title: Adjuvant therapy with flutamide for presurgical volume reduction in juvenile nasopharyngeal angiofibroma.
abstract: BACKGROUND
  Although 2 studies totaling 11 cases have indicated some benefit of anti-androgen treatment with flutamide on juvenile nasopharyngeal angiofibroma (JNA), it is not part of contemporary practice.
  
  
  METHODS
  Our approach was through a prospective, single-arm, before-and-after study, in which 20 patients with advanced JNA (Radkowski stage IIB-IIIB) were administered flutamide (per oral: 10 mg kg(-1) day(-1) × 6 weeks) prior to surgical excision. Pretherapy and posttherapy tumor volume measurements were established by MRI. Periodic assessments were recorded of liver, kidney functions, testosterone levels, and secondary sexual characteristics.
  
  
  RESULTS
  Prepubertal and postpubertal cases responded differently (p < .05). Prepubertal cases had inconsistent and minimal responses; 13/15 postpubertal cases demonstrated measurable volume reduction (mean, 16.5%; maximum, 40%). Two cases with optic nerve compression had visual improvement. Volume reduction correlated with serum testosterone level (r = .53; p < .05). No significant toxicity was noted, with the exception of transient breast tenderness.
  
  
  CONCLUSIONS
  Prepubertal and postpubertal patients differ in their response to flutamide. In postpubertal patients, 6 weeks preoperative use is safe and leads to partial tumor regression. Tumor regression from adjacent vital structures may facilitate surgical excision and limit morbidity.
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India. drathakar@gmail.com
authors.forename: Alok
authors.initials: A
authors.lastname: Thakar
authors.forename: Gaurav
authors.initials: G
authors.lastname: Gupta
authors.forename: Ashu Seith
authors.initials: AS
authors.lastname: Bhalla
authors.forename: Vandana
authors.initials: V
authors.lastname: Jain
authors.forename: Suresh C
authors.initials: SC
authors.lastname: Sharma
authors.forename: Raju
authors.initials: R
authors.lastname: Sharma
authors.forename: Sudhir
authors.initials: S
authors.lastname: Bahadur
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Deka
mesh_terms: D000293:Adolescent; D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage*; D018322:Angiofibroma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D005485:Flutamide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D047368:Tumor Burden / Q000187:drug effects; D055815:Young Adult
chemical_list: D000726:Androgen Antagonists; D005485:Flutamide