. 2019

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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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Delayed Sino‐nasal Complications of Radiotherapy for Nasopharyngeal Carcinoma

Abstract: The incidence of delayed sino-nasal complications after radiation treatment for NPC is not negligible and should be kept in mind when addressing the quality of life of NPC survivors.

Cited by 27 publications

References 17 publications

Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy

Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy

Treatment‐related morbidity in patients treated for sinonasal malignancy

Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening

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