Sinus mucosa status in patients with nasopharyngeal carcinoma treated with intensity‐modulated radiotherapy: A 5‐year follow‐up

Hsin, Chung‐Han; Tseng, Hsien-Chun; Lin, Huang-Pin; Chen, Tsai-Hsin

doi:10.1002/hed.23849

Cited by 22 publications

(15 citation statements)

References 28 publications

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“…Thus, in the current study, for precisely evaluating the radiotherapy toxicity exerted on the sinus mucosa, patients with pre-treatment L–M scores ≥ four were excluded. As a result, in the VMAT group, there was an approximately 9-fold and 38-fold incidence of SMD in the acute stage (third post-radiotherapy month) for the maxillary and anterior ethmoid sinuses, respectively, much higher than the two-fold increase reported by Hsin et al [ 8 ]. By contrast, in the IMPT group, only two- and three-fold increases in the incidence of SMD were observed in the acute stage for the maxillary and anterior ethmoid sinuses, respectively.…”

Section: Discussionmentioning

confidence: 61%

“…The incidences of SMD (score one or more) in the maxillary, anterior/posterior ethmoid, sphenoid, and frontal sinuses in each group before radiotherapy, and three months, one year, and two years after radiotherapy, are summarized in Table 3 . The sinuses could be generally categorized into high-risk (maxillary and anterior ethmoid sinuses), medium-risk (posterior ethmoid and sphenoid sinuses), and low-risk (frontal sinus) groups according to the vulnerability to treatment toxicity [ 8 ]. The incidence of SMD in medium- and low-risk sinuses in the IMPT group showed no significant change before and after treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Huang et al [ 6 ] and Hsin et al [ 8 ] found that nearly one-third (32.1% and 31.4%, respectively) of NPC patients had SMDs before treatment. The prevalence rate was similar to the rates reported regarding the incidental sinus abnormality seen on MRI scans in the normal population [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, improved cure rates and a reduction in long-term toxicity, as a result of the integration of adjuvant systemic therapy and advancements in radiation therapy delivery, were observed [ 5 ]. However, the incidence of post-irradiation sinus mucosa disease remains high [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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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: 61%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lee

et al. 2022

Cancers

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“…5 Radiographic sinusitis may persist for years following radiotherapy, and most commonly affects the maxillary and anterior ethmoid sinuses. [6][7][8] An increased incidence of contralateral sinonasal mucosal thickening in patients with sinonasal malignancies treated with targeted radiotherapy has also been described. 4 Similarly, head and neck cancer treatment with radiation has been closely linked with other infections such as otitis media, specifically chronic otitis media with effusion.…”

Section: Introductionmentioning

confidence: 99%

Detection of Microbiota in Post Radiation Sinusitis

Stoddard

Varadarajan

Dziegielewski

et al. 2019

Ann Otol Rhinol Laryngol

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

Ayoub

Walgama

Thamboo

et al. 2017

Int Forum Allergy Rhinol

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Sinus mucosa status in patients with nasopharyngeal carcinoma treated with intensity‐modulated radiotherapy: A 5‐year follow‐up

Abstract: 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.

Cited by 22 publications

References 28 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

Detection of Microbiota in Post Radiation Sinusitis

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

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