Radiographic assessment of the sinuses in patients treated for nasopharyngeal carcinoma.
BACKGROUND
Patients undergoing therapy for nasopharyngeal carcinoma (NPC) often experience dysfunction of the sinonasal mucosa as a side effect of radiotherapy and chemotherapy. Sinonasal mucosal changes may vary throughout the treatment and posttreatment periods, but little objective data exist characterizing such changes. We evaluated serial radiologic changes of the paranasal sinus mucosa in patients with NPC undergoing treatment.


METHODS
Medical and radiographic records were reviewed for all patients treated for NPC between 2004 and 2006 at Stanford University Medical Center. Pretreatment computed tomography (CT) images served as the baseline images for comparison, and posttreatment CT and magnetic resonance imaging (MRI) images were categorized temporally into 3-month intervals, up to 25 months after initiation of treatment. Images were scored in a blinded fashion using the Lund-Mackay (LM) staging system.


RESULTS
Thirty-five patients received treatment for NPC during the study period, of whom 27 had adequate data for analysis and inclusion in the study. The mean pretreatment LM score was 1.41, and a statistically significant increase in LM score was observed at 3, 6, 9, 12, 15, and 18, 22, and 28 months. There was continued progression of radiologic sinus opacification over the first 30 months after treatment.


CONCLUSIONS
The treatment of NPC with radiotherapy and chemotherapy is associated with radiologic evidence of sinus mucosal thickening. The extent of mucosal thickening can be expected to progress after treatment for up to 30 months. Patients undergoing treatment for NPC should be monitored carefully throughout the posttreatment period for clinical manifestations of dysfunctional sinonasal mucosa.
Raviv
Joseph
J
Department of Otolaryngology, Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Evanston, Illinois 60201, USA. jraviv@enh.org
Downing
Lance
L
Le
Quynh-Thu
QT
Hwang
Peter
P
D001706:Biopsy; D002277:Carcinoma / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging* / Q000473:pathology*; D016634:Radiosurgery / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome