Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma.
OBJECTIVE
The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC).


METHODS
The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC.


RESULTS
The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years.


CONCLUSIONS
Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.
Huang
Xiao-Ming
XM
Department of Otolaryngology, The Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GuangDong, P.R. China.
Zheng
Yi-Qing
YQ
Zhang
Xiang-Min
XM
Mai
Hai-Qiang
HQ
Zeng
Liang
L
Liu
Xiang
X
Liu
Wei
W
Zou
Hua
H
Xu
Geng
G
D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000175:diagnosis* / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome