Conformal radiotherapy in the treatment of advanced juvenile nasopharyngeal angiofibroma with intracranial extension: an institutional experience.
OBJECTIVE
To describe the results of conformal radiotherapy in advanced juvenile nasopharyngeal angiofibroma in a tertiary care institution.


METHODS
Retrospective chart review was conducted for 8 patients treated with conformal radiotherapy between 2006 and 2009. The median follow-up was 17 months. All patients had Stage IIIB disease with intracranial extension. Radiotherapy was considered as treatment because patients were deemed inoperable owing to extensive intracranial/intraorbital extension or proximity to optic nerve. All but 1 patient were treated with intensity-modulated radiotherapy using seven coplanar fields. Median (range) dose prescribed was 39.6 (30-46) Gy. Actuarial analysis of local control and descriptive analysis of toxicity profile was conducted.


RESULTS
Despite the large and complex target volume (median planning target volume, 292 cm(3)), intensity-modulated radiotherapy achieved conformal dose distributions (median van't Reit index, 0.66). Significant sparing of the surrounding organs at risk was obtained. No significant Grade 3/4 toxicities were experienced during or after treatment. Actual local control at 2 years was 87.5%. One patient died 1 month after radiotherapy secondary to massive epistaxis. The remaining 7 patients had progressive resolution of disease and were symptom-free at last follow-up. Persistent rhinitis was the only significant toxicity, seen in 1 patient.


CONCLUSIONS
Conformal radiotherapy results in good local control with minimal acute and late side effects in juvenile nasopharyngeal angiofibromas, even in the presence of advanced disease.
Chakraborty
Santam
S
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India. drsantam@gmail.com
Ghoshal
Sushmita
S
Patil
Vijay Maruti
VM
Oinam
Arun Singh
AS
Sharma
Suresh C
SC
D000293:Adolescent; D018322:Angiofibroma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D058958:Organs at Risk / Q000528:radiation effects; D011859:Radiography; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D047368:Tumor Burden