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

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.

Section: Discussionsupporting

confidence: 90%

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confidence: 99%

Distinct histopathologic features of radiation‐induced chronic sinusitis

Kuhar

Tajudeen

Heilingoetter

et al. 2017

“…On imaging, patients develop mucosal thickening, with significant increases in their Lund‐Mackay (LM) scores, even in the contralateral sinuses . Clinically, patients can develop symptomatic chronic rhinosinusitis (CRS), which may require further surgical management …”

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confidence: 99%

“…Endoscopic sinus surgery (ESS) in irradiated patients is potentially riskier and more challenging than in non‐irradiated patients due to fibrosis, increased bleeding, and impaired wound healing . This is further compounded in patients who have had prior endoscopic endonasal skull‐base surgery (SBS) given the abnormal anatomy, loss of normal bony landmarks, and possibility of a surgically reconstructed skull base . There are numerous potential risks, but the most feared complications are arguably major hemorrhage, blindness, skull‐base entry leading to intracranial complications, and death …”

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confidence: 99%

“…Because these cancers are relatively uncommon, the literature on patients with CRS after undergoing endoscopic SBS for malignancies with both sinonasal and skull base involvement is sparse. Previous groups have reviewed small groups of 6 to 18 patients who required ESS for CRS after treatment for sinonasal and/or NPC . This is the largest study to date investigating the need for revision ESS (rESS) in patients who previously underwent endoscopic surgical resection for both benign and malignant neoplasms with combined sinonasal and skull base involvement.…”

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confidence: 99%

See 1 more Smart Citation

Incidence, risk factors, and outcomes of endoscopic sinus surgery after endoscopic skull‐base surgery

Shah

Maina

Patel

et al. 2020

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.

Chronic rhinosinusitis after radiotherapy in patients with head and neck cancer: a population‐based cohort study in Taiwan

Cheng

et al. 2020

BackgroundChronic rhinosinusitis (CRS) is a common post‐radiotherapy (RT) side effect in patients with nasopharyngeal cancer (NPC). However, whether RT is a risk factor for CRS in patients with other types of head and neck cancer remains unclear. This study investigated the association, if any, between CRS and RT in patients with head and neck cancer.MethodsThis retrospective cohort study included the data of patients newly diagnosed as having head and neck cancer between January 1, 2005, and December 31, 2008, from the 2005 Longitudinal Health Insurance Database. Patients were categorized into the following groups according to the treatment regimens received: RT alone (RT‐alone), RT combined with other treatments (any‐RT), and treatments without RT (no‐RT). The outcome was the occurrence of CRS after treatment.ResultsOf the 701 patients, 7% experienced CRS within 5 years after initial treatment. Patients were divided into subgroups according to different treatment policies, and the RT‐alone group, any‐RT group, and no‐RT group had 5‐year incidence of CRS of 12%, 9.3%, and 4.5%, respectively. Patients in the RT‐alone and any‐RT groups exhibited an increased risk of CRS compared with patients in the no‐RT group (hazard ratio: 6.76 and 2.91; 95% confidence interval: 2.60 to 17.5 and 1.60 to 5.31, respectively).ConclusionThis is the first nationwide population‐based cohort study to evaluate the risk of posttreatment CRS in patients with head and neck cancer. Our findings indicate that RT is a major risk factor for CRS. Thus, physicians should consider this potential risk in patients with head and neck cancer after RT.