Efficacy of endoscopic sinus surgery for chronic rhinosinusitis following primary radiotherapy and concurrent chemotherapy for nasopharyngeal carcinoma

Ayoub, Noel; Walgama, Evan; Thamboo, Andrew; Nayak, Jayakar V.; Hwang, Peter H.

doi:10.1002/alr.22002

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…Patients are usually educated to use nasal irrigation for the maintenance of nasal hygiene and to assist in the recovery of sinonasal mucociliary clearing in clinical practice. However, a study conducted by Ayoub N et al suggested that nearly 50% of these patients receiving conservative treatment reported it to be ineffective and finally needed to receive endoscopic sinus surgery [ 28 ]. The adage “prevention is better than cure” is as important today as it has always been.…”

Section: Discussionmentioning

confidence: 99%

Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

Lee

et al. 2022

Cancers

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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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Section: Discussionmentioning

confidence: 99%

Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

Lee

et al. 2022

Cancers

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“…Moreover, endoscopic surgery following definitive treatment with chemoradiation is proven to be beneficial as well. 21 Not only can endoscopic sinus surgery identify and treat residual microscopic disease after definitive chemoradiation, it allows for better endoscopic surveillance of the paranasal sinuses as highlighted by the data presented in this manuscript. Overall, endoscopic sinus surgery has low morbidity in most patients, with lower rates of sinonasal complications such as nasal stenosis and chronic sinusitis.…”

Section: Discussionmentioning

confidence: 90%

Surgery with Post-Operative Endoscopy Improves Recurrence Detection in Sinonasal Malignancies

Nyquist

Patel

Vimawala

et al. 2021

Ann Otol Rhinol Laryngol

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Objective: The mainstay of treatment in sinonasal malignancy (SNM) is surgery, and when combined with chemoradiation therapy, often leads to the best overall prognosis. Nasal endoscopy is essential for post-treatment surveillance along with physical exam and radiologic evaluation. The ability to directly visualize the sinus cavities after surgery may also improve early detection of tumor recurrence and is another reason to potentially advocate for surgery in these patients. Methods: A retrospective chart review of medical records of patients with pathologically proven SNM was conducted from 2005 to 2019. Results: The nasal cavity and maxillary sinus were the most common primary tumor sub-sites. The most common pathology was squamous cell carcinoma (42%). The median time to recurrence was 9.8 months. Recurrence was initially detected endoscopically in 34.3% patients, by imaging in 62.7% patients, and by physical exam in 3.0% patients. 67 (29%) total recurrences were detected on follow-up, of which 46 (68.7%) were local. Twenty-three of the local recurrences were identified via nasal endoscopy. Thirteen recurrences were identified via endoscopic surveillance within the surgically patent paranasal sinuses while 13 were identified within the nasal cavity; 5 patients had multiple sites of recurrence. Conclusion: Local recurrence of SNM is the most common site for recurrent disease and nasal endoscopy identified half of these cases. 50% of these recurrences were within the paranasal sinuses and would not have been easily identified if the sinuses were not open for inspection. Thus, open sinus cavities aid in the detection of tumor recurrence and is another advantage of surgery in the management of SNM.

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“…Patients with a history of head and neck malignancy treated with radiation therapy can also develop RCMS. Histologically, epithelial metaplasia and sloughing, ciliary dysmorphism, and ciliary loss appear in postirradiated sinonasal mucosa [11]. Lower doses of radiotherapy (e.g.…”

Section: Possible Contributors Of Recalcitrant Chronic Maxillary Sinu...mentioning

confidence: 99%

“…40 Gy) are shown to lead to mucosal edema, adhesions, ciliary damage, thicker mucus, and prolonged crusting. MCC is disrupted as evidenced by delayed saccharin transit time following radiotherapy [11]. Higher doses of radiation (e.g.…”

Section: Possible Contributors Of Recalcitrant Chronic Maxillary Sinu...mentioning

confidence: 99%

Tips and tricks for management of the dysfunctional maxillary sinus

Chung¹,

Halderman²

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewTo review the various factors associated with the most common cause of maxillary sinus dysfunction; recalcitrant chronic maxillary sinusitis (RCMS). In addition, available medical and surgical management options are discussed along with various tips and tricks for optimal management.Recent findingsDefects in mucociliary clearance, immunodeficiency, anatomic factors, and infectious etiologies have been implicated in dysfunction of the maxillary sinus leading to RCMS. Medical management including oral antibiotics or topical drugs have shown varying degrees of success. Endoscopic modified medial maxillectomy (EMMM) has been shown to significantly improve symptoms in patients with RCMS.SummaryA dysfunctional maxillary sinus presents a clinical challenge. A thorough evaluation of any potential contributing factors must be done in addition to an assessment of the adequacy of prior surgical treatment of the maxillary sinus. Beyond the middle meatal antrostomy, EMMM can be used to effectively address RCMS. In cases that fail EMMM, removal of the condemned mucosa to encourage auto-obliteration of the sinus can be considered.

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Efficacy of endoscopic sinus surgery for chronic rhinosinusitis following primary radiotherapy and concurrent chemotherapy for nasopharyngeal carcinoma

Abstract: ESS appears to effectively manage recalcitrant CRS symptoms in patients previously treated with radiation therapy and concurrent chemotherapy for NPC.

Cited by 6 publications

References 23 publications

Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

Surgery with Post-Operative Endoscopy Improves Recurrence Detection in Sinonasal Malignancies

Tips and tricks for management of the dysfunctional maxillary sinus

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