title: Juvenile nasopharyngeal angiofibroma: clinical factors associated with recurrence, and proposal of a staging system.
abstract: BACKGROUND
  Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx. Our aim is to analyze prognostic factors, report results obtained with radiation therapy and propose a staging system.
  
  
  METHODS
  Retrospective study of patients with JNA. Clinical, radiological and therapeutic data were assessed for recurrence- and disease free survival-associated prognostic factors. Bivariate and multivariate analyses were performed.
  
  
  RESULTS
  Fifty-four males were analyzed. Invasion to anterior infratemporal fossae (ITF) +/or to pterygomaxillary fossae, to posterior infratemporal fossae, or intracranial extension were associated with recurrences in 2 of 15, in 8 of 18, and in 8 of 12 cases, respectively. Tumors < or > or =6 cm were associated with zero and with 18 recurrences, respectively (P = 0.006). A staging system is constructed considering extension patterns and size. Multivariate analyses conferred significance (P = 0.002) to a model including this staging system and surgical margins.
  
  
  CONCLUSIONS
  Our system stratifies recurrence risk and disease-free survival efficiently. Since radiotherapy at young age has potential to induce malignancies, it should be used with caution. It could be considered as primary treatment in stage IV cases with major invasion to cavernous sinus or orbital apex. Therapy design may be improved.
authors.affiliation: Head and Neck Department, Surgery Division, Instituto Nacional de Cancerología, Mexico City, Mexico. josecarr@prodigy.net.mx
authors.forename: J F
authors.initials: JF
authors.lastname: Carrillo
authors.forename: F
authors.initials: F
authors.lastname: Maldonado
authors.forename: O
authors.initials: O
authors.lastname: Albores
authors.forename: M C
authors.initials: MC
authors.lastname: Ramírez-Ortega
authors.forename: L F
authors.initials: LF
authors.lastname: Oñate-Ocaña
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies