Rhinology Abstracts

Otolaryngology

Development of musocal thickening after radiotherapy in contralateral sinuses of patients with nasal cavity and/or paranasal sinus carcinoma

Wang JH, Bong-Jae L, Lee JH, Kim J, Jang YJ. Ann Otol Rhinol Laryngol, 117(11):844-848, 2008

Paranasal sinus/nasal cavity carcinomas are commonly treated with surgical resection followed by postoperative radiotherapy. A varying portion of the target dose may also lead to significant exposure to the contralateral nose and sinuses. Long-lasting ciliary loss and dysmorphism of nasal epithelium with resultant impairment in mucociliary clearance have yielded chronic rhinosinusitis in some irradiated patients. This study was concerned with the development of radiotherapy-induced mucosal thickening in the contralateral sinuses of patients being treated for carcinoma of the nasal cavity and/or paranasal sinuses.

This study retrospectively reviewed the medical records and initial staging along with follow-up computed tomography (CT) scans of 37 patients treated with surgery plus postoperative radiotherapy and compared them to 10 patients in a control group who did not receive radiation treatment. The cases were clinically staged on the basis of initial CT findings using the American Joint Committee on Cancer guidelines. All CT scans were scored using the Lund-Mackay staging system.

The 37 patients in the treatment group included 21 men and 16 women having an age range of 22-82 years (mean age = 53 years at initial diagnosis). After surgical removal of their disease, each was treated with 3-dimensional conformal radiotherapy at a mean total radiation dose of 63.5 Gy. Ten patients in the control group included 6 males and 4 females with an age range of 47-68 years (mean age = 59 years at initial diagnosis).

Contralateral mucosal thickening of the paranasal sinuses was scored by a rhinologist and a radiologist using the Lund-Mackay staging system with a maximum possible score of 12 and a minimum score of 0 possible. After the evaluation of the initial CT scans, follow-up studies were performed at 3, 6, 12, 24, and 36 months after completion of radiotherapy.

Fifteen of the 37 patients in the treatment group had mucosal thickening in the contralateral paranasal sinuses with a mean Lund-Mackay score of 0.68. Three months after radiotherapy, 27 (p = 0.009) had mucosal thickening in the contralateral sinuses with a mean Lund-Mackay score of 2.84 (p < 0.001). The degree of mucosal thickening then was noted to decrease during the prescribed follow-up period to 1.73 at 36 months after completion of radiotherapy. The maxillary sinuses were noted to have the highest degree and incidence of mucosal thickening at 3 months, the other sinuses and the ostiomeatal complex were also noted to be significantly affected by radiotherapy. The Lund-Mackay scores pretreatment for the treatment group versus the control group were not statistically different. However, the scores were statistically different/higher (p = 0.033) at the 3-month follow-up in the treatment group.

Factors such as age, sex, T classification of the tumor, radiation dose, along with the presence of preradiotherapy mucosal thickening were not in any way associated with an increase in the Lund-Mackay score. Post-radiotherapy increases in the score were not consistently associated with the development of rhinosinusitis. The diagnosis of rhinosinusitis in such a postradiotherapy-treatment patient group should be based on the patients’ history, symptoms, and findings on diagnostic nasal endoscopy.

This manuscript is well written and provides an easy read for the busy clinician, fellow, or resident in-training. The included tables are well designed and provide ample information to be digested. The relevant topic is discussed in a thorough fashion and the paper provides a valuable piece of data for the rhinologic/oncologic literature.

Ronald G. Amedee, MD